No clinical differences at the 2-year follow-up between single radius and J-curve medial pivot total knee arthroplasty in the treatment of neutral or varus knees (original) (raw)
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Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose Revision of unicompartmental knee arthroplasty (UKA) is relatively rare, but there is concern that the minimally invasive approach might result in more complications and a higher rate of revision. Current data regarding the revision of UKA using the Oxford phase 3 prosthesis are confined to a few reviews of single-institution experience. The purpose of this study was to provide an evidence-based summarisation of the revision of UKA with a pooled analysis of the reported cases. Methods A systematic review of published studies that evaluated the causes that required further surgical intervention after UKA using the Oxford phase 3 prosthesis was performed. A structured literature review of multiple databases referenced articles from 1998 to 2012. The revision rates between Asian population and western population were compared. Results A total of 2,683 patients (3,138 knees) from 17 published studies were assessed. The median age of the patients was 62.5 (range 32-93) years. The median followup period was 5.6 (range 0.1-11) years. Postoperative revision was necessary in 146 knees with a pooled percentage of 4.6 %. Bearing dislocation was found to be the single most important predisposing cause of revision, with a pooled percentage of 1.5 % (47/3,138 knees). The rate of bearing dislocation was significantly higher in Asian population than that in western population (p \ 0.001). Conclusions Mobile bearing UKA seems to be less appropriate for the Asian population as extreme knee flexion is required for cultural purposes. Level of evidence Retrospective case series, Level IV.
Clinical Orthopaedics and Related Research®, 2009
Although high-flexion TKA designs aim to safely accommodate deep flexion, it is unknown how often patients use deep flexion outside the laboratory. We used a validated smart-activity monitor to document the prevalence of knee flexion greater than 90°in 20 consecutive patients (21 knees) who had high-flexion TKAs, at a minimum of 2 years' followup. Patients wore the device continuously for a mean of 35.7 ± 0.5 hours. The 21 knees flexed more than 90°for an average of 10 ± 3.8 minutes (0.5%). Activities performed with flexion greater than 90°w ere, on average, 70% in single-limb stance, 12% moving from sitting to standing, 8% walking, 7% moving from standing to reclining, 2% stepping, 0.9% moving from lying to standing, and 0.1% running. Eight knees flexed greater than 120°for an average of 2.2 minutes (range, 0.2-15 minutes), or 0.1% of the testing time. Activities performed with flexion greater than 120°were, on average, 90% in single-limb stance, 6% moving from sitting to standing, 3% walking, 0.6% moving from standing to reclining, 0.3% stepping, and 0.1% moving from lying to standing. Peak flexion used at any time during testing was, on average, 84% ± 11% of maximum postoperative flexion (125°± 12°). These patients rarely used deep flexion. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
High-flexion implants in primary total knee arthroplasty: A meta-analysis
The Knee, 2009
This review found that range of motion is improved with high flexion-implant design compared to traditional implants but there is no clinical advantage over traditional designs. These conclusions are supported by the data presented but should be interpreted with caution due to the failure to address study quality in the analysis. Authors' objectives To determine whether a high-flexion knee implant improves patient outcomes or range of motion after primary knee arthroplasty compared to conventional knee implants. Searching MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to 2007. Search terms were reported. Archives of orthopaedic meetings were searched for relevant abstracts and clinicaltrials.gov was searched. Both published and unpublished articles were eligible. Study selection Randomised controlled trials (RCTs) and observational studies that compared standard posterior-stabilised knee implants with high-flexion design knee implants in patients undergoing primary total knee replacement for osteoarthritis were eligible for inclusion. Studies had to report Knee Society Scores and preoperative plus postoperative range of motion. Specific high-flexion design knee implants evaluated were Genesis II High-Flex PS (Smith and Nephew), NexGen LPS-Flex (Zimmer) and Superflex (Stryker). Standard knee implants were Genesis II PS (Smith and Nephew), NexGen LPS (Zimmer) and Scorpio PS (Stryker). Mean age ranged from 62.3 to 70.1 where reported and the proportion of men in the included studies ranged from 4 to 45%. Abstracts were screened independently, the number of reviewers was unclear. The authors did not state how the full text papers were selected for the review, or how many reviewers performed the selection. Assessment of study quality Studies were assessed for methodological quality using the 21-point quality assessment scale of Detsky et al (1992). Observational studies were graded on an 11 point scale that included the following: well defined eligibility criteria that would limit potential for confounding, quality of outcome measures and statistical analysis. Two reviewers independently assessed study quality. Data extraction Outcome data were assessed after at least one year follow-up. For range of motion data, the difference between the mean postoperative range of motion and preoperative range of motion was calculated for each treatment group. Where standard errors for mean differences were not reported, these were calculated by converting the p-value to a z-score to estimate the standard error. Where necessary, authors were contacted for additional information. The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Methods of synthesis Weighted mean differences were estimated using random-effects models.
Archives of Orthopaedic and Trauma Surgery
Background Total knee arthroplasty is a reliable procedure able to reduce pain and disability in patients suffering from osteoarthritis. However, a considerable percentage of patients still experiences unsatisfactory results. Medial pivot total knee arthroplasty has been introduced in the clinical practice to overcome problems related with classic design implants and better mimic native knee kinematics. The aim of this study was to analyze survivorship and clinical and radiographic outcomes of medial pivot implants. Methods A systematic research was conducted in eight different databases. Thirty-four studies met the inclusion criteria and were included in the analysis. Data on objective and patients-reported outcomes, radiographic alignment, and survivorship were collected and analyzed. Revision rate was expressed as revision per 100 components years. Result A total of 3377 procedures were included. Mean follow-up was 85.7 months (range, 12–182). The revision per 100 components year...
Meta-Review of the Quantity and Quality of Evidence for Knee Arthroplasty Devices
PloS one, 2016
Some cardiovascular devices are licensed based on limited evidence, potentially exposing patients to devices that are not safe or effective. Research is needed to ascertain if the same is true of other types of medical devices. Knee arthroplasty is a widely-used surgical procedure yet implant failures are not uncommon. The purpose of this study was to characterize available evidence on the safety and effectiveness of knee implants. A review of primary studies included in health technology assessments (HTA) on total (TKA) and unicompartmental knee arthroplasty (UKA) was conducted. MEDLINE, EMBASE, CINAHL, Cochrane Library and Biotechnology & BioEngineering Abstracts were searched from 2005 to 2014, plus journal tables of contents and 32 HTA web sites. Patients were aged 18 and older who underwent primary TKA or UKA assessed in cohort or randomized controlled studies. Summary statistics were used to report study characteristics. A total of 265 eligible primary studies published betwee...
Does High Tibial Osteotomy Affect the Success or Survival of a Total Knee Replacement?
Clinical Orthopaedics and Related Research®, 2011
Background Whether a previous high tibial osteotomy (HTO) influences the long-term function or survival of a total knee arthroplasty (TKA) is controversial. Questions/purposes We compared long-term functional scores and survival of bilateral TKAs in patients who had a previous HTO in one of the knees. Patients and Methods From 1980 to 1995, we performed 5043 primary TKAs; 39 of these patients had bilateral TKAs at an average of 8.7 years after unilateral HTO. Surgery was simultaneous in 32 patients and staged in seven. There were 12 women and 27 men with an average age of 66.9 years at the time of surgery. At last followup, 19 of the 39 patients were living and had been reevaluated since our previous study. We determined function with Knee Society scores. The length of followup for patients who had HTOs averaged 14 years (range, 3-21 years); for patients without HTOs, the average followup was 13.9 years (range, 3-22 years). Results We observed no differences in Knee Society function and radiographic and pain scores between the knees without and with previous HTO. Terminal extension and flexion, arc of motion, and knee alignment were similar between the knees. There were no femorotibial revisions in either group of knees. Survival at 15 years was 100% for knees without previous HTO and 97% for knees with previous HTO. Conclusions Our observations suggest a previous high tibial osteotomy does not influence the function or survival of a knee long term.
SpringerPlus, 2016
Background: Total knee replacement is an effective treatment for knee arthritis. While the majority of TKAs have demonstrated promising long-term results, up to 20 % of patients remain dissatisfied with the outcome of surgery at 1 year. Implant malalignment has been implicated as a contributing factor to less successful outcomes. Recent evidence has challenged the relationship between alignment and patient reported outcome measures. Given the number of procedures per year, clarity on this integral aspect of the procedure is necessary.
Clinical outcome after total knee replacement
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2015
concept of resurfacing the distal femur and proximal tibia has not changed much, and the majority of implants is still placed perpendicular to the mechanical axis. However, numerous designs have been developed over the last 40 years with the aim of achieving more natural knee kinematics. How much does the implant design affect our clinical outcome? Should we use, for instance, a fixed or a mobile design? The prospectively designed study published in the current issue did not show any difference in clinical outcome between the two designs according to the Oxford Knee Score, American Knee Society Score, Short Form-12 and range of motion [3]. The finding is in line with the Cochrane Review published earlier this year [7]. The authors of the Cochrane Review also stated that there is still a lack of evidence because many of these studies are rather of low or moderate quality. Clinical research is very demanding for different reasons. First, the study needs to be very well designed in order to be able to answer the question of interest, which should be expressed in the author's hypothesis. Secondly, patients have to be selected and followed up for a long time. This requires good compliance by the patients. Some of them may drop out, which