Preoperative and intraoperative factors contributing to patient satisfaction after bi-cruciate stabilized total knee arthroplasty

Abstract

Background: One of the causes of dissatisfaction following total knee arthroplasty (TKA) is abnormal knee kinematics. A newly designed bi-cruciate stabilized (BCS) TKA system has been developed to produce close-to-normal kinematics because of its anatomic tibiofemoral articular geometry and cam-post mechanism. Although BCS TKA is expected to improve patient satisfaction, no reports have described the appropriate technique or soft tissue handling required to achieve excellent satisfaction with BCS TKA. This study is to identify preoperative and intraoperative predictors of patient satisfaction after BCS TKA. Methods: Altogether, we studied 113 knees with primary varus knee osteoarthritis that underwent BCS TKA with a navigation system. Preoperative parameters including Knee Society Score and patient-reported scores [the Knee injury and Osteoarthritis Outcome Score (KOOS)] and intraoperative parameters including coronal, sagittal and axial alignment and joint laxity in each compartment that affected patient satisfaction was evaluated. Satisfaction score was evaluated with use of the 2011 Knee Society Scoring system. The multivariate regression analysis included age and preoperative and intraoperative parameters that correlated with satisfaction scores in the univariate analysis ( P < 0.05). Results: The mean satisfaction score was 28.2 ± 6.1. Multivariate regression analysis showed that the predictors of patient satisfaction were a preoperative high KOOS score for activities of daily living ( P < 0.001), male sex ( P = 0.005), older age ( P = 0.027), and minimal medial joint laxity during flexion ( P = 0.031). Conclusion: When performing BCS TKA, surgeons should pay attention to maintaining proper stability of the medial compartment, especially during flexion.

Clinical Application of Perioperative Anaesthesia Management Based on Enhanced Recovery after Surgery Concept to Elderly Patients Undergoing Total Knee Replacement

“…Patients in SG were given preoperative health preaching and individualized assessment by anesthesiologists, which is beneficial to alleviate their anxiety and improve the perioperative cooperation. Patients with hypertension and diabetes must receive blood pressure and glucose control before operation, and can drink some water to improve circulation stability and reduce postoperative insulin resistance, thus accelerating the recovery of gastrointestinal function [ 20 ]. Ishii Yoshinori et al showed that insulin resistance could be reduced if patients undergoing TKR were to eat and drink water moderately before surgery, and their hospital stay could be shortened to (8.54 ± 0.54) d [ 21 ], which was consistent with the results obtained herein.…”

Mobile bearing shows larger rollback motion than fixed bearing in total knee arthroplasty using a medial stabilising technique with a navigation system

“…There have been several reports regarding intraoperative kinematics during TKA [ 6 , 7 , 8 , 9 , 11 , 12 , 14 , 15 , 17 , 20 , 21 , 22 , 24 , 25 , 28 , 30 , 35 ] using a navigation system. Kinoshita et al [ 15 ] reported that the normal rotational kinematics of the knee can be restored by controlling soft‐tissue balance during surgery and that medial rotational stability is important for the ROM responsible for inducing the ideal rotational movement.…”

Intraoperative midflexion medial laxity using navigation affects patient expectations following posterior stabilized total knee arthroplasty

“…23 The intraoperative predictor of patients’ satisfaction after bi-cruciate stabilized TKA was medial joint stability at 90°. 24 A modified gap balance technique was used in an attempt to achieve the same gap at 0° and 90°, but midflexion laxity could not be adjusted during surgery. In a previous study, joint gap kinematics were measured using a tensor device, and the center size of the joint gap was tight in extension and deep flexion and loose at midflexion ranges, especially at 30° of flexion.…”