Reduction Osteotomy vs Pie-Crust Technique as Possible Alternatives for Medial Release in Total Knee Arthroplasty and Compared in a Prospective Randomized Controlled Trial

Ahn, Ji Hyun; Yang, Tae Yeong; Lee, Jang Yun

doi:10.1016/j.arth.2016.01.018

Cited by 17 publications

(14 citation statements)

References 22 publications

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“…[ 92 ] 2018 Computer assisted vs conventional TKA 190 23 11 4 Abdel et al. [ 93 ] 2018 Intravenous vs topical tranexamic acid 664 24 2 13 Nam et al. [ 94 ] 2019 Cemented vs cementless TKA 147 6 2 14 KSSTA Demey et al.…”

Section: Appendixmentioning

confidence: 99%

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

et al. 2021

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Background: The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods: We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results: We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R ¼ 0.14, P ¼ .002) and between FI and P values (R ¼ 0.197, P ¼ .000012). Conclusions: This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence: Level I; Systematic Review.

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Section: Appendixmentioning

confidence: 99%

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

et al. 2021

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“…In a study by Seong et al [15], a soft tissue release was implemented in 43 out of 59 cases but in 16, an additional 2 mm femoral bone resection was required. Some authors recommend reduction osteotomy and using a small size component in cases of patients with a tight extension gap [16,17]. Measuring the joint distance and calculating the amount of tibial resection above all prevented an extra bone resection.…”

Section: Discussionmentioning

confidence: 99%

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

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Tosun

et al. 2020

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PurposeThe aim of this study was to demonstrate that measuring the medial gap before bone resection during total knee arthroplasty (TKA) provides an optimum gap adjustment in varus knees.MethodsPatients were separated into two groups, Group 1 being those whose medial joint gap was measured prior to bone resection and Group 2 comprising those who underwent conventional measured resection technique without measuring. The medial joint gap was measured with a custom-made gap measuring device up to the point that the knee was corrected and aligned along its mechanical axis. Medial joint gap distances, distal medial femoral bone cut thicknesses, amounts of tibial resection calculated, gap internal distances measured after cutting, and the thicknesses of the trial inserts were recorded. A comparison was made between the groups in terms of the number of patients requiring an additional tibial bone cut and the distribution of insert thicknesses.ResultsExtra tibial bone resections performed in two (5.7%) patients in Group 1 and in 10 (28.6%) patients in Group 2. In Group 1, where the medial joint gap was measured, the need for an additional bone resection was statistically less. (p=0.018). In the comparison of distribution of insert size by group, the number of patients on whom an 8 mm insert had been used was significantly greater in Group 1 (p=0.024). ConclusionMeasuring the medial joint gap prior to bone resection in total knee arthroplasty may prevent repeated bone recutting and additional bone resections. Furthermore, we can use this method to avoid the disadvantages of the measured resection technique.

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“…However, a cadaver study [ 24 ] considered the success of the MCL pie-crusting technique is likely technique dependent since failure occurs within the ligament itself. A new-published article [ 23 ] also found that the pie-crusting technique has a higher rate of failure in the ML gap balance compared with RO.…”

Section: Discussionmentioning

confidence: 99%

Reduction Osteotomy versus Extensive Release on Clinical Outcome Measures in Simultaneous Bilateral Total Knee Arthroplasty

et al. 2017

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BackgroundDuring total knee arthroplasty (TKA) in varus knee deformities, reduction osteotomy (RO) and medial soft tissue release are alternative techniques to aid in achieving deformity correction. In this study, we investigated the effect of RO compared to extensive medial soft tissue release (ER) on clinical outcome measures in simultaneous bilateral TKA.Material/MethodsWe prospectively enrolled 24 patients (48 knees) with bilateral varus knee deformity from July 2014 to December 20l5. For each patient, one knee was assigned to the RO group and the contralateral knee was assigned to ER group. One year postoperative, follow-up outcomes were collected and analyzed.ResultsTime to 90° flexion of the knee was significantly different in the RO group (1.6±0.3 days) compared to the ER group (2.0±0.4 days) (p<0.001). Using a 10-item patient reported outcome questionnaire, total scores were significantly different between the RO group (86.3±3.2) and the ER group (82.4±2.7) (p<0.001). Analysis of variance showed a significant difference on the visual analogue scale (VAS) score (p<0.001) but no significant difference in the range of motion (ROM) of the knee (p>0.05) during the follow-up year.ConclusionsKnees treated with RO were associated with greater improvements in pain and function than knees treated with conventional ER technique. Additionally, RO technique did not confer an increased risk for adverse clinical outcomes. RO may therefore by a safe method to decrease postoperative pain, achieve earlier functional recovery, and increase patients’ subjective satisfaction after TKA.

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Reduction Osteotomy vs Pie-Crust Technique as Possible Alternatives for Medial Release in Total Knee Arthroplasty and Compared in a Prospective Randomized Controlled Trial

Cited by 17 publications

References 22 publications

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

Reduction Osteotomy versus Extensive Release on Clinical Outcome Measures in Simultaneous Bilateral Total Knee Arthroplasty

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