Early Outcomes of Medial Pivot Total Knee Arthroplasty Compared to Posterior-Stabilized Design: A Randomized Controlled Trial

Kulshrestha, Vikas; Sood, Munish; Kanade, Sarang; Kumar, Santhosh; Mittal, Gaurav

doi:10.4055/cios19141

Cited by 32 publications

(43 citation statements)

References 25 publications

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“…So far, only a few studies compared MP knee design with posterior-stabilized implants [ [41] , [42] , [43] ]. In the study by Vikas Kulshrestha et al., authors followed up for 2 years 80 patients randomly allocated to receive a MP design total knee implant ADVANCE MP Knee System in comparison to NexGen LPS.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants—Retrospective Matched-Cohort Study

et al. 2022

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Background Total knee arthroplasty (TKA) is considered to be highly successful in treatment of end-stage osteoarthritis. There are multiple implant designs available on the market, and it is difficult to point which one is the best. The aim of this study was to compare the clinical and functional outcomes and gait pattern after TKA with the use of fixed-bearing medial pivot (K-Mod) vs multi-radius design (NexGen) implants and to compare them to norms for healthy patients with no osteoarthritis or arthroplasty procedure in anamnesis. Methods A group of 30 patients who received the medial pivot (MP) TKA and 33 patients who received the posterior-stabilized (PS) TKA between May and August of 2018 were included. All surgeries were performed in the level III academic hospital by a single surgeon. Every patient was asked to fulfill the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire preoperatively and 2 years postoperatively. Standard X-ray, biomechanical gait analysis using a motion capture system, and statistical analysis were performed at 2 years postoperatively. Results A total of 28 patients from either MP cohort (93%) or PS (85%) matched-control cohort completed the whole assessment at the final follow-up. There were statistically significant differences in a few gait parameters such as shorter mean step length both in operated and healthy limb, lower mean gait velocity, and lower mean walking cadence than the norm in both MP and PS groups. As to the WOMAC score, there was statistically significant improvement in both groups comparing preoperative and postoperative outcomes. Nevertheless, in the MP group, there was a significantly higher score, indicating worse outcomes, in the stiffness part of the WOMAC score than in the PS group. No significant differences were found between groups during radiological evaluation. Conclusions There were satisfying and promising clinical, radiographic, and patient-reported outcomes in both MP and PS groups with very little difference in relation to norm values. However, both implants failed in fully restoring gait patterns similar to the healthy limb of the same patient.

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Section: Discussionmentioning

confidence: 99%

Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants—Retrospective Matched-Cohort Study

et al. 2022

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“…Several studies reported no signi cant differences in clinical results between the two prosthesis types among patients undergoing unilateral TKA [24,25]. No study has analysed whether these two different prostheses in uence outcomes in patients with staged BTKA at different intervals.…”

Section: Discussionmentioning

confidence: 99%

The Interval Between Staged Bilateral Total Knee Arthroplasties Does Not Affect Early Complications of the Second Knee or Long-term Function of the First and Second Knees

Shang

Xiang

Guo

et al. 2021

Preprint

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Background: This study explored the optimal time interval between staged bilateral total knee arthroplasty (BTKA) to minimise early complications of the second TKA and maximise long-term function of the first and second knees.Methods: We retrospectively reviewed 266 patients who underwent staged BTKA between 2010 and 2015. Groups 1–4 had time intervals between BTKAs of 1–6, 6–12, 12–18, and 18–24 months, respectively. Demographics, postoperative complications within 90 days of the second TKA, Knee Society Score (KSS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score were compared among the groups.Results: In total, 54, 96, 75, and 41 patients were assigned to groups 1–4, respectively. Although group 1 had the highest overall complication rate (11.11%), there was no significant difference in the complication rate among the four groups. Also, no significant differences were found among the four groups in functional and patient-reported outcomes, in either the first or second knee at 5 years postoperatively, including KSS-knee, KSS-function, WOMAC-pain, WOMAC-stiffness, and WOMAC-physical function. The interval between BTKA did not influence complications or the function of the second knee. The TKA type (posterior-stabilised vs. medial-pivot) and age did not correlate significantly with any scores.Conclusions: There was no group difference in early complications of the second TKA, and postoperative function was equivalent between the two knees and did not vary by the interval between surgeries. Our results can help surgeons discuss the timing of the second TKA with patients, which should be based on their own preferences. If patients cannot tolerate severe symptoms in the contralateral knee after the first TKA, the second TKA should be performed as early as possible.

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“…Lin et al reached similar conclusions in a retrospective study 14 . Kulshrestha et al reported that patients who underwent MP-TKA were better at getting up from a chair and had a faster walking speed, while PS-TKA resulted in better knee flexion 15 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Postoperative Effects between Medial Pivot Prosthesis and Posterior Stabilized Prosthesis

Zhang

Feng

Yan

et al. 2020

Orthopaedic Surgery

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Objective: To compare the postoperative inflammation and pain response between medial pivot (MP) and posterior stabilized (PS) prostheses among total knee arthroplasty (TKA) patients. Methods: A prospective cohort study was conducted from January 2019 to May 2019 at the Affiliated Hospital of Qingdao University. The study included patients diagnosed with stage III or IV Kellgren-Lawrence knee osteoarthritis (KOA) who had failed conservative treatment, had undergone no previous knee surgeries, had varus substantial deformities (11-20 deviation), and had received their first unilateral TKA. A total of 109 patients who underwent PS prosthesis TKA and 98 patients who underwent MP prosthesis TKA were continuously enrolled. Inflammation biomarkers, such as leukocyte (white blood cells), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), together with hemoglobin (Hb), the visual analog pain score (VAS) and range of motion (ROM) were compared between the two groups. The Student t-test was applied to analyze continuous parameters, and the χ 2-test was used for categorical parameters. The linear mixed model was used for the repeated measurement data from the follow-up visits. Multivariate backward logistic and linear regression models were used to determine the factors potentially influencing prostheses and VAS scores. Results: All these enrolled patients were followed up at 2, 4, 7, and 30 days after TKA. There were no significant differences between the PS group and the MP group in body mass index (BMI), gender, laterality, usage of nonsteroidal antiinflammatory drugs (NSAIDs) and opioids, and drain tube extubation time (P > 0.05). Compared with the PS group, the MP group were older (67.5 years vs 65.4 years), and had a higher mid-vastus approach rate (67.3% vs 26.6%), a shorter tourniquet duration (68.3 AE 10.2 h vs 73.9 AE 11.2 h), a larger prosthetic pad (10.8 AE 1.2 mm vs 10.4 AE 1.2 mm), and a lower drain tube diversion volume (187.6 AE 119.3 mL vs 234.0 AE 155.7 mL). In the linear mixed model, MP prostheses had less CRP and ESR elevation and less Hb decrease than PS prostheses (P for group × time < 0.001). There were no significant differences in the changing trends between MP and PS prostheses by time for VAS scores and ROM. In the multivariate logistic regression model, MP prostheses showed significant differences compared with PS prostheses in treatment approach (odds ratio [OR] = 3.371, 95% confidence interval [CI]: 1.953-7.127; P < 0.001), ultrasound treatment start time (OR = 2.669, 95% CI: 1.385-5.141; P = 0.003), and tourniquet duration (OR = 0.954, 95% CI: 0.925-0.984; P = 0.003). Higher VAS scores on the second day postoperatively were related to high VAS scores preoperatively, use of opioids, high drain tube diversion, long tourniquet duration, and long drain tube extubation (P < 0.05), respectively. Conclusion: The MP prostheses showed potential advantages compared with PS prostheses in TKA in inflammatory responses.

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Early Outcomes of Medial Pivot Total Knee Arthroplasty Compared to Posterior-Stabilized Design: A Randomized Controlled Trial

Cited by 32 publications

References 25 publications

Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants—Retrospective Matched-Cohort Study

Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants—Retrospective Matched-Cohort Study

The Interval Between Staged Bilateral Total Knee Arthroplasties Does Not Affect Early Complications of the Second Knee or Long-term Function of the First and Second Knees

Comparison of Postoperative Effects between Medial Pivot Prosthesis and Posterior Stabilized Prosthesis

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