Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Kakoulidis, Panagiotis; Panagiotidou, Sousana; Profitiliotis, Georgios; Papavasiliou, Kyriakos A.; Tsiridis, Eleftherios; Topalis, C

doi:10.1007/s00167-022-07238-2

Cited by 6 publications

(3 citation statements)

References 43 publications

(85 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the KSS function score in our study was 78.5 (ranging from 68 to 97), which closely resembled the average scores reported by Longo et al [51] for CR (76.6) and PS (77.7). These findings are consistent with other studies investigating various designs of TKA, indicating that the outcomes of MP-TKA are comparable to, if not superior to, alternative designs [36][37][38][48][49][50][51]. These results support the effectiveness and viability of MP-TKA as a reliable option for achieving long-term knee function.…”

Section: Discussionsupporting

confidence: 90%

“…These findings align with previous mid-term publications, which reported survivorship estimates for MP-TKA equal to or higher than the thresholds for follow-ups of 5 (99.2%) and 8 (97.6%) years, respectively [33,34]. Comparable survivorship rates have also been reported in published studies evaluating other types of implants, even among young and active patients [35,36]. When comparing our findings with the existing literature on other implant designs, it is crucial to consider the variability in study methodologies, patient populations, and follow-up durations.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Long-Term Follow-Up of Medial Pivot Total Knee Arthroplasty: A Systematic Review of the Current Evidence

et al. 2023

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is a popular treatment for end-stage knee osteoarthritis. Advances in understanding knee biomechanics have led to the development of medial pivot (MP) prostheses, which aim to replicate natural knee kinematics. While short- and mid-term studies have shown favorable outcomes for MP-TKA, long-term follow-up studies are limited. This systematic review aims to analyze the available evidence on long-term outcomes of MP-TKA, including survivorship, complications, and patient-reported outcome measures (PROMs). A comprehensive search was conducted in PubMed, Embase, and Cochrane Database of Systematic Reviews for English language studies reporting long-term outcomes of primary MP-TKA. Nine studies with an average follow-up of 12.4 years were included. Data on survivorship, complications, and PROMs were collected and analyzed. The overall survivorship of MP-TKA was 98.2% at an average follow-up of 12.4 years. Aseptic loosening and periprosthetic joint infection (PJI) were the most common reasons for revision, with a revision rate of 0.4% for each. The overall complication rate was 6.6%, with secondary anterior knee pain and PJI being the most frequent complications. The reoperation rate was 3.1%, primarily due to PJI and knee instability. PROMs significantly improved postoperatively. MP-TKA demonstrates favorable long-term outcomes with high survivorship, low complication rates, and enhanced PROMs. The procedure provides reliable management for end-stage osteoarthritis, offering patients improved knee function and pain relief. Further research with standardized reporting and larger sample sizes is needed to validate and compare these findings to other implant designs.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Long-Term Follow-Up of Medial Pivot Total Knee Arthroplasty: A Systematic Review of the Current Evidence

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Moreover, rotational soft‐tissue laxity has been reported to be a possibility to lead appropriate rotational kinematics such as medial pivot [11]. However, despite the invention of new implant concepts, such as medial pivot design, the key issue of patient satisfaction has not been solved [8]. In contrast, little work has been done concerning AP kinematics during knee flexion.…”

Section: Discussionmentioning

confidence: 99%

Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion

Kinoshita

Hino

Kutsuna

et al. 2023

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeThe purpose of this study was to investigate the position of the femur relative to the tibia throughout range of motion in the osteoarthritic knee to evaluate knee kinematics and assess its relationship with the degree of varus deformity. MethodsIn this study, 116 preoperative knees with varus deformity were evaluated using a navigation system. The internal–external, anteroposterior, and mediolateral positions of the femur relative to the tibia were measured at maximum extension, 15°, 30°, 45°, 60°, 90°, 105°, and 120°, and maximum flexion angles. From these parameters, two‐dimensional translation of the surgical epicondylar axis was projected onto the tibial axial plane, and the femoral movement was evaluated relative to the tibia. In addition, the knees were retrospectively classified into three groups according to their degrees of preoperative hip–knee–ankle angle: mild (< 10°), moderate (10°–20°), and severe (> 20°). Then, the differences in each parameter between these groups were investigated. The Steel–Dwass test was performed to identify the difference among three groups. Statistical significance was set at p values < 0.05. ResultsThere was a significant difference in the anteroposterior position of the femur relative to the tibia among the three groups, especially from extension to early flexion (p < 0.05). The anteroposterior position at knee extension deviated posteriorly according to the progression of varus deformity. Rotational and mediolateral translation were not significantly different among the groups. Normal knee kinematics were diminished in almost all cases in each group. In addition, anterior paradoxical motion of the femur during early knee flexion was observed in 45.6% (n = 26), 57.1% (n = 28), and 80.0% (n = 8) of cases in the mild, moderate, and severe groups, respectively. The anteroposterior position of the femur relative to the tibia at knee extension was significantly more posterior in patients with than in those without anterior paradoxical motion (p < 0.0001). ConclusionThe anteroposterior position of the femur relative to the tibia changed according to the progression of varus deformity in osteoarthritic knees, especially from knee extension to early flexion. Posterior deviation of the femur at knee extension induced its anteroposterior movement relative to the tibia, resulting in anterior paradoxical motion. Level of evidenceIII.

show abstract

Low‐constraint insert with a medial pivot design as a potential predictor of favourable outcomes in cruciate‐retaining total knee arthroplasty: A propensity score‐matched analysis

Okamoto,

Saika,

Okayoshi

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeThe influence of polyethylene insert conformity on the outcomes of cruciate‐retaining (CR) total knee arthroplasty (TKA) with a medial pivot design remains uncertain. Therefore, this study aimed to evaluate the effects of polyethylene insert conformity in CR‐TKA on patient‐reported outcomes.MethodsThe data of 255 knees (FINE Total Knee System) from 255 patients were retrospectively analysed to compare outcomes for high‐ or low‐constraint medial pivot inserts, as determined through historical controls, over an average follow‐up period of 2.2 years (range, 2.0–5.5 years). Multivariate logistic regression analysis was used to identify predictors of achieving the patient‐acceptable symptom state (PASS) for the Forgotten Joint Score‐12 (FJS‐12). Propensity score‐matched cohorts for age, sex, body mass index, Kellgren‐Lawrence grade, Charlson Comorbidity Index, knee flexion contracture, FJS‐12 and follow‐up duration were created for between‐group comparison (n = 50 in each group).ResultsLow‐constraint insert (p = 0.031) and age (p = 0.043) were independent predictors of achieving the PASS for the FJS‐12 (>33, 153/255). After successful matching, compared to the high‐constraint insert, the low‐constraint insert improved patient satisfaction (p = 0.029 for pain on going up or downstairs, and p = 0.047 for the function of going upstairs) and increased the likelihood of achieving the minimal clinically important difference (p = 0.019) and PASS (p = 0.025) for the FJS‐12. A significant correlation was observed between the posterior tibial slope and the FJS‐12 in the low‐constraint insert group (p < 0.001), indicating that a greater posterior tibial slope was associated with better functional outcomes in this group.ConclusionsCompared with high‐constraint inserts, low‐constraint medial pivot inserts yielded higher functional outcomes and patient satisfaction. Therefore, insert conformity may play a crucial role in CR‐TKA outcomes.Level of EvidenceLevel III.

show abstract

Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials

Cited by 6 publications

References 43 publications

Long-Term Follow-Up of Medial Pivot Total Knee Arthroplasty: A Systematic Review of the Current Evidence

Long-Term Follow-Up of Medial Pivot Total Knee Arthroplasty: A Systematic Review of the Current Evidence

Progression of varus deformity in osteoarthritic knees induces anterior paradoxical motion of the femur during early knee flexion

Low‐constraint insert with a medial pivot design as a potential predictor of favourable outcomes in cruciate‐retaining total knee arthroplasty: A propensity score‐matched analysis

Contact Info

Product

Resources

About