Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review

Panni, Alfredo Schiavone; Ascione, Francesco; Rossini, Marco; Braile, Adriano; Corona, Katia; Vasso, Michele; Hirschmann, Michael T.

doi:10.1007/s00167-017-4823-0

Cited by 83 publications

(82 citation statements)

References 37 publications

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“…Unexplained pain after TKR, particularly in fixed bearing designs may be associated with component malrotation, 2 which is also associated with worse functional outcomes, 42,43 particularly in relation to tibial rotation. 44 The self-correcting characteristic of the rotating platform in rotation may be advantageous in this regard. The low rate of instability could be attributed to the gap-balancing approach in flexion and extension.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

Scholes¹,

Ebrahimi²,

Ektas³

et al. 2019

J Knee Surg

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There is a lack of clinical outcomes reported for the rotating bearing knee (RBK) total knee arthroplasty (TKA), which is a second-generation rotating platform knee, with purported benefits over earlier versions. The purpose of the study was to report the complications, short-term (minimum 1 year) patient-reported outcomes and long-term (up to 15 years) procedure survival in a consecutive series of patients receiving a rotating platform TKA (RBK) from an independent clinic. A retrospective analysis of a single-surgeon, private/public practice, with prospectively collected data in a subset of patients were performed. A total of 1,130 procedures (primary, revision from unicompartmental knee arthroplasty (UKA) to TKA) were crossmatched with manufacturer records. Clinical outcomes (complications, reoperations) were summarized and linked to patient-reported outcome measures (Eq. 5D, KSS-function, Oxford knee score [OKS]). OKS results were classified using minimally clinical important difference (MCID) and patient acceptable symptom state (PASS). PROMs were summarized and regression models used to determine relationships between patient factors and outcomes in this cohort. Cumulative percent revision was reported by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and compared between the senior author and national data using Kaplan–Meier survival analysis. We report a complication rate of 19.7% with the majority (> 60%) being thromboembolic events and complaints of stiffness. Significant improvements were observed in general health, knee pain, and function with > 89% exceeding the MCID for the OKS and > 65% exceeding the PASS for the OKS at an average follow-up of 3.2 years. We report a cumulative revision rate of 4.3% at 5 years and 4.8% at 14 years, with significantly lower revision rates in females and patients aged 55 to 64 years compared with AOANJRR data for fixed bearing designs. The RBK rotating platform TKA provides good functional outcomes, with relatively low revision and complications rates at up to 14 years follow-up. This design in conjunction with a gap balancing technique may be advantageous in certain patient subgroups.

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Section: Discussionmentioning

confidence: 99%

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

Scholes¹,

Ebrahimi²,

Ektas³

et al. 2019

J Knee Surg

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“…The knee score assesses pain, stability, and range of motion. 13 Although the effect of TKA component alignment on PROMs has been widely investigated in the current literature, 15,16 there are currently no studies that have investigated the potential relation between component alignment and PROMs in the contemporary BCR TKA design. Therefore, this study aims to determine: (1) accurate three-dimensional (3D) component alignment of BCR TKA and (2) whether the component alignment of BCR TKA affects patient-reported outcomes.…”

mentioning

confidence: 99%

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

Peng

Arauz

et al. 2019

J Knee Surg

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AbstractThis is an experimental study. Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) retaining bicruciate retaining (BCR) total knee arthroplasty (TKA) have the potential to restore normal knee kinematics and thus improve patient outcome. Limited studies have examined the relationship between component alignment and patient-reported outcome measures (PROM). This study aims to determine (1) accurate three-dimensional (3D) component alignment of BCR TKA and (2) whether the component alignment of BCR TKA affects PROMs. The 3D modeling analysis was performed based on computed tomography images from 29 BCR TKAs. Component orientations were quantified for femoral and tibial components in the sagittal, axial, and coronal planes. The knee society scores (KSS) were collected preoperatively and postoperatively at 1-year follow-up. Multiple comparisons were performed to analyze the relationship between component alignment and patient outcomes. High variability was observed in the tibial component alignment (root–mean-square values: axial plane 6.6 degrees, sagittal plane 5.1 degrees, and coronal plane 4.0 degrees). At 1-year follow-up, significant improvement in KSS was noted in BCR TKA patients (p < 0.001). However, regression analysis adjusting for baseline KSS demonstrated the postoperative KSS was negatively associated with the posterior tibial slope (B [slope of the output of the regression analysis] = 2.597, p = 0.006). Patients with greater posterior tibial slopes were reported poorer postoperative functions at 1-year follow-up. Excessive posterior tibial slope may generate greater posterior force on the femur that leads to continuous overloading of the preserved ACL, suggesting optimal sagittal plane alignment of the tibial component may be important for the optimization of postoperative functions of BCR TKA patients.

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“…Самым распространенным вариантом нарушения позиционирования компонентов оказа-лись ошибки в аксиальной плоскости. По данным различных исследований, значимыми считаются: внутренняя ротация только большеберцового компонента выше 5-6°, внутренняя ротация только бедренного компонента выше 4°, суммарная внутренняя ротация компонентов 6-10° и несоответствие ротационных положений компонентов от 5° [16,[28][29][30]. В соответствии с этими данными ошибки позиционирования компонентов в аксиальной плоскости были выявлены у 19 пациентов (24%).…”

Section: Discussionunclassified

Evaluation of Pain Syndrome in Patients after Total Knee Replacement

Мурылев

Алексеев

Елизаров

et al. 2019

Traumatology and Orthopedics of Russia

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Total joint replacement is one the most effective methods for treatment of degenerative, systemic and posttraumatic diseases of the knee. However, up to 25% of patients remain dissatisfied with surgery outcomes. In the majority of cases the patients complain of pain in the operated joint. Identification of pain cause in the operated joint can turn to become a challenge for the surgeon.Purpose of the study — to identify the causes of pain syndrome basing on examination algorithm in patients after TKR as well as to assess the diagnostic value of each particular examination method.Materials and Methods. The authors analyzed results of comprehensive examination of 79 patients who complained of chronic knee pain after primary TKR and seeked medical help from the beginning of 2016 until December 2018. Inclusion criteria were as follows: knee prosthesis and presence of pain syndrome in the operated joint. Exclusion criteria: fistulous peri-prosthetic infection, suspected “culture-negative” infection and revisions. All patients included into the study were managed according to the standard algorithm of comprehensive examination.Results. The most likely causes of pain were identified during the examination. Infection was observed in 39 patients (49.4%), errors in three-dimensional positioning of components was considered as a probable cause of pain in 14 patients (17.7%), aseptic loosening was reported in 13 cases (16.5%), ligamentous instability — in 6 patients (7.6%), extraarticular pain origin was observed in 5 patients (6.3%) and peri-prosthetic fractures were reported in two patients (2.5%). The authors confirmed a combination of several pain causes in 17 patients (21.5%).Conclusion. Examination of patients with painfull knee joint prosthesis should be comprehensive due to potential combination of issues in each particular case. Integral and systematic approach to pain diagnostics in the operated joint is the “key to success” for planning further treatment tactics and for understanding the necessity and scope of revision procedure.

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Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review

Abstract: III.

Cited by 83 publications

References 37 publications

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

Does Component Alignment Affect Patient Reported Outcomes following Bicruciate Retaining Total Knee Arthroplasty? An In Vivo Three-Dimensional Analysis

Evaluation of Pain Syndrome in Patients after Total Knee Replacement

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