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1.
Knee Surg Sports Traumatol Arthrosc ; 32(2): 461-472, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38284904

RESUMO

PURPOSE: The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options. METHODS: A treatment-based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS-PS, OKS, OKS-APQ and WORQ. Secondary outcome measures were pain, fear of movement, self-efficacy, quality of life (QoL), health care and pain medication use, work rehabilitation and patient satisfaction. The assessments took place pre- and directly posttreatment, at 1, 3 and 12 months follow-up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC). RESULTS: At baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10-360) months. The results at 12-month follow-up: first, a significant improvement was shown in function, pain, fear of movement, self-efficacy and QoL. Second, in 38.5%-69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain, and 50% for self-efficacy. Third, 42% of patients reported 'no healthcare use in the past three months'. CONCLUSION: One year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self-efficacy and QoL. It seems to be a promising treatment option in this difficult-to-treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost-efficacy. LEVEL OF EVIDENCE: Level II.


Assuntos
Artroplastia do Joelho , Dor Crônica , Osteoartrite do Joelho , Humanos , Feminino , Masculino , Artroplastia do Joelho/efeitos adversos , Qualidade de Vida , Osteoartrite do Joelho/cirurgia , Dor Crônica/etiologia , Dor Crônica/terapia , Estudos Prospectivos , Recuperação de Função Fisiológica , Articulação do Joelho/cirurgia , Resultado do Tratamento , Medidas de Resultados Relatados pelo Paciente
2.
J Arthroplasty ; 39(3): 651-657.e1, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37611678

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) can have a number of adverse consequences for patients that might contribute to a poor outcome. This study aimed to prioritize these consequences, from the perspective of patients and knee specialists. METHODS: There were 95 TKA patients and 63 knee specialists who prioritized a set of 29 adverse consequences, based on a previous qualitative study, using a Maximum Difference Scaling method. A hierarchical Bayesian analysis was used to calculate relative importance scores. Differences and agreements between patients versus knee specialists and satisfied versus dissatisfied patients were analyzed using Mann-Whitney-U tests and Kendall's coefficients of concordance. RESULTS: There were 4 out of 5 items in the top-5 of both patients and knee specialists that were similar, however, the ranking was different. The highest-ranked consequence for patients was: "Inability to do normal activities such as walking, cycling, swimming and heavy household chores", while knee specialists ranked: "No improvement in pain during the day" as the highest. "No improvement in walking" was in the patients' top-5, but was not ranked in the top-5 of knee specialists. For satisfied and dissatisfied patients, the top-5 of consequences was similar. CONCLUSION: Comparable perspectives were found for patients versus knee specialists and satisfied versus dissatisfied patients on the importance of adverse consequences after TKA. However, when looking in more detail, differences in ranking of specific subitems suggest that patients place slightly more importance on the inability to perform valued activities, while knee specialists prioritize lack of pain relief to a higher degree.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Teorema de Bayes , Satisfação do Paciente , Osteoartrite do Joelho/cirurgia , Articulação do Joelho/cirurgia , Dor/cirurgia , Resultado do Tratamento
3.
J Arthroplasty ; 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38759818

RESUMO

BACKGROUND: Variations in defining poor response to total knee arthroplasty (TKA) impede comparisons of response after TKA over time and across hospitals. This study aimed to compare the prevalence, overlap, and discriminative accuracy of 15 definitions of poor response after TKA using 2 databases. METHODS: Data of patients one year after primary TKA from the Dutch Arthroplasty Register (n = 12,275) and the Osteoarthritis Initiative database (n = 204) were used to examine the prevalence, overlap (estimated by Cohen's kappa), and discriminative accuracy (sensitivity, specificity, positive predictive value, negative predictive value, and Youden index) of 15 different definitions of poor response after TKA. In the absence of a gold standard for measuring poor response to TKA, the numeric rating scale satisfaction (≤ 6 'poor responder') and the global assessment of knee impact (dichotomized: ≥ 4 'poor responder') were used as anchors for assessing discriminative accuracy for the Dutch Arthroplasty Register and Osteoarthritis Initiative dataset, respectively. These anchors were chosen based on a prior qualitative study that identified (dis)satisfaction as a central theme of poor responses to TKA by patients and knee specialists. RESULTS: The median (25th to 75th percentile) prevalence of poor responders in the examined definitions was 18.5% (14.0 to 25.5%), and the median Cohen's kappa for the overlap between pairs of definitions was 0.41 (0.32 to 0.59). Median (25th to 75th percentile) sensitivity was 0.45 (0.39 to 0.54), specificity was 0.86 (0.82 to 0.94), positive predictive value was 0.45 (0.34 to 0.62), negative predictive value was 0.89 (0.87 to 0.89), and the Youden index was 0.36 (0.20 to 0.43). CONCLUSIONS: This study found a lack of overlap between different definitions of poor response to TKA. None of the examined definitions adequately classified poor responders to TKA. In contrast, the absence of a poor response could be classified with confidence.

4.
J Arthroplasty ; 38(12): 2680-2684.e1, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37286056

RESUMO

BACKGROUND: Revision knee arthroplasty (R-KA) is rising globally. Technical difficulty of R-KA varies from liner exchange to full revision. Centralization has been shown to reduce mortality and morbidity rates. The present study aimed to evaluate the association between hospital R-KA volume and overall second revision rate, as well as revision rate for different types of revision. METHODS: The R -KAs between 2010 and 2020 with available data on the primary KA in the Dutch Orthopaedic Arthroplasty Register were included. Minor revisions were excluded. Implant data and anonymous patient characteristics were obtained from the Dutch Orthopaedic Arthroplasty Register. Survival analyses and competing risk analysis were performed per volume category (≤12, 13 to 24, or ≥25 cases/year) at 1, 3, and 5 years following R-KA. There were 8,072 R-KA cases available. Median follow-up was 3.7 years (range 0 to 13.7 years). There were a total of 1,460 second revisions (18.1%) at the end of follow-up. RESULTS: There were no statistically significant differences between second revision rates of the three volume groups. Adjusted hazard ratio for second revision were 0.97 (Confidence Interval (CI) 0.86 to 1.11) for hospitals with 13 to 24 cases/year and 0.94 (CI 0.83 to 1.07) with ≥25 cases/year compared to low volume (≤12 cases/year). Type of revision did not influence second revision rate. CONCLUSION: Second revision rate of R-KA does not seem to be dependent on hospital volume or type of revision in the Netherlands. LEVEL OF EVIDENCE: Level IV, Observational registry study.


Assuntos
Artroplastia do Joelho , Ortopedia , Humanos , Hospitais , Sistema de Registros , Reoperação , Resultado do Tratamento
5.
Acta Orthop ; 94: 185-190, 2023 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-37096567

RESUMO

BACKGROUND AND PURPOSE: Rotating hinged knee implants are highly constrained prostheses used in cases in which adequate stability is mandatory. Due to their constraint nature, multidirectional stresses are directed through the bone-cement-implant interface, which might affect fixation and survival. The goal of this study was to assess micromotion of a fully cemented rotating hinged implant using radiostereometric analysis (RSA). PATIENTS AND METHODS: 20 patients requiring a fully cemented rotating hinge-type implant were included. RSA images were taken at baseline, 6 weeks, and 3, 6, 12, and 24 months postoperatively. Micromotion of femoral and tibial components referenced to markers in the bone was assessed with model-based RSA software, using implant CAD models. Total translation (TT), total rotation (TR), and maximal total point motion (MTPM) were calculated (median and range). RESULTS: At 2 years, TTfemur was 0.38 mm (0.15-1.5), TRfemur was 0.71° (0.37-2.2), TTtibia was 0.40 mm (0.08-0.66), TRtibia was 0.53° (0.30-2.4), MTPMfemur was 0.87 mm (0.54-2.8), and MTPMtibia was 0.66 mm (0.29-1.6). Femoral components showed more outliers (> 1 mm, > 1°) compared with tibial components. CONCLUSION: Fixation of this fully cemented rotating hinge-type revision implant seems adequate in the first 2 years after surgery. Femoral components showed more outliers, in contrast to previous RSA studies on condylar revision total knee implants.


Assuntos
Prótese do Joelho , Osteoartrite do Joelho , Humanos , Seguimentos , Análise Radioestereométrica/métodos , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Articulação do Joelho/cirurgia , Resultado do Tratamento , Falha de Prótese
6.
Knee Surg Sports Traumatol Arthrosc ; 30(4): 1273-1281, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33860338

RESUMO

PURPOSE: The present study assessed the effect of insert articular surface geometry (anatomical versus conventional insert design) on anteroposterior (AP) translation and varus-valgus (VV) laxity in balanced posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA). Secondly, we evaluated if the AP translation and VV laxity in the reconstructed knee resembled the stability of the native knee. METHODS: Nine fresh-frozen full-leg cadaver specimens were used in this study. After testing the native knee, anatomical components of a PCL-retaining implant were implanted. The knee joints were subjected to anteriorly and posteriorly directed forces (at 20° and 90° flexion) and varus-valgus stresses (at 20°, 45° and 90° flexion) in both non-weightbearing and weightbearing situations in a knee kinematics simulator. Measurements were performed in the native knee, TKA with anatomical insert geometry (3° built-in varus, medial concave, lateral convex), and TKA with symmetrical insert geometry. RESULTS: In weightbearing conditions, anterior translations ranged between 2.6 and 3.9 mm at 20° flexion and were < 1 mm at 90° flexion. Posterior translation at 20° flexion was 2.7 mm for the native knee versus 4.0 mm (p = 0.047) and 7.0 mm (p = 0.02) for the symmetrical insert and the anatomical insert, respectively. Posterior translation at 90° flexion was < 1.1 mm and not significantly different between the native knee and insert types. In non-weightbearing conditions, the anterior translation at 20° flexion was 5.9 mm for the symmetrical and 4.6 mm for the anatomical insert (n.s.), compared with 3.0 mm for the native knee (p = 0.02). The anterior translation at 90° flexion was significantly higher for the reconstructed knees (anatomical insert 7.0 mm; symmetrical insert 9.2 mm), compared with 1.6 mm for the native knee (both p = 0.02). Varus-valgus laxity at different flexion angles was independent of insert geometry. A valgus force in weightbearing conditions led to significantly more medial laxity (1°-3° opening) in the native knee at 45° and 90° flexion compared with the reconstructed knee for all flexion angles. CONCLUSIONS: Insert geometry seems to have a limited effect with respect to AP translation and VV laxity, in the well-balanced PCL-retaining TKA with an anatomical femoral component. Secondly, AP translation and VV laxity in the reconstructed knee approximated the laxity of the native knee.


Assuntos
Artroplastia do Joelho , Instabilidade Articular , Prótese do Joelho , Ligamento Cruzado Posterior , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular
7.
J Arthroplasty ; 37(3): 482-487, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34864066

RESUMO

BACKGROUND: Clinical observations revealed higher rates of aseptic loosening for hybrid fixated rotating hinge knee implants compared to fully cemented ones. We hypothesize that the use of a fully cemented fixation technique had a higher survival rate for aseptic loosening compared to a hybrid fixation technique in a rotating hinge knee implant. METHODS: All procedures of patients who were treated with the RT-PLUS rotating hinge knee implant (Smith & Nephew, Memphis, TN) between 2010 and 2018 were included. Primary outcome was revision for aseptic loosening. Kaplan-Meier survivorship and Cox proportional hazard regression analysis were performed to calculate survival rates and hazard ratios. RESULTS: A total of 275 hinge knee implants were placed in 269 patients (60 primary procedures, 215 revisions). Median follow-up was 7.3 ± 3.9 years. In total, 24 components (16 hybrid femur, 2 fully cemented femur, 6 hybrid tibia; all revision procedures) in 19 patients were revised for aseptic loosening. Kaplan-Meier survivorship analysis showed superior survival rates of fully cemented components (femur 97.1%; tibia 100%) compared to hybrid fixated components (femur 89.5%; tibia 95.9%) at the 10-year follow-up. Multivariate Cox hazard analysis showed a significantly higher risk of aseptic loosening for hybrid fixated components, a prior stemmed component and the femoral component. CONCLUSION: Fully cemented fixation showed superior survival rates for aseptic loosening compared to hybrid fixation in a single design rotating hinge knee implant. A prior stemmed component appears to be a risk factor for aseptic loosening and the femoral component seems to be more prone to loosening.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Fêmur/cirurgia , Humanos , Prótese do Joelho/efeitos adversos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
8.
Eur J Clin Microbiol Infect Dis ; 40(6): 1283-1290, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33479882

RESUMO

Ruling out an infection in one-stage knee and hip revisions for presumed aseptic failure by conventional tissue cultures takes up to 14 days. Multiplex polymerase chain reaction (mPCR) is a quick test (4-5 h) for detecting pathogens. The purpose of this study was to evaluate the diagnostic accuracy of an automated mPCR of synovial fluid obtained intraoperatively in unsuspected knee and hip revisions. A prospective study was conducted with 200 patients undergoing a one-stage knee or hip revision. Synovial fluid was analyzed with the mPCR Unyvero implant and tissue infection G2 cartridge (U-ITI G2) system and compared to intraoperative tissue cultures. The primary outcome measure was the diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), of the mPCR U-ITI G2 system compared to conventional cultures. In the knee revision group, there were no patients with a positive mPCR in combination with positive cultures. This resulted in a non-calculable sensitivity and PPV. The specificity and NPV in the knee revision group of the mPCR compared to tissue cultures was 96.8% and 96.8%, respectively. In the hip revision group, the sensitivity, specificity, PPV, and NPV of the mPCR compared to tissue cultures was 36.4%, 96.6%, 57.1%, and 92.5%, respectively. Sixteen mismatches occurred between the mPCR and tissue cultures. The mPCR U-ITI G2 system is a quick and reliable synovium fluid test for ruling out infection in presumed aseptic knee and hip revisions with a high NPV compared with tissue cultures, although some mismatches were observed. Periprosthetic tissue cultures are still advised as back-up for false negative and positive mPCR test results.


Assuntos
Bactérias/isolamento & purificação , Quadril/microbiologia , Joelho/microbiologia , Reação em Cadeia da Polimerase Multiplex/métodos , Infecções Relacionadas à Prótese/microbiologia , Idoso , Artroplastia de Quadril/efeitos adversos , Bactérias/classificação , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Feminino , Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia
9.
BMC Musculoskelet Disord ; 22(1): 700, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404359

RESUMO

BACKGROUND: Patients undergoing total knee arthroplasty (TKA) tend to be younger and tend to receive TKA at an earlier stage compared to 20 years ago. The Oxford Knee Score - Activity and Participation (OKS-APQ) questionnaire evaluates higher levels of activity and participation, reflecting activity patterns of younger or more active people. The purpose of this study was to translate the OKS-APQ questionnaire into Dutch, and to evaluate its measurement properties in pre- and postoperative TKA patients. METHODS: The OKS-APQ was translated and adapted according to the forward-backward translation multi step approach and tested for clinimetric quality. Floor and ceiling effects, structural validity, construct validity, internal consistency and test-retest reliability were evaluated using COSMIN quality criteria. The OKS-APQ, the Oxford Knee Score (OKS), the Short Form-36 (SF-36), a Visual Analogue Scale (VAS) for pain and the Forgotten Joint Score (FJS) were assessed in 131 patients (72 preoperative and 59 postoperative TKA patients), and the OKS-APQ was administered twice in 50 patients (12 preoperative and 38 postoperative TKA patients), after an interval of minimal 2 weeks. RESULTS: Floor effects were observed in preoperative patients. Confirmatory factor analyses (CFA) indicated a good fit of a 1-factor model by the following indices: (Comparative Fit Index (CFI): 0.97, Tucker-Lewis Index (TLI): 0.96 and Standardized Root Mean Square Residual (SRMR): 0.03). Construct validity was supported as > 75% of the hypotheses were confirmed. Internal consistency (Cronbach α's from 0.81 to 0.95) was good in the pooled and separate pre- and postoperative samples and test-retest reliability (Intraclass Correlation Coefficients (ICCs) from 0.63 - 0.85) were good in postoperative patients and moderate in preoperative patients. The standard Error of Measurements (SEMs) ranged from 8.5 - 12.2 and the Smallest Detectable Changes in individuals (SDCind) ranged from 23.5 - 34.0 (on a scale from 0 to 100). CONCLUSIONS: Preliminary findings suggest that the Dutch version of the OKS-APQ is reliable and valid for a Dutch postoperative TKA patient sample. However, in a preoperative TKA sample, the OKS-APQ seems less suitable, because of floor effects and lower test-retest reliability. The Dutch version of the OKS-APQ can be used alongside the OKS to discriminate among levels of activity and participation in postoperative patients.


Assuntos
Comparação Transcultural , Osteoartrite do Joelho , Humanos , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Traduções
10.
BMC Musculoskelet Disord ; 21(1): 378, 2020 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534571

RESUMO

BACKGROUND: A significant proportion of patients experiences poor response (i.e. no or little improvement) after total knee arthroplasty (TKA) because of osteoarthritis. It is difficult to quantify the proportion of patients who experiences poor response to TKA, as different definitions of, and perspectives (clinician's and patient's) on poor response are being used. The aim of this study was therefore to review the literature and summarize definitions of poor response to TKA. METHODS: A systematic search was performed to identify and review studies that included dichotomous definitions of poor outcome after primary TKA. The type, amount and combination of domains (e.g. functioning), outcome measures, type of thresholds (absolute/relative, change/cut-off), values and moments of follow-up used in definitions were summarized. RESULTS: A total of 47 different dichotomous definitions of poor response to TKA were extracted from 2163 initially identified studies. Thirty-six definitions incorporated one domain, seven definitions comprised two domains and four definitions comprised three domains. Eight different domains were used in identified definitions: pain, function, physical functioning, quality of life (QoL), patient satisfaction, anxiety, depression and patient global assessment. The absolute cut-off value was the most common type of threshold, with large variety in value and timing of follow-up. CONCLUSIONS: Our inventory review shows that definitions of poor response to TKA are heterogeneous. Our findings stresses the need for an unambiguous definition of poor response to draw conclusions about the prevalence of poor-responders to TKA across hospitals and countries, and to identify patients at risk.


Assuntos
Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/estatística & dados numéricos , Artroplastia do Joelho/psicologia , Humanos , Osteoartrite do Joelho/psicologia , Medição da Dor , Qualidade de Vida , Recuperação de Função Fisiológica , Resultado do Tratamento
11.
BMC Med Inform Decis Mak ; 20(1): 92, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414368

RESUMO

BACKGROUND: To evaluate the effect of a stand-alone mobile and web-based educational intervention (eHealth tool) compared to usual preparation of a first orthopedic consultation of patients with hip or knee osteoarthritis (OA) on patients' satisfaction. METHODS: A two-armed randomized controlled trial involving 286 patients with (suspicion of) hip or knee OA, randomly allocated to either receiving an educational eHealth tool to prepare their upcoming consultation (n = 144) or usual care (n = 142). Satisfaction with the consultation on three subscales (range 1-4) of the Consumer Quality Index (CQI - primary outcome) and knowledge (assessed using 22 statements on OA, range 0-22), treatment beliefs (assessed by the Treatment beliefs in OsteoArthritis questionnaire, range 1-5), assessment of patient's involvement in consultation by the surgeon (assessed on a 5-point Likert scale) and patient satisfaction with the outcome of the consultation (numeric rating scale), were assessed. RESULTS: No differences between groups were observed on the 3 subscales of the CQI (group difference (95% CI): communication 0.009 (- 0.10, 0.12), conduct - 0.02 (- 0.12, 0.07) and information provision 0.02 (- 0.18, 0.21)). Between group differences (95% CI) were in favor of the intervention group for knowledge (1.4 (0.6, 2.2)), negative beliefs regarding physical activities (- 0.19 (- 0.37, - 0.002) and pain medication (- 0.30 (- 0.49, - 0.01)). We found no differences on other secondary outcomes. CONCLUSIONS: An educational eHealth tool to prepare a first orthopedic consultation for hip or knee OA does not result in higher patient satisfaction with the consultation, but it does influence cognitions about osteoarthritis. TRIAL REGISTRATION: Dutch Trial Register (trial number NTR6262). Registered 30 January 2017.


Assuntos
Osteoartrite do Quadril , Osteoartrite do Joelho , Telemedicina , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Joelho/tratamento farmacológico , Pacientes , Encaminhamento e Consulta , Resultado do Tratamento
12.
J Arthroplasty ; 35(6): 1671-1677, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32070659

RESUMO

BACKGROUND: There is limited information about long-term clinical outcomes following revision total knee arthroplasty (TKA) in relation to the indication for revision. Previously, a clear relation between indication for revision and clinical outcome was shown after 2 years. Present study evaluated (1) whether the reported association at 2 year remains present at 7.5 years, and (2) how clinical outcome at 7.5 years developed compared to baseline and 2-year follow-up, and (3) whether patients had additional adverse events. METHODS: A cohort of 129 patients with a total system revision TKA was selected. Range of motion, Visual Analog Scale for pain and satisfaction, and clinical and functional Knee Society Score were obtained preoperatively, at 3 months, 1, 2, and 7.5 years. Reasons for revision were septic loosening, aseptic loosening, malposition, instability, and severe stiffness. RESULTS: Patients revised for severe stiffness had significantly worse outcomes. No difference was found between the other indications. The clinical outcome after revision TKA at 7.5 years remained stable for septic and aseptic loosening, malposition, and instability but deteriorated slightly for the severe stiffness group. Visual Analog Scale satisfaction remained constant for all indications. There were 11 additional complications between 2- and 7.5-year follow-up, 9 of which necessitated reoperation. CONCLUSION: All indications except severe stiffness had a similar clinical outcome which was maintained up to 7.5-year follow-up. The severe stiffness group had worse outcomes and deteriorated slightly at longer follow-up. Outcome at 3 months seems predictive for long-term outcome. Additional complications did not differ significantly for the different reasons for revision. LEVEL OF EVIDENCE: Level III, prognostic study.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Falha de Prótese , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
13.
Arch Orthop Trauma Surg ; 140(10): 1495-1501, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32468168

RESUMO

INTRODUCTION: Physiological motion after total knee arthroplasty (TKA) should result in a large range of motion, which would lead to good clinical outcomes. An adjusted design of a bicruciate-stabilizing TKA was developed to reproduce physiological motion. The aim of this study was to (1) investigate the maximal knee flexion of this knee system, 1 year post-operatively; (2) determine the clinical and functional improvement and compare the outcomes between patients with and without high maximal flexion; and (3) evaluate the adverse events. MATERIALS AND METHODS: In this prospective study, 62 patients with osteoarthritis received a bicruciate-stabilizing TKA. Maximum flexion was measured on a lateral X-ray pre- and post-operatively. Clinical and functional scores and the adverse events were reported up until 2 years after surgery. RESULTS: Pre-operatively, the median (range) maximal flexion was 131.5 (90-153)° and 1 year post-operatively, it was 130 (82-150)°. The results for the clinical scores showed an improvement between pre-operative values and post-operative values. The Kujala score and Knee Osteoarthritis Outcome Score (KOOS) symptoms, sport and quality of life score were better in patients with high maximal flexion (≥ 125°). Ten (serious) adverse device events were reported. CONCLUSIONS: In conclusion, the bicruciate-stabilizing TKA obtained a maximal flexion comparable to the flexion pre-operatively and resulted in good clinical and functional outcomes. Patients with high flexion ability seem to perform better on clinical and functional outcomes. Furthermore, the adjusted design of the bicruciate-stabilizing TKA reduced the number of adverse events. LEVEL OF EVIDENCE: Prospective cohort study, Level II.


Assuntos
Artroplastia do Joelho , Amplitude de Movimento Articular/fisiologia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos , Resultado do Tratamento
14.
Knee Surg Sports Traumatol Arthrosc ; 27(3): 716-723, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29947843

RESUMO

PURPOSE: Trochlear dysplasia is a major risk factor predisposing to patellar instability and has been reported to occur in up to 85% of patients with recurrent patellar dislocation. Different operative techniques have been described to correct trochlear dysplasia, including the Bereiter technique, in which subchondral bone is removed and the cartilage can be compressed into a U-shaped groove. The hypothesis was that after a Bereiter-type trochleoplasty combined with medialisation of the tibial tubercle and MPFL reconstruction, patellar pain and instability decreased and anatomic reconstruction can be seen radiographically after 5-year follow-up. METHODS: Between 2004 and 2011, a combined procedure including Bereiter-type trochleoplasty was performed on 21 consecutively included patients (22 knees) with objective patellar instability and severe trochlear dysplasia. Instability and pain were assessed preoperatively and 3, 6, 12, 24 and 60 months postoperatively with the visual analogue scale (VAS) for pain and instability, Kujala, International Knee Documentation Committee Subjective Knee Evaluation (IKDC SKE) and Short Form Health Survey (SF-36). Pre- and postoperatively, a true lateral radiograph was made to investigate the presence of the crossing sign and to measure the trochlear bump and trochlear depth, as well as a sunrise patella view to measure the sulcus angle. RESULTS: VAS pain and instability, Kujala and IKDC SKE improved significantly 5 years after trochleoplasty (p < 0.05). SF-36 showed no significant improvement. None of the patients reported patellar dislocations postoperatively. Sport activities remained limited. Postoperative radiographs showed no crossing sign. There was a significant increase in trochlear depth (p < 0.0001) and also a significant decrease in trochlear bump and sulcus angle (both p < 0.0001). CONCLUSIONS: A combined procedure consisting of Bereiter-type trochleoplasty, medialisation of the tibial tubercle and MPFL reconstruction in patients with objective patellar instability and severe trochlear dysplasia resulted in a clear decrease of pain and instability. Radiological assessment showed anatomical reconstruction. Nevertheless, residual symptoms remain and the possibility of future cartilage damage is uncertain. LEVEL OF EVIDENCE: IV.


Assuntos
Artroplastia/métodos , Instabilidade Articular/prevenção & controle , Luxação Patelar/prevenção & controle , Articulação Patelofemoral/fisiologia , Articulação Patelofemoral/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Osteotomia , Período Pós-Operatório , Radiografia , Adulto Jovem
15.
Knee Surg Sports Traumatol Arthrosc ; 27(11): 3614-3625, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30903221

RESUMO

PURPOSE: During total knee arthroplasty (TKA), an orthopaedic surgeon is focused on soft-tissue balance in extension (0°) and in flexion (90°). Patients with instability problems of the knee often report a feeling of instability during daily life activities, at around 30° knee flexion. There are no reference values available for knee laxity of healthy subjects in mid-flexion (30°) and flexion (90°) for comparison with the TKA population. Therefore, the aim was to quantify varus and valgus knee laxity in extension, mid-flexion and flexion in the asymptomatic native knee. METHODS: In 40 healthy volunteers matched for age, gender and BMI with the TKA-population, varus and valgus knee laxity in extension (0°), mid-flexion (30°) and flexion (90°) was measured on low-dose radiographs. For each subject, one randomly selected knee was stressed in extension, mid-flexion and flexion (with 15 Nm) using a stress device. RESULTS: Varus laxity in mid-flexion was higher than in extension and flexion (p < 0.01). Valgus laxity tended to be highest in mid-flexion laxity; however, no differences in knee laxity between flexion angles were seen (n.s.). Varus knee laxity in extension was higher in females than in males (p < 0.05). CONCLUSIONS: Mid-flexion laxity in the native knee is more prominent on the lateral side of the knee, while the medial side is more stable and constrained. Varus knee laxity in extension was shown to be higher in females than in males. LEVEL OF EVIDENCE: Prognostic Level II.


Assuntos
Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiologia , Idoso , Artroplastia do Joelho , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Valores de Referência
16.
Knee Surg Sports Traumatol Arthrosc ; 27(7): 2289-2296, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30689000

RESUMO

PURPOSE: The number of revision total knee arthroplasties (rTKA) is increasing. Unfortunately, not all patients benefit from revision surgery. The aim of this study was to develop a clinical prediction model that can be used to predict the functional outcome 5 years after rTKA. METHODS: Data of patients receiving rTKA at Sint Maartenskliniek, Nijmegen, The Netherlands, from 2004 onwards were prospectively collected. Demographic and clinical variables and patient-reported outcome scores were collected and considered as potential predictors. Beneficial outcome was defined as an increase of ≥ 20 points on the functional knee society scores (fKSS) or an absolute fKSS ≥ 80 points 5 years after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. RESULTS: Overall, 295 rTKA patients were included of whom 157 (53%) had beneficial fKSS 5 years later. Age, gender, femoral bone defects, preoperative fKSS, and stiffness as reason for revision were included in the model. Men had a higher chance of beneficial fKSS than women (OR 1.59, 95% CI 0.91-2.78). Patients with major bone defects (OR 0.44, 95% CI 0.22-0.85), higher age (IQR OR 0.39, 95% CI 0.26-0.58), higher preoperative fKSS (IQR OR 0.42, 95% CI 0.30-0.59), and severe stiffness (OR 0.48, 95% CI 0.20-1.15) had a lower chance of successful outcome. The model's AUC was 0.76, 95% CI 0.70-0.81. CONCLUSION: Easily determinable characteristics of patients who need rTKA can be used to predict future functional outcome. Young men with low preoperative fKSS without severe stiffness are more likely to achieve a beneficial outcome. LEVEL OF EVIDENCE: IV.


Assuntos
Artroplastia do Joelho , Modelos Estatísticos , Recuperação de Função Fisiológica , Reoperação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos
17.
Knee Surg Sports Traumatol Arthrosc ; 27(4): 1043-1048, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30367195

RESUMO

PURPOSE: Management of the severely stiff total knee arthroplasty (TKA) is challenging, with the outcome of revision arthroplasty being inferior compared to the outcome for other indications. The aim of this study was to analyse the outcome after revision TKA with hinged-type implants for severely stiff TKA [range of motion (ROM) ≤ 70°] at 2 years. METHODS: A cohort of 38 patients with a hinged-type revision TKA (Waldemar Link or RT-Plus) and preoperative ROM ≤ 70° were selected from a prospectively collected database. ROM, visual analogue scale (VAS) for pain and satisfaction and Knee Society Score (KSS) were obtained preoperatively and at 3 months, 1 year and 2 years. Pre- and postoperative outcome were compared at 2 years. RESULTS: There was a significant increase in ROM and KSS. VAS pain scores did not differ significantly. The median ROM at 2 years was 90° (range 50°-125°) with a median gain of 45° (range 5°-105°). Median VAS pain was 28.5 (range 0-96) points and median VAS satisfaction was 72 (range 0-100) points at 2 years. Twelve patients suffered a complication. Recurrent stiff knee was the most frequently reported complication (n = 5). CONCLUSIONS: Hinged-type revision TKA following a severely stiff TKA renders a significant, although moderate, clinical improvement at 2 years. LEVEL OF EVIDENCE: Retrospective case series. Level IV.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Desenho de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
19.
Knee Surg Sports Traumatol Arthrosc ; 26(11): 3377-3385, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29560510

RESUMO

PURPOSE: When downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics. METHODS: A validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics. RESULTS: Compared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size. CONCLUSION: Flexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to prevent anterior notching when downsizing the femoral component.


Assuntos
Artroplastia do Joelho/métodos , Simulação por Computador , Prótese do Joelho , Articulação Patelofemoral/fisiologia , Desenho de Prótese , Fenômenos Biomecânicos , Humanos , Ligamentos Articulares/fisiologia , Ligamento Patelar/fisiologia , Músculo Quadríceps/fisiologia , Amplitude de Movimento Articular/fisiologia
20.
Knee Surg Sports Traumatol Arthrosc ; 26(6): 1792-1799, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29181560

RESUMO

PURPOSE: The primary aim of the study was to examine stability and alignment after total knee arthroplasty (TKA) using patient-specific instrumentation (PSI) and conventional instrumentation (CI). The hypothesis was that stability and alignment would be better using PSI than CI, 12 months postoperatively. The secondary aim included the evaluation of clinical outcomes after TKA. METHODS: In this prospective randomized controlled trial, 42 patients with knee osteoarthritis received a Genesis II PS prosthesis with either PSI or CI. Patients visited the hospital preoperatively and postoperatively after 6 weeks and 3 and 12 months. To evaluate stability, varus-valgus laxity was determined in extension and flexion using stress radiographs 12 months postoperatively. Three months postoperatively, a long-leg radiograph and CT scan were obtained to measure hip-knee-ankle (HKA) alignment and component rotation. Furthermore, frontal and sagittal alignment of the components, the Knee Society Score, VAS Pain, VAS Satisfaction, Knee injury and Osteoarthritis Outcome score, Patella score (Kujala), University of California Los Angeles activity score, anterior-posterior laxity, (serious) adverse device-related events, and intraoperative complications were reported. The clinical outcomes were compared using independent t tests or non-parametric alternatives, and repeated measurements ANOVA with a significance level of p < 0.05. RESULTS: No significant differences were found between the two groups regarding stability, HKA angle, and rotational alignment. In four patients, the PSI did not fit correctly on the tibia and/or femur requiring intraoperative modifications. Both groups improved significantly over time on all clinical outcomes, with no significant differences between the groups 12 months postoperatively. The PSI group showed less tibial slope than the patients in the CI group [PSI 2.6° versus CI 4.8° (p = 0.02)]. Finally, the PSI group more frequently received a thinner insert size than the CI group (p = 0.03). CONCLUSIONS: Patients operated with PSI did not differ from CI in terms of stability and alignment. However, in the PSI group ligament releases were more often required intraoperatively. Furthermore, the two methods did not show different clinical results. It seems that the preoperative planning for the PSI facilitates more conservative bone cuts than CI, but whether this is clinically relevant should be investigated. Since PSI is more expensive and time consuming than CI, and does not outperform CI with regard to clinical results, we recommend to use CI. LEVEL OF EVIDENCE: I.


Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Idoso , Mau Alinhamento Ósseo/cirurgia , Feminino , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Modelagem Computacional Específica para o Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Método Simples-Cego , Cirurgia Assistida por Computador
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