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Posterior-stabilized total knee arthroplasty: a matched pair analysis of a classic and its evolutional design.

ABSTRACT: Total knee arthroplasty (TKA) designs continue to be modified to optimize patient's outcome. This study was designed to compare clinical and radiological results of classic worldwide used TKA posterior-stabilized (PS) design to those of its recent evolution.A consecutive group of 100 patients undergoing TKA using a classic cemented fixed-bearing PS TKA system was matched by age, gender, body max index to 100 patients having the newer cemented fixed-bearing PS design, both by the same manufacturer. Patients were assessed preoperatively, at 12 months and at 24 months minimum follow-up (range, 24-46) in a standard prospective fashion. The outcome assessments used were the Oxford Knee Score, the Knee Society Score, range of motion, and a satisfaction survey. A 2-sample t test comparing the 2 groups was performed.No patients were lost at follow-up. At 2-year follow-up, differences in clinical and radiological Knee Society Score (P = .09), Oxford Score (P = .08), and overall satisfaction rate did not reach statistical significance. Implant group 2 showed a statistically significant decrease in postoperative anterior knee pain (P = .006). At final follow-up, 16% of group 1 knees achieved > 130° flexion compared with 37% in group 2 (P = .0009). There were 2 revisions for any reason in group 1 and none in group 2.Design modifications applied to the newer TKA system allowed greater flexion and lower patellofemoral complications but did not appear to achieve better overall clinical scores.

SUBMITTER: Indelli PF

PROVIDER: S-EPMC5247512 | biostudies-other | 2016 Dec

REPOSITORIES: biostudies-other

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Posterior-stabilized total knee arthroplasty: a matched pair analysis of a classic and its evolutional design.

Indelli Pier Francesco PF Pipino Gennaro G Johnson Paul P Graceffa Angelo A Marcucci Massimiliano M

Arthroplasty today 20160821 4

<h4>Background</h4>Total knee arthroplasty (TKA) designs continue to be modified to optimize patient's outcome. This study was designed to compare clinical and radiological results of classic worldwide used TKA posterior-stabilized (PS) design to those of its recent evolution.<h4>Methods</h4>A consecutive group of 100 patients undergoing TKA using a classic cemented fixed-bearing PS TKA system was matched by age, gender, body max index to 100 patients having the newer cemented fixed-bearing PS d ...[more]

PMID: 28326427

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Project description:BACKGROUND: Posterior stabilized total knee arthroplasty requires an intercondylar notch to accommodate the cam housing that articulates with the tibial post to create femoral rollback required for deep flexion. The volume of bone resected for the intercondylar notch varies with implant design, and newer designs may accommodate high flexion with less bone resection. QUESTIONS/PURPOSES: This study aims to analyze the bone volume and density resected from the intercondylar notch for three posterior stabilized implants from a single company: a Posterior Stabilized (PS) system, a Hi-Flex system (HF), and a rounded new box-reamer (RB) system and to further assess whether the newer RB with a cylindrical cutting tool would preserve more native bone. MATERIALS AND METHODS: Using a computer model, the PS, HF, and RB femoral components were digitally implanted into CT scans of 19 cadaver femurs. Nine cadavers were fit with a size 4 implant, six with size 3, and four with a size 2. The volume of intercondylar bone resected digitally for femoral preparation was measured. Bone density was measured by CT scans in Hounsfield units (HU). A paired t test was used to compare the mean volume of bone resected for each implant. RESULTS: For the size 4 femurs, the newer RB design removed 8% less intercondylar bone than the PS design (7,832?±?501 vs. 8,547?±?377 mm(3), p?<?0.001) and 28% less bone than the HF design (7,832?±?501 vs. 10,897?±?444 mm(3), p?<?0.001). The average HU for size 4 femurs for RB design was 427?±?72 (PS?=?399?±?69, p?<?0.001; HF?=?379?±?66, p?<?0.001). For the size 3 femurs, the RB design removed 12% less intercondylar bone than the PS (6,664?±?786 vs. 7,516?±?648 mm(3), p?<?0.001) and 27% less bone than the HF (6,664?±?786 vs. 9,078?±?713 mm(3), p?<?0.001). HU for size 3 femurs for the RB design was 452?±?70 (PS?=?422?±?53, p?<?0.1; HF?=?410?±?59, p?<?0.01). For the size 2 femurs, the RB design removed 5% less intercondylar bone than the PS (5,730?±?552 vs. 6,009?±?472 mm(3), p?<?0.01) and 22% less bone than the HF (5,730?±?552 vs. 7,380?±?532 mm(3), p?<?0.001). HU for size 2 femurs for the RB design was 430?±?48 (PS?=?408?±?55, p?<?0.01; HF?=?385?±?56, p?<?0.01). CONCLUSIONS: The newer RB design removes less bone from the intercondylar notch than the classic PS and HF designs in all sizes tested. The bone-conserving cuts incorporated into this newer implant design appear to preserve native bone without compromising design objectives.

Project description:BackgroundThe controversy regarding the outcome of total knee arthroplasties after high tibial osteotomy may relate to malalignment secondary to overcorrection after high tibial osteotomy (HTO) [1, 2] and to the type of arthroplasty itself (posterior-stabilized arthroplasty or posterior cruciate ligament-retaining prosthesis).Questions/purposeWe asked two questions: (1) Would a posterior-stabilized arthroplasty provide sufficient constrain and improve pain and function in patients with severe malalignment due to a previous HTO? (2) Will malalignment of the previous HTO jeopardize the long-term results of a total knee reconstruction with a posterior-stabilized implant?Patients and methodsWe retrospectively reviewed 25 posterior-stabilized TKAs in 25 patients with severe valgus deformity after HTO (ranging from 10° to 20° of valgus) and compared the results with a series of matched 25 posterior-stabilized TKAs in 25 patients with normocorrection after HTO ranging from 5° of valgus to 5° of varus. Clinical, operative, and radiographic data were reviewed. Minimum follow-up was 10 years after the arthroplasty (average, 15 years; range, 10-20 years).ResultsAll the knees had standard posterior-stabilized total knee arthroplasty implants. Patients with an overcorrected HTO were more likely to require a soft tissue release to balance the knee. However, Average Knee Society and Function Score improved, respectively, from 48 to 85 and from 50 to 90 points in the severely overcorrected group, versus, respectively, 50 to 89 and 52 to 97 in the normocorrected group, but the range of mobility was superior for patients with normal alignment. Fifteen-year survivorship after the arthroplasty comparison showed no significant difference between the two groups (one revision in each group).ConclusionsPatients with an overcorrected HTO are more likely to require a soft tissue release to balance the knee. However, both groups show improvements in function and pain. With a posterior-stabilized arthroplasty, the degree of deformity has no impact on the longevity of the TKA.

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Posterior-stabilized total knee arthroplasty: a matched pair analysis of a classic and its evolutional design.

Publications

Posterior-stabilized total knee arthroplasty: a matched pair analysis of a classic and its evolutional design.

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