Analysis of differences in bone removal during femoral box osteotomy for primary total knee arthroplasty

Abstract

Purpose: this study was conducted to compare the quantity of intercondylar bone removed during femoral box osteotomy for implantation of three contemporary posterior stabilized (PS) total knee arthroplasty designs: Sigma PS (DePuy), Vanguard (Biomet) and Persona (Zimmer). Methods: we compared the maximum volumetric bone resection required for the housing of the PS mechanism of these three designs. Bone removal by each PS box cutting jig was three-dimensionally measured. The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test was used for pairwise comparisons. The level of significance was set at p<0.05. Results: for small-size implants, the average box osteotomy volume of Persona was significantly smaller than the Vanguard and Sigma PS volumes (p=0.003). The mean difference between Vanguard and Sigma PS (p=0.01) was also significant. For medium size implants, the mean difference between Persona and Sigma PS (p=0.008) and the mean difference between Vanguard and Sigma PS (p=0.01) were statistically significant. For large size implants, the mean difference between Vanguard and Sigma PS (p=0.01) and the mean difference between Sigma PS and Persona (p=0.008) were statistically significant. Conclusions: irrespective of implant size, the Persona cutting jig always resected significantly less bone than did Vanguard and Sigma PS. Clinical Relevance: although this study does not establish any clinical relevance of removing more or less bone at primary TKA, its results suggest that if a PS design is indicated, it is preferable to select a model which resects less distal femoral bone. JOINTS 2014;2(2):76-80 J oints

Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty

“…Despite excellent long-term performance, posterior stabilized TKA requires removing additional bone from the central portion of the distal femoral metaphysis to accommodate the box-shaped housing. Graceffa et al [23] reported significant differences in the volumetric box resections among several posterior stabilized designs, raising the theoretical concern that a larger resection for a smaller femoral component size could place more tension-based strains on the femoral condyles and lead to a unicondylar or intercondylar fracture [24]. This concern could logically be extended to our 2 cases, which used the 2 smallest femoral component sizes available within the Persona implant system.…”

“…This concern could logically be extended to our 2 cases, which used the 2 smallest femoral component sizes available within the Persona implant system. We were surprised to find that this implant system had the lowest box resection volume of all the designs in the study by Graceffa et al [23]. However, insufficiency fractures have occurred when no box resection was performed because the largest case series of insufficiency fractures, comprising 15 cases (over half of all reported cases), involved cruciate-retaining implants only [12].…”

The evaluation of the distance between the popliteus tendon and the lateral collateral ligament footprint and the implant in Total Knee Arthroplasty using a 3-dimensional template.

“…In the Journey BCS, distal and posterior bone cut thickness was 7.0mm and 7.4mm, respectively [10,19]. In the Persona PS, the distal and posterior bone cut thickness was 9.0mm and 10.0mm [9], respectively. In femoral PT footprint placement, the standard thickness of bone resection in TKA presents a potential risk of iatrogenic femoral PT footprint injury.…”

“…In the bone cut simulation bone, distal femoral bone cut thickness was 7.0mm for the Journey II BCS and 9.0mm for the Persona PS, respectively. Posterior bone cut thickness was 7.4mm for the Journey II BCS and 10.0mm for the Persona PS [9,10]. In the TKA simulating, the valgus angle to the femoral shaft was 6° and the external rotation angle was 3° from the posterior femoral condyle axis for both models.…”

Total Knee Arthroplasty Using a Medial Pivot or Posterior Cruciate-Stabilizing Prosthesis in Chinese Patients

“…21,[58][59][60][61][62][63][64][65] The MP implant has advantages over these traditional prostheses in terms of kinematics and contact area. The MP implant is designed to imitate normal knee flexion kinematics, [66][67][68] which includes the lateral condyle pivoting around the medial condyle and the lateral condyle moving front to back, rotating around the center of the medial side. 24 During flexion, the medial condyle undergoes minimal movement, while the lateral condyle moves posteriorly on the tibia.…”