Can TKA design affect the clinical outcome? Comparison between two guided-motion systems

Mugnai, Raffaele; Digennaro, Vitantonio; Ensini, Andrea; Leardini, Alberto; Catani, Fabio

doi:10.1007/s00167-013-2509-9

Cited by 64 publications

(40 citation statements)

References 53 publications

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“…This in contrast to stiffness rates with the original BCS I design of 22.6% [7], 2.7% [6], and 2.2% [4] reported in the literature. It remains unclear whether the absence of stiffness in our series was supported by the kinematic rotational alignment obtained using an extension-first surgical technique.…”

Section: Discussioncontrasting

confidence: 59%

“…Recent data from a retrospective analysis indicated superior results with this device when compared with another guided-motion implant, the Scorpio Non-Restrictive Geometry posterior-stabilized knee system (Stryker Orthopedics, Mahwah, NJ) [6]. Patients undergoing TKA with the Journey BCS experienced statistically significantly better outcomes in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories of pain and quality of life, as well as in postoperative range of motion [6].…”

Section: Introductionmentioning

confidence: 99%

“…Patients undergoing TKA with the Journey BCS experienced statistically significantly better outcomes in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories of pain and quality of life, as well as in postoperative range of motion [6]. …”

Section: Introductionmentioning

confidence: 99%

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Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

Hommel¹,

Wilke²

2017

TOORTHJ

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Background:Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer.Objective:The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature.Material and Methods:This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available.Results:Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes.Conclusion:When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant.

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Section: Discussioncontrasting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

Hommel¹,

Wilke²

2017

TOORTHJ

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“…The research presented here represents the continuation of a previously reported study [15]. All patients gave informed consent prior to being included in this retrospective study performed in accordance with the Ethical Standards of the 1964 Declaration of Helsinki as revised in 2000.…”

Section: Patientsmentioning

confidence: 99%

Design and kinematics in total knee arthroplasty

Digennaro

Zambianchi

Marcovigi

et al. 2014

International Orthopaedics (SICOT)

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Purpose Posterior stabilised (PS) total knee arthroplasty (TKA) design development that focused on restoring normal knee kinematics was followed by the introduction of reasonguided motion designs. Although all PS fixed-bearing knee designs were thought to have similar kinematics, reports show they have differing incidences and magnitudes of posterior femoral rollback and axial rotation. In this retrospective comparative study between two guided-motion total knee systems, we hypothesised that kinematic pattern has an influence on clinical and functional outcomes. Methods This study represents the continuation of a previously reported clinical and kinematics analysis. We retrospectively reviewed 347 patients treated with two different TKA designs: Scorpio NRG (Stryker Orthopedics) and Journey Bi-Cruciate Stabilised (BCS) knee system (Smith & Nephew). Two hundred and eighty-one patients were assessed clinically. Patients were divided into groups according to implanted TKA. Clinical evaluation with the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire was performed. Fifteen Scorpio NRG and 16 Journey BCS patients underwent video fluoroscopy during stair climbing, chair rising/sitting and step up/down at six months of follow-up. Results At an average 29 months of clinical follow-up, patients with Journey BCS TKAs reported better clinical results. Stiffness was more frequently reported in the Journey group (5.2 % vs 1.2 %), whereas anterior knee pain was observed in the Scorpio NRG group (1.9 %) only. Both prosthetic models reported different posterior translation of the medial and lateral contact points (CP) in all analysed motor tasks during knee flexion (BCS 10-18 mm; NRG Scorpio 2-3 mm). Both designs produced progressive external rotation of the femoral component relative to the tibia during flexion. Conclusions Journey BCS showed statistically significant better KOOS results. The higher posterior femoral rollback observed in the kinematic assessment of this design, associated with a better patellofemoral design, may be the reason for better clinical outcome. The reported cases of stiffness and anterolateral joint pain could be attributed to excessive medial and lateral tibiofemoral posterior translation. The NRG group demonstrated good axial rotation, but this was not coupled with physiological kinematic patterns. Patellofemoral pain can be explained by a less friendly femoral-groove design. TKA clinical-functional outcome and complications were highly influenced by the bearing geometry and kinematic pattern of prosthetic designs.

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“…Despite the current success of total knee arthroplasty (TKA) , patellofemoral complications are a common postoperative problem and one of the causes of revision surgery [1]. The bearing geometry and kinematic pattern of different guided-motion prosthetic designs can in uence the clinical and functional outcomes and complications of TKA [2,3]. The prosthetic trochlear groove design is considered the main determinant [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Differences in trochlear groove based on morphometric measurements of three-dimensional reconstruction models between native knees and five different femoral component designs in Chinese subjects

Chen¹,

Xu²,

Gong³

2020

Preprint

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Background: The p rosthetic trochlear design is important in postoperative patellofemoral kinematics and knee function. However, little research has been conducted on the differences in trochlear groove between native and prosthetic knees. We aimed to investigate the differences between Chinese native knees and prosthetic knees of five different femoral component designs using three-dimensional computerized quantification Of the entire trochlear length. Methods: Virtual total knee arthroplasty was performed using three-dimensional models of 42 healthy Chinese knees matched to the femoral components of five different prosthe tic systems by mechanical alignment . T he deepest points of the trochlear groove were marked in multiple cross sections for both the native and prosthetic knees . Taking the lower extremity mechanical axis as reference line, the differences in the mediolateral location of the trochlear groove were analyzed between the native and prosthetic knees. Results: From the proximal to the distal end, the native trochlear groove started from 0° cross section and extended laterally and then medially , with its turning point located at 69° cross section . T he prosthetic trochlear groove showed a similar medial orientation and extended more proximally, but varied in mediolateral location and the length extending to the intercondylar notch . Compared with the proximal portion of the native trochlear groove , the prosthetic knee s extended along a paradoxical orientation and started from a more proximal and lateral position to 3.2 mm in the 0° cross section , with maximal discrepancy. Distally, the prosthetic trochlear groove s were located significantly medial to 2.4 mm in the 69° cross section , with maximal discrepancy. Conclusion: The prosthetic trochlear design varie d among the different types and did not conform to the native knee in terms of shape, orientation, and location, which may cause soft tissue tension imbalance and abnormal patellofemoral biomechanics during knee flexion. This study may provide useful information for creating prosthetic trochlear design s that conform with the native knee anatomy to optimize patellofemoral biomechanics and reduce the risk of patellofemoral complications.

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Can TKA design affect the clinical outcome? Comparison between two guided-motion systems

Abstract: Clinical study, Level III.

Cited by 64 publications

References 53 publications

Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

Design and kinematics in total knee arthroplasty

Differences in trochlear groove based on morphometric measurements of three-dimensional reconstruction models between native knees and five different femoral component designs in Chinese subjects

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