Association of sagittal alignment of tibial and femoral components with clinical outcome in total knee arthroplasty: A prospective cohort study.

Background: In total knee replacement component alignment is a very crucial parameter to achieve better clinical outcomes. Only a few studies exist in the literature on the association between sagittal alignment of components and clinical outcomes. The study aimed to measure the functional outcome and association between the sagittal alignment of total knee replacement components and their clinical outcome. Material & methods: Prospectively we collected data of 81 knees (cases) following total knee replacement. The sagittal femoral angle, anterior and posterior tibial slopes were assessed on 2nd postoperative week using a lateral radiograph. Based on these measures 2 groups were made. Group A comprises of the femoral component which was further divided into A1 (41 cases) and A2 (40 cases) based on the component's sagittal femoral angle in flexion or extension.Group B comprises of Tibial component subgrouped based on the degree of Tibal angle as the posterior tibial slope or anterior tibial slopes. The B1 subgroup has posterior tibial slope of more than 5° (23 cases), B2 posterior tibial slope within 5° (53 cases), and B3 anterior tibial slope (5 cases). Preoperative and follow-ups at one month, 6 months, and 3 year; the functional assessment was performed using the American Knee Society score and Oxford knee scores. The duration to raise the leg straight (in days) was also measured. Results: 52 patients (81 total knee replacement cases) with a mean age of 62.88 ± 8.21 were enrolled. Results showed significant improvement in mean American Knee Society score (preoperative 32.91 ± 2.61 to 86.68 ± 2.52 postoperatively at 3 years; P < 0.001) and mean Oxford knee score (preoperative 34.69 ± 1.06 to 19.20 ± 1.91 postoperatively at 3-years; P < 0.001). The correlation of American Knee Society score between the femoral component angle and tibial component angle suggested that the maximum correlation was between Group A2 (Femoral angle = 91 to 95) and Group B2 (Tibal angle = 86 to 90), with p-value <0.0001. Conclusions: There is a positive association between the proper sagittal alignment of femoral component and tibial component in total knee replacement with clinical outcome. The functional outcome (in terms of mean American Knee Society score) is better when the femoral component is positioned in extension and the posterior tibial slope of less than 5° is achieved.

Proximal Fibular Osteotomy for Medial Joint Osteoarthritis of the Knee: A Prospective Cohort Study.

Background and objective Osteoarthritis (OA) is a polyarticular disease that most commonly afflicts the knee joint. Established operative treatment options for medial joint OA of the knee include high tibial osteotomy, unicompartmental knee arthroplasty, and total knee arthroplasty. Proximal fibular osteotomy (PFO) is a relatively new procedure for treating medial joint OA of the knee. The objective of this study was to describe the functional and radiological outcomes at one year in patients undergoing PFO for medial joint OA of the knee. Materials and methods The study included 21 patients with medial joint OA of the knee who underwent PFO. Visual analog scale (VAS) score, medial to lateral knee joint space ratio (ML ratio), Kellgren-Lawrence (KL) grade, and the American Knee Society Score (AKSS) (clinical and functional) were recorded preoperatively. VAS score, ML ratio, and AKSS (clinical and functional) were documented again at the three-month and one-year follow-ups. Results The mean age of the patients was 58.85 ±6.94 years; 12 (57.1%) were female and nine (42.9%) were males. The mean VAS score for pain decreased from 7.86 ±0.66 at baseline to 5.14 ±1.15 at three months (p<0.001) and 3.78 ±1.26 at one year (p<0.001). The mean clinical AKSS was 56.49 ±6.95 at baseline, which increased to 63.41 ±6.20 at three months (p<0.001) and 72.71 ±9.87 at one year (p<0.001). The mean functional AKSS at baseline was 48.24 ±14.31, which increased to 60.10 ±14.81 at three months (p<0.001) and 71.46 ±15.18 at one year (p<0.001). The mean ML ratio at baseline was 0.33 ±0.19, which increased to 0.41 ±0.20 at three months (p<0.01) and 0.51 ±0.22 at one year (p<0.001). Conclusion In patients who undergo PFO for OA of the knee, improvements in VAS score for pain, AKSS (functional and clinical), and ML ratio were observed to be maintained for a period of one year postoperatively.

Similar postoperative patient-reported outcome in both second generation patellofemoral arthroplasty and total knee arthroplasty for treatment of isolated patellofemoral osteoarthritis: a systematic review.

INTRODUCTION: Due to inconsistent results and high failure rates, total knee arthroplasty (TKA) is more often used to treat isolated patellofemoral osteoarthritis (PFOA) despite the theoretical advantage of patellofemoral arthroplasty (PFA). It is perceived that second-generation PFA may have improved the outcomes of surgery. In this systematic review, the primary aim was to compare outcomes of second-generation PFA and TKA by assessment of patient-reported outcome measures (PROMs). METHODS: A systematic search was made in PubMed, Medline, Embase, Cinahl, Web of Science, Cochrane Library and MeSH to identify studies using second-generation PFA implants or TKA for treatment of PFOA. Only studies using The American Knee Society (AKSS), The Oxford Knee Score (OKS) or The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to report on PROMs were included. RESULTS: The postoperative weighted mean AKSS knee scores were 88.6 in the second-generation PFA group and 91.8 in the TKA group. The postoperative weighted mean AKSS function score was 79.5 in the second-generation PFA group and 86.4 in the TKA group. There was no significant difference in the mean AKSS knee or function scores between the second-generation PFA group and the TKA group. The postoperative weighted mean OKS score was 36.7 and the postoperative weighted mean WOMAC score was 24.4. The revision rate was higher in the second-generation PFA group (113 revisions [8.4%]) than in the TKA group (3 revisions [1.3%]). Progression of OA was most commonly noted as the reason for revision of PFA, and it was noted in 60 cases [53.1%]; this was followed by pain in 33 cases [29.2%]. CONCLUSION: Excellent postoperative weighted mean AKSS knee scores were found in both the second-generation PFA group and in the TKA group, suggesting that both surgical options can result in a satisfying patient-reported outcome. Higher revision rates in the second-generation PFA studies may in part be due to challenges related to patient selection. Based on evaluation of PROMs, the use of second-generation PFA seems to be an equal option to TKA for treatment of isolated PFOA in appropriately selected patients. Hopefully, this can be considered by physicians in their daily clinical work. LEVEL OF EVIDENCE: IV.

Instrumented gait analysis in patients with medial osteoarthritis of the knee after mobile-bearing unicompartmental knee arthroplasty.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an effective treatment for patients with medial osteoarthritis of the knee joint. Instrumented gait analysis provides an objective measure to quantify and qualify postoperative changes of gait. The purpose of this study was to evaluate standardized instrumented gait analysis for functional recovery and gait as an outcome of mobile-bearing UKA in patients with medial osteoarthritis of the knee. METHODS: Twenty-one patients with isolated medial osteoarthritis of the knee joint received mobile-bearing UKA. They were examined by a gait analysis before surgery and after an average follow-up time of seven months. Gait analysis was performed on a treadmill with six infrared-cameras to identify changes of gait characteristics (e.g., velocity, stride time, stride length, knee adduction and hip abduction). RESULTS: Mean velocity (chosen by individuals) increased from 0.61 to 0.76m/s and further significant advancements, particularly in the knee adduction and the hip abduction were detected. Time and length of strides improved significantly as well as the clinical scores American Knee Society Score (AKSS), Oxford-12, Hannover Functional Ability Questionnaire for Osteoarthritis (FFbH-OA) Score and Devane Score. CONCLUSION: Mobile-bearing UKA can restore physiological axis of the leg and improve gait and function of the knee joint. The combination of instrumented gait analysis with clinical scores constitutes an eligible measuring instrument to quantify and qualify changes in patients' gait patterns.

Clinical Evaluation of Efficacy and Performance of All-Poly Tibial Freedom® Total Knee System for Treating Osteoarthritis Patients: Three-Year Follow Up Study.

INTRODUCTION: Advancement in technology in terms of design and building materials has made Total Knee Replacement (TKR) a highly effective, safe, and predictable orthopedic procedure. AIM: To review the clinical outcomes for efficacy and performance of Freedom Total Knee System for the management of Osteoarthritis (OA), at a minimum of three years follow up. MATERIALS AND METHODS: For this retrospective, post-marketing study, clinical data of patients treated with Freedom Total Knee System was retrieved from the clinical records after approval from the Institutional Ethics Committee . All the patients above the age of 18 years who completed at least three years after TKR were observed for the study purpose. Patients treated for OA were included while the patients who received the implant for treatment of rheumatoid arthritis and traumatic injury were excluded. Factors such as aseptic loosening, implant failure, and need for revision surgery were observed to evaluate implant performance. Cases were recruited for clinical assessment of primary efficacy endpoint in terms of post-surgery maximun range of motion. Secondary efficacy endpoint was to determine the clinical and social quality of life as per the American Knee Society Score (AKSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores. RESULTS: A total of 158 patients who had 191 TKR were observed for performance. The mean age of the patients was 67.67 years; mean BMI was 28.97±3.33, and the group comprised of 43% men and 57% women. Telephonic follow up at three years of 158 patients identified that none of them required revision surgery or had aseptic loosening suggesting excellent performance. Final clinical follow up at three years was available for only 35 patients (41 knee implants). The range of motion significantly improved from preoperative 104°±5.67° (range, 85°-119°) to 119.8°±11.05° (98°-123°) at follow-up (p<0.05). There was a significant improvement in clinical and functional AKSS score and WOMAC score at follow-up. CONCLUSION: The evaluation of Freedom Total Knee System for TKR in treating OA, at a minimum of three years follow up showed excellent outcomes in terms of performance, range of motion, reduced postoperative stiffness and pain, and improved functionality.

Cementless metaphyseal sleeves without stem in revision total knee arthroplasty.

INTRODUCTION: Revision total knee arthroplasty with a cementless metaphyseal sleeve is suggested to be used without stem in revision total knee arthroplasty (rTKA). To the best of our knowledge, no papers investigating this have been published. The purpose of this study was to evaluate clinical outcome. METHOD: In this retrospective study, 71 patients operated with rTKA with sleeves without stem in the period 2009-2011 were identified; 63 were examined. All patients with the prosthesis still in place were invited to a medical examination including X-rays. American Knee Society Score (AKSS) and Oxford Knee Score (OKS) were used as primary clinical outcome scores. RESULTS: Mean number of revisions including the revision with sleeve was 1.7. AKSS increased significantly from 62.7 to 109.6; (p value <0.0001). The overall satisfaction was 2.5 on a four-stage scale, going from very satisfied to dissatisfied (range 1-4). The Anderson Orthopaedic Research Institute (AORI) classification showed 63 % of the tibias and 56 % of the femurs to be type 2B, whereas 19 % tibias and 5 % femurs were type 3. Review of the X-rays showed all prostheses fixed. Mean tibiofemoral alignment was 6.0° valgus, and 51 % were outside optimal alignment (2.4°-7.2°). Six patients were excluded from the study. CONCLUSIONS: We found that the prostheses were overall well fixed and patients' AKSS increased significantly. Many patients had pain conditions, both comorbid pain and pain that might be alignment-related, and adding a stem thus seems to be a good idea in terms of alignment. Level of evidence Level IV, case series without control group.