Rationale of Cruciate Retaining Design in Rheumatoid Arthritis: A Review of Clinical Analysis and its Role in Rheumatoid Arthritis

Ashraf, Munis; Sharma, Om P.; Priyavadhana, Sruthi; Sambandam, Senthil; Mounasamy, Varatharaj

doi:10.2174/1874325001711011023

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…4 ). As a result of this box cut, the intercondylar notch would have been further weakened and the cyst defect would have been connected, creating a massive bone defect and increasing the risk of periprosthetic fractures [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Management of a Massive Solitary Femoral Condyle Bone Cyst at the Site of Knee Osteoarthritis with a Synthetic Bone Graft and Primary Robotic-assisted Cementless Total Knee Arthroplasty: A Case Report

Ibaseta,

Pasqualini,

Tidd

et al. 2023

jocr

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Introduction: Subarticular cystic lesions, also known as geodes, present a challenge in the management of patients undergoing primary total knee arthroplasty (TKA). Although multiple treatment options are available for addressing these lesions, uncertainty persists regarding the optimal approach. Case Report: A 58-year-old man with a history of rheumatoid arthritis presented with several years of left knee pain. Evaluation showed severe left knee degenerative osteoarthritis complicated by the presence of a large lateral femoral condyle cyst. After failing conservative management, a robotic-assisted cementless cruciate-retaining TKA was indicated. The large bone cyst was managed with augmentation using synthetic bone grafting. 1 year postoperatively, he showed excellent clinical outcomes and radiographic evidence of osteointegration. Conclusion: This case highlights the value of robotic-assisted technology to plan and execute bone grafting of a large femoral cystic lesion while performing TKA with primary components. A computed tomography-imaged robotic TKA offers the potential benefit of screening bone cysts and thus planning a surgical approach in which bone preservation can be maximized. Keywords: Robotic arthroplasty, geode, bone cyst, injectable regenerative graft, bone void filler.

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Section: Discussionmentioning

confidence: 99%

Management of a Massive Solitary Femoral Condyle Bone Cyst at the Site of Knee Osteoarthritis with a Synthetic Bone Graft and Primary Robotic-assisted Cementless Total Knee Arthroplasty: A Case Report

Ibaseta,

Pasqualini,

Tidd

et al. 2023

jocr

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“…Some studies have even suggested improved long-term survivorship with CR designs [ 14 ]. Advocates of CR designs in TKA cite long-term survivorship in addition to preservation of bone stock and controlled femoral rollback as advantages of this design over PS designs [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluating Posterior Cruciate Ligament Integrity in Inflammatory Arthritis Patients Prescribed Biologic Agents: A Radiological Case-Control Study

Nolan¹,

O’Sullivan²,

Gorman³

et al. 2021

Cureus

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Introduction Patients with inflammatory arthropathies present a significant challenge to the arthroplasty surgeon when they present with symptomatic degenerative changes of their knee joint. Debate is ongoing regarding the selection of implants for this cohort of patients. There is conflicting evidence for the use of posterior-stabilising (PS) over cruciate-retaining (CR) designs in this cohort. Biologics are licensed for use in moderate-to-severe disease that has not responded to conventional treatment. To our knowledge, there are no studies that have assessed the integrity of the posterior cruciate ligament (PCL) on magnetic resonance imaging (MRI) in these patients with more advanced disease prescribed biologic agents. Aim The aim of this study is to assess the integrity of the PCL on MRI in patients with inflammatory arthritis who are prescribed biologic agents. Methods A case-control study was performed, with cases identified through chart review to confirm prescription of biologic agents for inflammatory arthropathies, who also had contemporaneous MRI knee scans performed. Knee MRIs for age- and sex-matched controls with osteoarthritis (OA) and meniscal pathology were identified from the National Joint Registry and the Hospital In-Patient Enquiry (HIPE), respectively. The MRIs were reviewed by two musculoskeletal radiologists who were blinded to the clinical details. They were asked to assess the MRIs to determine PCL integrity, synovial Inflammation, and any associated pathology. Results No difference was noted in the rate of synovitis, PCL attenuation, or PCL tears between the OA and inflammatory arthropathy groups (p > 0.05). Conclusions The results of this study show no difference in the integrity and continuity of the PCL in those patients for age- and sex-matched controls on MRI. This finding lends support to the use of CR total knee arthroplasty in patients with inflammatory arthropathy on biologic agents.

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“…Although inflammatory arthritis, such as rheumatoid arthritis, was previously reported to be one of the contraindications for CR TKA, 15 advances in implant design, surgical techniques, and rehabilitation have led to an expansion of the indications for CR TKA. Archibeck et al 16 and Dennis et al 17 suggested that CR TKA would yield satisfactory results in patients with rheumatoid arthritis.…”

Section: Preoperative Factors Predicting the Sacrificing Of Pclmentioning

confidence: 99%

Preoperative Factors Predicting the Preservation of the Posterior Cruciate Ligament in Total Knee Arthroplasty

Wang

Zhang

Lin

et al. 2022

Orthopaedic Surgery

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Objective Predicting the successful preservation of posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) is an important step for preoperative planning to secure the satisfactory outcomes. We aimed to examine the preoperative factors predicting the successful preservation of the PCL in cruciate‐retaining TKA and the outcome of sacrificing the PCL. Methods In this retrospective study, we analyzed TKAs consecutively performed by a single surgeon between January 2019 and August 2021 who had been preoperatively planned to undergo implantation of cruciate‐retaining (CR) prostheses. The outcome of the current study was whether the PCL was retained or sacrificed. Anterior‐stabilized (AS) tibial bearings when the PCL was sacrificed as needed were used intraoperatively. Age, sex, body mass index (BMI), and preoperative diagnosis from the patients' medical records were obtained. The medial‐lateral width of epicondyle (MLW), the medial posterior condyle height (MPCH), the lateral posterior condyle height (LPCH), the ratio of MLW and MPCH, the ratio of MLW and LPCH, the Insall–Salvati index, and the severity of the varus or valgus deformity were measured using preoperative radiographs. Univariate and multivariate regression were fitted to assess the association of these factors with the successful retention of PCL. To examine the influence of sacrifice of the PCL on the surgical procedure, the size of the tibial and femoral components, the thickness of the polyethylene insert, and the rate of patella replacement between the CR group and AS group were also compared using t tests or chi‐square tests. Results Among 307 TKAs included, PCL was sacrificed with concurrent use of AS prostheses in 89 (29.0%) procedures. Knees with rheumatoid arthritis (P < 0.01), lower Insall–Salvati index (P < 0.01), and more severe varus deformity (P = 0.011) were at a higher risk of sacrificing the PCL intraoperatively. There was no significant difference in age, sex, BMI, MLW, MPCH, LPCH, ratio of MLW and MPCH, ratio of MLW and LPCH, size of the tibial and femoral components, or replacement of the patella between the CR and AS groups. Converting from CR to AS was associated with a higher risk of using a thicker polyethylene insert (P < 0.01). Conclusion Rheumatoid arthritis, lower Insall–Salvati index, and more severe varus deformity were associated with an increased risk of sacrificing the PCL in TKAs planned to undergo implantation CR prostheses. Converting to AS tibial bearing may result in a thicker polyethylene insert. These factors should be carefully considered for the appropriate selection of prosthesis type preoperatively.

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Rationale of Cruciate Retaining Design in Rheumatoid Arthritis: A Review of Clinical Analysis and its Role in Rheumatoid Arthritis

Cited by 6 publications

References 19 publications

Management of a Massive Solitary Femoral Condyle Bone Cyst at the Site of Knee Osteoarthritis with a Synthetic Bone Graft and Primary Robotic-assisted Cementless Total Knee Arthroplasty: A Case Report

Management of a Massive Solitary Femoral Condyle Bone Cyst at the Site of Knee Osteoarthritis with a Synthetic Bone Graft and Primary Robotic-assisted Cementless Total Knee Arthroplasty: A Case Report

Evaluating Posterior Cruciate Ligament Integrity in Inflammatory Arthritis Patients Prescribed Biologic Agents: A Radiological Case-Control Study

Preoperative Factors Predicting the Preservation of the Posterior Cruciate Ligament in Total Knee Arthroplasty

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