Radiolucent lines below the tibial component of a total knee replacement (TKR)--a comparison between single-and two-stage cementation techniques.
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ABSTRACT:
SUBMITTER: Guha AR
PROVIDER: S-EPMC2532273 | biostudies-other | 2008 Aug
REPOSITORIES: biostudies-other
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Project description:Patients with knee osteoarthritis in the setting of ipsilateral below-knee amputation present a challenge in terms of patient positioning, intraoperative assistance, implant alignment, postoperative rehabilitation, and prosthesis adjustment. This is a report of a patient with a history of below-knee amputation with ipsilateral knee pain due to osteoarthritis, treated with elective total knee arthroplasty. This was done using custom cutting blocks made via preoperative computed tomography scans, and a single assistant as well as a large hip bump and lateral support were used for positioning. The patient was weight-bearing as tolerated in his regular below-knee prosthesis starting from postoperative day 1, with 1 prosthetic adjustment made during the first week of rehabilitation. The patient was pain-free with full range of motion at 1-year follow-up.
| S-EPMC9234005 | biostudies-literature
Project description:A 51-year-old woman suffered cardiac arrest requiring emergent intraosseous access that abutted the tibial component of her total knee arthroplasty. She developed a wound at the site and knee pain which was concerning for deep infection. Subsequent imaging was consistent with osteonecrosis developing around the tibial component. The component eventually loosened, requiring a revision surgery. Her deep cultures remained negative throughout. Her findings are most consistent with osteonecrosis and aseptic loosening of her prosthesis. While intraosseous access may be beneficial during resuscitation, it has complications. This is the first reported case of osteonecrosis secondary to intraosseous access leading to prosthetic loosening necessitating a revision surgery.
| S-EPMC9860108 | biostudies-literature
Project description:PURPOSE:During total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi's lines. MATERIALS AND METHODS:In this case-control simulation study, we retrospectively evaluated 38 patients with varus knee and 28 patients with valgus knee. We defined the reference cutting plane as 10 mm distal from the lateral articular surface of the tibia in varus group and as 7 mm distal from the medial articular surface in the valgus group. We measured angles between Akagi's line and the ATR line (ATR line angle) as well as between Akagi's line and 1/3 Akagi's line (1/3 Akagi's line angle), which passes through the midpoint of PCL and the medial third of the patellar tendon. We used paired t-tests to determine the significance of differences between these angles, with p < 0.05 indicating statistical significance. Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi's line angle and ATR line angle were analyzed by two surgeons. RESULTS:We found that 1/3 Akagi's line angle was 10.2° ± 1.3° in the varus group and 10.9° ± 1.3° in the valgus group (p = 0.017). The ATR line was positioned externally compared with Akagi's line in all patients. Mean ATR line angles at 0°, 3° and 7° posterior slopes were 6.1° ± 1.9°, 5.8° ± 2.0° and 6.0° ± 1.7° in the varus group and 6.3° ± 2.3°, 6.2° ± 2.3° and 5.4° ± 2.1° in the valgus group, respectively. There were no significant differences in the ATR line angle between the varus and valgus groups. (p = 0.34-0.67) Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi's line angle were 0.936 and 0.986 and those for the reproducibility of ATR line angle were 0.811 and 0.839. CONCLUSIONS:The ATR line was positioned between Akagi's line and 1/3 Akagi's line in all patients and was a valid option for evaluating rotational tibial alignment after tibial resection.
| S-EPMC6301685 | biostudies-literature
Project description:PurposeThe aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points.MethodsThe study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student's t test, and one-way ANOVA together with Tukey's post hoc test (or Games-Howell post hoc test) were used in the analyses.ResultsTibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later.ConclusionUnder-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient's prognosis, while the alignment of components might not be as important.
| S-EPMC7881541 | biostudies-literature
Project description:The rotational axis of the tibial component in total knee arthroplasty described by Insall is generally accepted, but rotational mismatch between the femoral and the tibial components can occur because the alignment of each component is determined separately. We developed a connecting instrument to synchronise the axis of the tibia to the axis of the femur. We compared the rotational axis of the tibial component using our method and medial one third of tibial tuberosity (Insall's reference) in 70 consecutive TKAs. The rotational axis of the tibial component from the femoro-tibial synchronisation was rotated internally 13.8 degrees +/- 5.8 degrees (range, 2 degrees - 24 degrees ) more than the axis of Insall's reference. Eighty three percent of patellae tracked centrally and the patellae tilt measured 2.2 degrees on average. More attention should be given to the rotational congruency between the femoro-tibial components, because the recent prosthetic design has more conforming articular surfaces.
| S-EPMC2269015 | biostudies-other
Project description:Many pathologic entities can produce a painful total knee replacement (TKR) that may lead to potential prosthetic failure. Polyethylene insert dissociation from the tibial baseplate has been described most frequently after mobile-bearing and cruciate-retaining TKRs. However, only 3 tibial insert dislocations in primary fixed-bearing High-Flex posterior-stabilized TKRs have been reported. We present a new case of tibial insert dislocation in a High-Flex model that shares similarities and differences with the cases reported, facilitating the analysis of the potential causes, which still remain undefined.
| S-EPMC4592716 | biostudies-literature
Project description:BackgroundAccurate sizing is critical for the overall success of a total knee arthroplasty (TKA). This study's primary purpose was to investigate the ability to predict the tibial and femoral component size in a single implant system from patient demographics and anthropometric data. A secondary goal was to compare the predicted tibial and femoral component sizes from our statistical model with a previously validated electronic application used to predict the implant size.MethodsA consecutive series of 484 patients undergoing a primary TKA at a single institution was reviewed. Data on height, weight, body mass index, sex, age, and component size were collected. A proportional odds model was developed to predict tibial and femoral component sizes. The relationship between the proportional odds model predictions was also compared with the component sizes determined by the Arthroplasty Size Predictor electronic application.ResultsWeight, height, and sex predicted the implanted component size with an accuracy of 54.0% (n = 247/484) for the tibia and 51.1% (n = 231/484) for the femur. The accuracy improved to 94.4% (n = 457/484) for the tibia and 93.4% (n = 452/484) for the femur within ±1 component size. Our data are highly correlated to the Arthroplasty Size Predictor for the predicted tibial component size (ρ = 0.91, P < .001) and femoral component size (ρ = 0.89, P < .001).ConclusionsOur novel templating model may improve operative efficiency for a single TKA system. Our findings have a high concordance with a widely available electronic application used to predict implant sizes for a variety of TKA systems.
| S-EPMC7606840 | biostudies-literature
Project description:Anteroposterior radiographs that included the whole tibia were taken before and after 75 total knee arthroplasties in 48 patients. The same tibial extra-medullary alignment guide system was used in every knee. The average tibial component alignment was 0.4 (SD 2.5, range -4.9 to 6.4) degrees of valgus post-operatively. 59 tibial components (78.7%) had a tibial cut within 3 degrees from being perpendicular to the mechanical axis, ten were too valgus (13.3%) and six were too varus (8%). The chance of the tibial components becoming too varus was higher if there was lateral tibial bowing, compared with no tibial bowing (p=0.048). A smaller lateral width of the leg increased the chance of the tibial components becoming too valgus (p=0.047).
| S-EPMC2532261 | biostudies-other
Project description:BackgroundThe link between tobacco consumption and wound complications following total knee arthroplasty (TKA) is well established. However, the effect of tobacco use on biologic fixation in cementless TKA remains unknown. This study evaluated the influence of tobacco use on the presence of radiolucent lines of tibial components in cementless TKA.MethodsA total of 293 consecutive cementless TKAs of 2 contemporary designs were retrospectively reviewed. Tibial radiolucent lines and component alignment were measured using an established measurement protocol. Patients with any history of tobacco use or active tobacco use (tobacco users) were compared to those with no history of tobacco use (tobacco nonusers). No significant differences which influenced outcomes were detected between the tobacco user and tobacco nonuser groups (P ≥ .071).ResultsRadiolucent lines decreased from 1-month to latest follow-up (mean 2.5 years) in all 10 radiographic zones regardless of tobacco use (P ≤ .084). However, evaluating intrapatient change in radiolucent line width, the tobacco nonuser group had more radiolucent lines resolve by the latest follow-up in nearly all radiographic zones, although most differences did not reach statistical significance, except for anteroposterior zone 1 (-31% vs -19%, P = .022). No tibial components were revised for aseptic loosening.ConclusionsResults from this study suggest that any tobacco use prior to cementless TKA has the potential to hinder biologic fixation of tibial components. While no tibial components were revised for aseptic loosening, follow-up was relatively short at 2.5 years and therefore warrants further study to discern the effect of persistent radiolucent lines on long-term fixation.
| S-EPMC9860107 | biostudies-literature
Project description:ObjectiveTotal knee arthroplasty (TKA) is currently the best option for management of advanced knee arthritis for patients who have exhausted conservative management. There have been significant implant design improvements and this is a continuing process to help the surgeon replicate patient anatomy and kinematics. Amongst the many variables in implantation to achieve a well-functioning TKA, getting optimal femoral component sizing is one. Every implant system has certain discreet implant sizes and the surgeon has to strive to obtain the best fit possible for the patient and attain a well aligned and stable TKA. The aim of this study was to assess the frequency of various femoral component sizes being implanted with a system which has 2.5 mm antero-posterior increment between sizes, and to assess the incidence of anterior femoral notching when using a posterior referencing system.Materials and methodsA retrospective analysis of 739 TKAs implanted in 532 patients between January 2013 and January 2016 at a single center using a single posterior stabilized implant system was done. Patient demographics and femur component size used was obtained from hospital patient records. Immediate post-operative radiographs were analyzed to look for anterior femoral notching and presence of this was classified according to Tayside classification. A telephonic follow up at minimum 2 tears post-surgery was done to interview for occurrence of supracondylar femur fracture or revision for any other causes.ResultsThere were 207 bilateral and 325 unilateral TKAs performed in 532 patients during the study period. There were 245 males and 287 females with an average age of 61.3 years (43-81 years, SD = 7.2). The most commonly used femoral component was 60 mm and an intermediate size prosthesis was used in 43.11% patients. The incidence of femoral notching ranged from 0 to 6.3%. No patient had sustained a supracondylar condylar fracture at minimum 2 years follow up.ConclusionThe availability of a larger number of femoral components in a TKA system allows the surgeon the modularity to choose and obtain the best fit possible. Restoration of posterior condylar offset, preventing anterior notching, medio-lateral overhang and patellofemoral joint stuffing are greatly dependent on correct femoral component sizing. The findings from our study underscore the need to use an implant system with as many femoral size options as possible with lesser increments in between sizes to minimize anterior femoral notching when using a posterior referencing technique.
| S-EPMC7068002 | biostudies-literature