Time-dependent improvement in functional outcome following LCS rotating platform knee replacement

Seong

et al. 2012

Knee Surg Relat Res

PurposeThere are controversies around the role of the posterior cruciate ligament and the effect of design modifications for high flexion in total knee arthroplasty (TKA). So, we compared the clinical outcomes of the cruciate retaining (CR), posterior stabilized (PS), and high flexion posterior stabilized (F-PS) designs in TKA with identical femoral geometry.Materials and MethodsOne hundred seventy nine knees with 3 different types of prostheses after a minimum 5-year follow-up were enrolled in this retrospective study: 45 with CR, 40 with PS and 94 with F-PS. The mean ages of these groups were 65.7, 67.2, and 67.5, and the mean durations of follow-up were 8.1, 8.0, and 6.8 years, respectively. We compared the range of motion, functional outcomes, and radiographic measurements at the 2-year follow-up and last follow-up.ResultsThe maximal flexion angle was significantly lower in the CR group than the F-PS group at the 2-year follow-up. However, there was no significant difference at the last follow-up. Functional outcomes and survival rate of the three groups were similar at the last follow-up.ConclusionsThree different types of TKAs (CR, PS and F-PS) with identical femoral geometry showed similar mid-term outcomes with regard to the range of motion, functional outcomes and survival rate.

Section: Discussionmentioning

confidence: 55%

Outcomes of the Different Types of Total Knee Arthroplasty with the Identical Femoral Geometry

Seong

et al. 2012

Knee Surg Relat Res

“…32 Previous studies comparing clinical outcomes of TKA longitudinally have suggested that further clinical improvement and recovery can take place beyond 6 months up to 2 years after surgery. 30,33,34 Our comparatively higher OKS are attributable to the fact that they were reviewed at a later follow-up interval of at least 2 years after surgery hence allowing for adequate time for maximal recovery and return to function. Altered kinematics and the resultant decrease in functional outcome in VVC knee implants, as compared with conventional primary TKA designs, have always been a concern owing to the increased constraint of the articulation.…”

Section: Discussionmentioning

confidence: 99%

Early Clinical and Radiological Outcomes of the Metaphyseally Fixed Totally Stabilized Knee Prosthesis in Primary Total Knee Arthroplasty

et al. 2019

The use of valgus–varus constrained (VVC) implant designs in primary total knee arthroplasty (TKA) is considered in situations of severe deformities, bone loss, and inadequate soft tissue balance. It is not known whether the use of such prosthesis designs may predispose to reduced function owing to its constraining design. The components are usually implanted with diaphyseal stem extensions to dissipate the increased forces. The totally stabilized (TS) implant is a contemporary VVC design with metaphyseal fixation only. It has a conforming articulation with increased rotational freedom compared with conventional VVC designs. The aim of this study was to assess whether the use of the contemporary TS implant with its metaphyseally fixed components would be associated with inferior outcomes compared with conventional standard primary posterior stabilized (PS) implants. We reviewed 38 consecutive complex primary TKAs performed using the metaphyseally fixed TS implant and 76 matched patients receiving primary PS TKA, at a minimum follow-up of 24 months. The mean follow-up was 61.1 months (24–102). Only patients with osteoarthritis were included. Clinical outcome was assessed using range of motion (ROM) and Oxford knee score (OKS). Radiographic assessment was performed using the femorotibial angle (FTA) at 6 weeks followed by assessment of bone–implant interface lucencies at final follow-up. There were no major early postoperative complications. The mean postoperative ROM in the TS and PS groups were 114.1 and 112.0, respectively. There was no difference in the mean ROM and OKS between the two groups. The mean FTA for patients in both groups was within 3° of the expected. There was no evidence of progressive lucencies or implant migration at final follow-up. The metaphyseally fixed TS knee design achieves comparable short-term functional outcomes when compared with conventional PS designs in primary knee arthroplasty. Long-term follow-up studies are required to assess survivorship.

“…A prospective randomized study found no significant difference in functional outcome evaluated using WOMAC and SF-36 scores at 3-month and 1-year postoperative periods between the two groups4). As functional outcome measures were reported to improve up to 2 years of follow-up after TKA26,27), a difference in outcome at 2 years more comprehensively indicates the role of discharge destination. These results need to be communicated with patients, preoperatively, so that they can make informed decisions about their discharge destination.…”

Section: Discussionmentioning

confidence: 99%

Does Discharge Destination Matter after Total Knee Arthroplasty? A Single-Institution Korean Experience

Tiwari

Park

et al. 2018

Knee Surg Relat Res

PurposeTo compare extended care facility (ECF) and home as discharge destination after total knee arthroplasty (TKA) at a single high-volume tertiary center in South Korea.Materials and MethodsWe retrospectively analyzed 1,120 primary TKAs (614 patients) performed between January 2012 and December 2013. A telephonic survey was conducted to determine discharge destination. The data reviewed included demographic and surgical data, functional outcome at 2 years and complications within 3 months.ResultsECF and home received 316 patients (51%) and 298 patients (49%), respectively. The ECF group had more bilateral TKA patients than the home group (272 vs. 234; p=0.014) and more patients with additional hospital stay (44 vs. 22; p=0.009). A higher tendency of complications was seen at home (n=8, 2.7%) than the ECF (n=2, 0.6%) (p=0.057). No significant differences were found in any functional outcome measure. Home patients had better patient satisfaction than ECF patients (81.9% vs. 54.3%; p<0.001).ConclusionsPatients who returned home after discharge had similar functional outcome at 2 years after surgery and higher patient satisfaction than those in the ECF in spite of the higher tendency of complications. Patients need adequate counseling and education regarding advantages and limitations of the two discharge destinations.