Do Medial Pivot Kinematics Correlate With Patient-Reported Outcomes After Total Knee Arthroplasty?

Warth, Lucian C.; Ishmael, Marshall K.; Deckard, Evan R.; Ziemba-Davis, Mary; Meneghini, R. Michael

doi:10.1016/j.arth.2017.03.019

Cited by 44 publications

(37 citation statements)

References 29 publications

(27 reference statements)

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“…Thus, no conclusions can be drawn for other specific TKA designs. However, differently from previous studies where PS and CR designs were pooled together [19,21,23], the investigated cohort of the present study was highly homogenous. This might be considered a strength rather than an issue.…”

Section: Discussionmentioning

confidence: 82%

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Pizza

Paolo

Zinno

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

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Section: Discussionmentioning

confidence: 82%

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Pizza

Paolo

Zinno

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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“…Recently, Warth et al 23 published an article with different results. It was also aimed to determine whether intraoperative medial pivot kinematic patterns are associated with improved patient outcomes; however, at minimum 1-year FU, Knee Society objective, satisfaction, function, walking pain, stair pain, and the University of California Los Angeles (UCLA) activity level did not differ based on medial vs nonmedial pivot patterns.…”

Section: Discussionmentioning

confidence: 99%

Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience

Sabatini

Risitano

Parisi

et al. 2018

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Background:Traditional total knee implants designs, usually, are not able to reproduce the physiological kinematics of the knee, leaving almost 20% of the patients, those who underwent a total knee arthroplasty (TKA), not fully satisfied. Modern inserts are nowadays designed with a fully congruent medial compartment to reproduce the normal medial pivoting biomechanics of the knee. The aim of this article was to evaluate preliminary clinical improvement using the Medial Congruent (MC) insert as specific level of constraint.Materials and methods:A total of 10 consecutive patients have been enrolled in this study and treated using an MC tibial polyethylene insert. The Oxford Knee Score (OKS) and the Knee Society Score (KSS) have been assessed preoperatively and at 3-month, 6-month, and 1-year follow-up (FU) and used as validated measurements to evaluate early clinical improvements. Postoperative radiological examination was reviewed looking for radiolucent lines or loosening of the components.Results:Average improvement in OKS was from 19.5 to 41.2, whereas KSS improved with an average score from 64.7 preoperatively to 167.5 at the final FU showing good to excellent results in 95% of the treated knees. Evaluating the range of motion, the average maximum active movement was 124° and none of the patients needing for a revision surgery or manipulation under anesthesia. No complications were observed at the final FU as septic or aseptic loosening or vascular or neurologic injury.Discussion and conclusions:Medial Congruent insert showed good to excellent clinical results at 1-year FU. Range of motion and subjective outcomes were satisfying and comparable with results obtained in literature using traditional TKA design.

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“…They concluded that the medially conforming total knee shows a medial pivot motion with tibial internal rotation. However, Warth et al [ 9 ] showed that a medial pivot pattern may not significantly govern clinical success after TKR based on intraoperative kinematics and modern outcome measures. They pointed out that further research is warranted to determine if a particular kinematic pattern promotes optimal clinical outcomes.…”

Section: Design Of Total Knee Replacementmentioning

confidence: 99%

An Approach to Developing Customized Total Knee Replacement Implants

Wang

Guo

et al. 2017

Journal of Healthcare Engineering

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Total knee replacement (TKR) has been performed for patients with end-stage knee joint arthritis to relieve pain and gain functions. Most knee replacement patients can gain satisfactory knee functions; however, the range of motion of the implanted knee is variable. There are many designs of TKR implants; it has been suggested by some researchers that customized implants could offer a better option for patients. Currently, the 3-dimensional knee model of a patient can be created from magnetic resonance imaging (MRI) or computed tomography (CT) data using image processing techniques. The knee models can be used for patient-specific implant design, biomechanical analysis, and creating bone cutting guide blocks. Researchers have developed patient-specific musculoskeletal lower limb model with total knee replacement, and the models can be used to predict muscle forces, joint forces on knee condyles, and wear of tibial polyethylene insert. These available techniques make it feasible to create customized implants for individual patients. Methods and a workflow of creating a customized total knee replacement implant for improving TKR kinematics and functions are discussed and presented in this paper.

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Do Medial Pivot Kinematics Correlate With Patient-Reported Outcomes After Total Knee Arthroplasty?

Abstract: A medial pivot pattern may not significantly govern clinical success after TKA based on intraoperative kinematics and modern outcome measures. Further research is warranted to determine if a particular kinematic pattern promotes optimal clinical outcomes.

Cited by 44 publications

References 29 publications

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience

An Approach to Developing Customized Total Knee Replacement Implants

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