This work is a retrospective cohort study evaluating patients who had undergone third-generation cemented total knee arthroplasty (TKA) with prostheses (NexGen, Zimmer Biomet) utilizing posterior-stabilized (PS) and cruciate-retaining (CR) designs at a single center at their 15-year follow-up. The purpose of this study is to determine the functional knee scores, reoperations, and long-term survivorship for patients with the NexGen Zimmer Biomet Knee system at the 15-year follow-up. In total, 99 patients who had undergone primary TKA were followed for 15 years. At the 15-year follow-up, survivorship in both study groups was similar: 98% for PS TKAs and 100% for CR TKAs. The 2 groups also showed similar functionality: 80% of the PS implants and 89% of the CR implants were associated with no or mild pain (P = .40). Reoperation rates were 2% for the PS group and 0% for the CR group (P = .38). No differences in any of the outcomes analyzed were observed between patients who had CR TKA and those who had undergone PS TKA. Our study found no significant differences in functional outcomes between PS and CR NexGen knee implants. Patients treated by both methods showed excellent longevity and survivorship at the 15-year follow-up.
The modified intervastus approach to the anterior knee is an approach that may be used in the majority of patients undergoing total knee arthroplasty. This article presents the first description of this approach. The advantages of this approach include its extensile nature, similar to a medial parapatellar approach, and preservation of the extensor mechanism and the vastus medialis, leading to a more rapid return to active knee extension than is traditionally observed. The approach is also simple to perform, easy to close, and is compatible with more extensile approaches such as a quadriceps snip if required in revision scenarios.
Case series Patients: Female, 47-year-old • Female, 58-year-old Final Diagnosis: Periprosthetic fracture Symptoms: Medial knee pain • varus deformity Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology Objective: Diagnostic/therapeutic accidents Background: Computer navigation in total knee arthroplasty has been gaining worldwide interest among orthopedic surgeons. While there is controversial data regarding its potential better clinical outcomes compared to conventional total knee arthroplasty, it has been shown to improve component and limb alignment reliability at a potential cost of increased complications. We present 2 case reports of medial tibial stress fracture through navigated tibial cutting block pinhole sites. Case Reports: Both cases involved morbidly obese patients who underwent a navigated total knee arthroplasty. During surgery, there were no intraoperative concerns. Both knees were well aligned postoperatively and no unusual pain was reported. At 6 months after total knee arthroplasty, a periprosthetic fracture was initiated at a cutting block pinhole site with varus collapse of the tibial component. In both cases, the pinhole site was close to the me-dial tibial cortex and the primary tibial component collapsed into the varus, requiring revision to a stemmed component with allograft bone. For both patients, the revision arthroplasty continues to perform well. We believe cutting block design in combination with small tibias and elevated body mass index contributed to this complication. Conclusions: Robotic-assisted total knee replacement has been shown to improve precision in component alignment. We caution against placing cutting block pinholes close to the medial tibial cortex, especially in morbidly obese patients with small tibias.
Background: The modified intervastus (MIV) approach is a new muscle and tendon sparing approach to the knee that is easy to perform and compatible with more extensile approaches such as a quadriceps snip. The study reports the clinical and functional outcomes of patients undergoing total knee arthroplasty (TKA) using the MIV approach. These results will be compared with published results of TKA done utilizing the subvastus approach.Methods: A total of 84 patients underwent TKA using the MIV approach from 2017 to 2019. Clinical and functional outcomes were assessed by recording the knee injury and osteoarthritis outcomes score, visual analog scale for pain, and knee range of motion (ROM). Outcome data was collected preoperatively, on the day of surgery, and postoperatively at 2, 6 weeks, 3, 6 months, 1, and 2 years. Paired sample t tests were conducted to assess the statistical significance observed in the outcomes between different time intervals.Results: All patients were able to walk on the day of surgery. The knee ROM increased significantly by 2 weeks after surgery (9.36%) and a net improvement for knee ROM of 37.89% was observed by the end of 2 years (P < 0.001). Knee injury and osteoarthritis outcomes score improved by 226.35% and visual analog scale for pain decreased by 82.34% following 2 years of surgery (Ps < 0.001). Conclusion:The study reports impressive clinical and functional outcomes using the MIV approach. The approach is safe and affords adequate exposure for the majority of primary TKA cases.
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