Femoral component rotation and arthrofibrosis following mobile-bearing total knee arthroplasty

Boldt, J.; Stiehl, James B.; Hodler, J; Zanetti, M.; Munzinger, U.

doi:10.1007/s00264-006-0085-z

Cited by 91 publications

(78 citation statements)

References 22 publications

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“…In particular we found no increase in the rate of patellofemoral complications in the KA group, similar to previous series using the KA technique [14,15,22,24,25]. The patellofemoral articulation is relevant because currently there is no implant specifically designed for use with KA; therefore, the relative internal rotation of the femoral component in KA versus the MA technique theoretically may adversely affect patellofemoral tracking [9,10].…”

Section: Discussionsupporting

confidence: 86%

The Chitranjan S. Ranawat Award

Young

Walker

Bayan

et al. 2017

Clinical Orthopaedics &Amp; Related Research

198

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Background Neutral mechanical alignment (MA) in total knee arthroplasty (TKA) aims to position femoral and tibial components perpendicular to the mechanical axis of the limb. In contrast, kinematic alignment (KA) attempts to match implant position to the prearthritic anatomy of the individual patient with the aim of improving functional outcome. However, comparative data between the two techniques are lacking.Questions/purposes In this randomized trial, we asked: (1) Are 2-year patient-reported outcome scores enhanced in patients with KA compared with an MA technique? (2) How does postoperative component alignment differ between the techniques? (3) Is the proportion of patients undergoing reoperation at 2 years different between the techniques? Methods Ninety-nine primary TKAs in 95 patients were randomized to either MA (n = 50) or KA (n = 49) groups. A pilot study of 20 TKAs was performed before this trial using the same patient-specific guides positioning in kinematic alignment. In the KA group, patient-specific cutting blocks were manufactured using individual preoperative MRI data. In the MA group, computer navigation was used to ensure neutral mechanical alignment accuracy. Postoperative alignment was assessed with CT scan, and functional scores (including the Oxford Knee Score, WOMAC, and the Forgotten Joint Score) were assessed preoperatively and at 6 weeks, 6 months, and 1 and 2 years postoperatively. No patients were lost to followup. We set sample size at a minimum of 45 patients per treatment arm based on a 5-point improvement in the mean Oxford Knee Score (OKS; the previously reported minimum clinically significant difference for the OKS in TKA), a pooled SD of 8.3, 80% power, and a two-sided significance level of 5%. Results We observed no difference in 2-year change scores (postoperative minus preoperative score) in KA versus MA The institution of one or more of the authors (SWY, MLW, AB, BF) has received, during the study period, funding from Stryker (Kalamazoo, MI, USA) One or more of the authors (AB, MLW, BF) or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Stryker. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand. Postoperative hipknee-ankle a...

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Section: Discussionsupporting

confidence: 86%

The Chitranjan S. Ranawat Award

Young

Walker

Bayan

et al. 2017

Clinical Orthopaedics &Amp; Related Research

198

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“…Malrotation of the femoral component has been associated with numerous undesirable conditions including patellofemoral and tibiofemoral instability, arthrofibrosis, knee pain, and disturbed knee kinematics [1,3,4,11,19,21]. The best method to determine correct femoral component rotation and subsequent coronal plane stability is debated.…”

Section: Discussionmentioning

confidence: 99%

“…Femoral component malrotation has been associated with numerous adverse sequelae, including patellofemoral and tibiofemoral instability, knee pain, arthrofibrosis, and abnormal knee kinematics [1,3,4,12,21,23]. Controversy exists, however, regarding the most favorable method to determine accurate femoral component rotation.…”

Section: Introductionmentioning

confidence: 99%

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Dennis

Komistek

Kim³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

243

197

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Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCLretaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and -substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear.

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“…In particular, a higher incidence of stiffness was reported in the BCS group (5.2 %) than in the NRG group (1.2 %). Multiple factors can have significant effects on ROM after TKA: PFR, patellofemoral kinematics and posterior condyle offset are the most important ones [25][26][27]. Prosthetic design may have had a role in knee stiffness in the BCS group, considering other factors affecting clinical outcomes in the same manner in a homogeneous population, such as this series.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, we believe that excessive femoral rollback reported for the BCS design could induce excessive mechanical stress on soft tissues. This mechanism may be responsible of fibrous metaplasia [27] and knee-joint synovitis with consequent knee stiffness. Conversely, the NRG group reported a higher rate of anterior knee pain (1.9 %): this was probably related to the use of trochlear flange depth in this design.…”

Section: Discussionmentioning

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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Femoral component rotation and arthrofibrosis following mobile-bearing total knee arthroplasty

Cited by 91 publications

References 22 publications

The Chitranjan S. Ranawat Award

The Chitranjan S. Ranawat Award

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Design and kinematics in total knee arthroplasty

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