The John Insall Award: Patient Expectations Affect Satisfaction with Total Knee Arthroplasty

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175

Background Coronal alignment may impact clinical outcome and survivorship in TKA. Patient-specific instrumentation has been developed to restore mechanical or kinematic axis and potentially reduce component malpositioning. Although it is clear these instruments add cost, it is unclear whether they improve alignment. Questions/purposes We determined whether the mean coronal alignment after TKA performed with conventional versus patient-specific instrumentation better restored the mechanical and kinematic axes and whether there were more outliers with one of the two methods. Methods We retrospectively evaluated 150 primary TKAs performed for osteoarthritis: Group 1 (n = 50) conventional instrumentation; Group 2 (n = 50) patientspecific instrumentation restoring the mechanical axis; Group 3 (n = 50) patient-specific instrumentation restoring the kinematic axis, and measured femorotibial angle, hipknee-ankle angle, and the zone of the mechanical axis from scout CT images taken 0 to 6 weeks postoperatively.

Section: Discussionmentioning

confidence: 99%

“…Short term, limb and knee malalignment might be related to persistent pain, stiffness, instability, and dissatisfaction [8,28]. Long term, malalignment might increase the risk of loosening, instability, wear, and osteolysis [1-3, 6, 9, 18, 20, 24, 30-32].…”

Section: Introductionmentioning

confidence: 99%

Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Nunley

Ellison

Zhu

et al. 2012

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175

“…It is estimated that as many as 25% of patients who undergo primary TKA report residual knee symptoms after surgery [2,17]. One possible reason for the high level of patients experiencing residual symptoms is potentially that conventional TKA, with sacrifice of the ACL, poorly replicates normal knee kinematics and proprioception.…”

Section: Discussionmentioning

confidence: 99%

“…As many as 25% of patients who undergo primary TKA report residual knee symptoms after surgery [2,17]. As a result, alternative implant designs and surgical techniques have been proposed in an effort to improve patient-reported outcomes and clinical results after TKA [1].…”

Section: Introductionmentioning

confidence: 99%

Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty

Christensen

Stoddard

Anderson

et al. 2017

Background With as many as 25% of patients reporting residual knee symptoms after primary total knee arthroplasty (TKA), alternative implant designs and surgical techniques have been proposed to further reduce these symptoms. There is growing evidence that retention of the anterior cruciate ligament (ACL) results in more natural knee kinematics; thus, implants with more normal joint mechanics could provide improved physical function postoperatively and reduce the amount of residual symptoms. Advancements in the bicruciate-retaining (BCR) TKA implant design have been made, and based on these, we wished to compare the BCR with a more traditional cruciate-retaining (CR) implant. Questions/purposes (1) Was there a difference in the risk of reoperation after primary TKA between BCR and CR implant designs? (2) Was there a difference in the radiographic findings of radiolucent lines (RLLs) between the implant designs? (3) Was there a difference in patient-reported and clinical outcomes between the two implant designs? Methods Between January 2013 and May 2014, two surgeons performed 475 primary TKAs. During this time, 78 (16%) of these were performed with BCR implants and 294 (62%) with CR implants; the remainder were performed with anterior-stabilized or more constrained designs as a result of increased deformity and/or ligamentous deficiencies. During this period, the general indications for BCR TKA were arthritic knees with only slight to moderate deformity and sufficient ligamentous integrity of both the ACL and posterior cruciate ligament. The indications for CR TKA were similar other than these patients presented with a deficient ACL. A total of 66 (85%) of the BCR and 237 (81%) of the CR TKAs were available for followup at a minimum of 12 months or when reoperation occurred before 12 months (mean, 18 months; range, 2-32 months). With the numbers available, there were no differences between the groups in terms of age and sex, but the patients undergoing CR TKA had a greater mean body mass index (33 ± 7 versus 31 ± 5 kg/m 2 , p = 0.032). The frequency of early reoperation was compared between the groups as were radiographic evidence of RLL, patient-reported outcomes, and knee range of motion (ROM).

“…Using these systems, pain and function of the knee after TKA have been reported by numerous investigators [4,6,18,24]. However, discrepancy exists between assessment by these scoring systems and patient satisfaction with the function or symptoms after TKA [14,21]. Although patient satisfaction is a complex phenomenon affected by many variables [7,14,21], we believe the current scoring systems do not properly assess some aspects of knee status.…”

Section: Introductionmentioning

confidence: 95%

A New High-flexion Knee Scoring System to Eliminate the Ceiling Effect

Lee

2012

Background Various scoring systems document improvement after TKA, but most are associated with a ceiling effect that may fail to distinguish between patients having different levels of knee function after TKA. We therefore developed a new scoring system for patients with higher levels of flexion to eliminate ceiling effects observed with current systems. Questions/purposes The purposes of this study were (1) to determine whether the high-flexion knee score eliminates the ceiling effect, (2) to assess the validity and responsiveness of the high-flexion knee score, and (3) to determine whether the high-flexion knee score can aid in differentiation of the knee status of patients at the ceiling level. Methods We prospectively studied 165 patients with 201 well-functioning knees who had undergone primary TKA. We obtained Knee Society scores, WOMAC scores, Feller scores, SF-36 scores, and high-flexion knee scores for all patients. The high-flexion knee score includes items that reflect knee function in the high functional range, such as sitting on or rising from the floor, squatting, or kneeling. We determined the ceiling effects and score distributions of various scoring systems. We performed a convergent validity test of the high-flexion knee score by correlation analysis with these various scoring systems. Responsiveness of the high-flexion knee score was assessed by correlation analysis of changes in various scoring systems. To determine whether the high-flexion knee score can aid in differentiation of knee status of patients at the ceiling level, relative responsiveness of the various scores in the ceiling versus below the ceiling range was determined. Results The high-flexion knee score showed no ceiling effect, whereas the other systems did. Addition of the highflexion knee score to the other scoring systems eliminated these ceiling effects and resulted in more normalized score distributions. The high-flexion knee score correlated (r = À0.77) with WOMAC in postoperative scores, and it also correlated with the changes in WOMAC (r = À0.69) and SF-36 physical functioning (r = 0.62).