Level of constraint in revision knee arthroplasty

Indelli, Pier Francesco; Giori, Nick; Maloney, William J.

doi:10.1007/s12178-015-9295-6

Cited by 27 publications

(15 citation statements)

References 29 publications

(28 reference statements)

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“…Moreover, the MCL elongation patterns observed in this study indicate the highest aMCL elongation at 50-60°knee flexion, therefore concurring with previous data reported on the MCL restraining function in natural and replaced knees. Clinically, as noted in previous studies, 21,46 these findings suggest that excessive release of the aMCL should be avoided intraoperatively in order to reduce the risk of midflexion instability after TKA.…”

Section: Discussionsupporting

confidence: 72%

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Nasab

Schütz

et al. 2020

Ann Biomed Eng

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This study aimed to quantify the elongation patterns of the collateral ligaments following TKA during functional activities of daily living. Using mobile videofluoroscopy to capture radiographic images of the knee in a group of six patients, each with an ultra-congruent knee implant, tibiofemoral kinematics were reconstructed throughout complete cycles of level gait, downhill walking, stair descent, and squat activities. Kinematic data were then used to drive subject-specific multibody knee models to estimate length-change patterns of the LCL as well as three bundles of the MCL. In addition, a sensitivity analysis examined the role of the attachment site in the elongation patterns. Our data indicate a slackening of the LCL but nonuniform length-change patterns across the MCL bundles (ranging from lengthening of the anterior fibers to shortening of the posterior fibers) with increasing knee flexion angle. Near-isometric behavior of the intermediate fibers was observed throughout the entire cycle of the studied activities. These length-change patterns were found to be largely consistent across different activities. Importantly, lengthchange patterns were critically sensitive to the location of the femoral attachment points relative to the femoral component. Thus, in TKA with ultra-congruent implants, implantation of the femoral component may critically govern postoperative ligament function.

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Section: Discussionsupporting

confidence: 72%

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Nasab

Schütz

et al. 2020

Ann Biomed Eng

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“…The increased stress in the CCK is a consequence of the post-cam constraint: in fact, the anteroposterior force increases with flexion [3,4] and consequently is transmitted by the post-cam mechanism, hence generating a lever arm that will greatly load the proximal tibia. Contrariwise, the hinged design will transmit the stress to a more distal region in the tibia, leading then to a more gradual stress distribution on the bone, thanks to the RTH pin.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Biomechanical Differences Between Condylar Constrained Knee and Rotating Hinged Implants: A Numerical Study

Andreani

Pianigiani

Bori

et al. 2020

The Journal of Arthroplasty

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Background: Different levels of constraint for total knee arthroplasty can be considered for revision surgeries. While prior studies have assessed the clinical impact and patient outcomes of condylar constrained knee (CCK) and rotating hinged (RTH) implants, nowadays little is known about the biomechanical effects induced by different levels of constraint on bone stress and implant micromotions. Methods: CCK and RTH implant models were analyzed using a previously validated numerical model. Each system was investigated during a squat and a lunge motor task. The force in the joint, the bone and implant stresses, and micromotions in this latter were analyzed and compared among designs. Results: Different activities induced similar bone stress distributions in both implants. The RTH implant induces mostly high stress compared to the CCK implant, especially in the region close to tip of the stem. However, in the proximal tibia, the stresses achieved with the CCK implant is higher than the one calculated for the RTH design, due to the presence of the post-cam system. Accordingly, the condylar constrained design shows higher implant micromotions due to the greater torsional constraint. Conclusion: Different levels of constraint in revision arthroplasty were always associated with different biomechanical outputs. RTH implants are characterized by higher tibial stress especially in the region close to the stem tip; condylar implants, instead, increase the proximal tibial stress and therefore implant micromotions, as a result of the presence of the post-cam mechanism. Surgeons will have to consider these findings to guarantee the best outcome for the patient and the related change in the bone stress and implant fixation induced by different levels of constrain in a total knee arthroplasty.

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“…Prostheses with increasing levels of constraint, particularly those designed to address dysfunctional or deficient collateral ligaments, may be associated with increased interface transmission forces and earlier aseptic loosening. [1][2][3] Consequently, it is recommended that the least constrained prosthesis necessary to obtain a stable and balanced knee is selected. 1,4 2wWhen requiring more constraint than is provided by standard cruciate retaining or posterior stabilized devices, the two options are fully stabilized TKA (FSTKA) or hinged TKA (HTKA).…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Consequently, it is recommended that the least constrained prosthesis necessary to obtain a stable and balanced knee is selected. 1,4 2wWhen requiring more constraint than is provided by standard cruciate retaining or posterior stabilized devices, the two options are fully stabilized TKA (FSTKA) or hinged TKA (HTKA). Increased stability for FSTKA is provided by the condylar constraint of a closely fitting elevated tibial spine and deep femoral intercondylar box.…”

Section: Introductionmentioning

confidence: 99%

Survivorship of highly constrained prostheses in primary and revision total knee arthroplasty: analysis of 6070 cases

Knight

Lewis

Peng

et al. 2020

ANZ Journal of Surgery

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Background: Concerns exist about the survival and complication rates of highly constrained total knee arthroplasty (TKA) prostheses. The aims of this study were to determine if there were differences between the revision and complication rates of fully stabilized (FSTKA) and hinged (HTKA) TKA, when used in both primary and revision procedures. Methods: Survivorship of all highly constrained TKA prostheses implanted over a 17 year period were analysed by the Australian Orthopaedic Association National Joint Replacement Registry. The primary outcome measure was time to first revision using Kaplan Meier estimates of survivorship. Results: In the primary setting, the cumulative percent revision at 11 years was higher for HTKA than for FSTKA prostheses (P = 0.014). However, this finding was only significant for patient >75 years. In the revision setting, there were no differences in the revision rates for either category of prosthesis for any age group. For the indication of periarticular/periprosthetic fracture, HTKA resulted in a lower revision rate than FSTKA in both primary and revision cohorts. There were no differences in the rates of revision for infection and aseptic loosening for either prosthesis type in primary or revision settings. The revision risk for periprosthetic fracture was higher after HTKA prostheses. Conclusion: Both FSTKA and HTKA prostheses provide similar outcomes in primary and revision procedures except for the setting of periarticular/periprosthetic fracture, where a HTKA should be used. In elderly patients, a FSTKA prosthesis is recommended as the risk of periprosthetic fracture is higher with a HTKA.

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Level of constraint in revision knee arthroplasty

Cited by 27 publications

References 29 publications

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Analysis of Biomechanical Differences Between Condylar Constrained Knee and Rotating Hinged Implants: A Numerical Study

Survivorship of highly constrained prostheses in primary and revision total knee arthroplasty: analysis of 6070 cases

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