Unconstrained total knee arthroplasty in significant valgus deformity: a modified surgical technique to balance the knee and avoid instability

Pagoti, R.; O’Brien, Seamus; Doran, E.; Beverland, David

doi:10.1007/s00167-015-3881-4

Cited by 13 publications

(9 citation statements)

References 46 publications

(116 reference statements)

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“…Furthermore, other authors were also able to obtain satisfactory outcomes on more severely deformed knee. 6,19,27 Even though in this study the revision rate was available only over a short period of time, it is worthy to mention that also Sorrels et al 26 obtained comparable revision rate using cementless low contact stress (LCS) mobile bearing design; however, they were not able to obtain a systematically corrected alignment, which was instead achieved most of the times in the present study.…”

Section: Discussionmentioning

confidence: 52%

“…Czekaj et al 6 additionally obtained a survival rate at ten years of 98.6% with severe deformities using a low-constraint deep-dish mobile bearing implant design, showing a high reliability of ultra-congruent mobile bearing prosthesis for malaligned knees. On the other hand, other studies are specific to severe valgus deformities such as Tucker et al 27 and Pagoti et al 19 who both reported satisfactory results using unconstrained mobile inserts.…”

Section: Introductionmentioning

confidence: 95%

“…22 Several studies addressing alignment correction propose surgical techniques as a potential solution for both significant varus 23,28 and valgus 1,5,10,18,20 knee deformities, this latter one known to be more challenging. 17,19 Even though the use of unconstrained mobile bearing for severe knee deformities is rare, 6 it has been shown to give successful outcomes. 6,26 Sorrels et al 26 investigated survivorship and postoperative alignment of cementless mobile bearing implants on a wide range of coronal deformities and evaluated a ten-year survival of 89.7% for their severely abnormal alignment group.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The use of mobile bearing TKA in valgus deformities – A clinical study

Castellarin¹,

Bori

Biava

et al. 2022

Journal of Orthopaedics

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The use of mobile bearing TKA in valgus deformities – A clinical study

Castellarin¹,

Bori

Biava

et al. 2022

Journal of Orthopaedics

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“…A cementless CORAIL stem and a cementless Pinnacle cup (DePuy Synthes, Warsaw, IN) were used in all THRs, which were performed via the posterior approach using a 12- to 14-cm incision [29]. Cementless LCS implants (DePuy Synthes, Warsaw, IN) were used for all TKRs via a medial Insall approach under tourniquet, released at capsule closure [30], [31]. Cementless Oxford Microplasty medial unicompartmental implants (Biomet Ltd., Bridgend, UK) were used for all UKRs via a distal medial parapatellar approach under tourniquet, released at capsule closure [32].…”

Section: Methodsmentioning

confidence: 99%

Identifying the period of greatest blood loss after lower limb arthroplasty

et al. 2018

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BackgroundThe use of tranexamic acid (TXA) in total hip replacement (THR) typically reduces blood loss by approximately 400 mL, and typical total blood loss is still approximately 1 L. A barrier to harnessing the full potential of TXA is disagreement on the optimum timing of administration. To address this, we aimed to identify the period of greatest blood loss.MethodsWe analyzed the perioperative data of 870 patients who had undergone THR, total knee replacement, or unicompartmental knee replacement just before the introduction of TXA to our unit. Total blood loss was calculated on postoperative day (POD) 1 and POD2 using an equation based on change in hematocrit.ResultsAverage total blood loss at POD2 was 1505, 1322, and 611 mL for THR, total knee replacement, and unicompartmental knee replacement, respectively. Between 86% and 96% of this blood loss occurred in the period between skin closure and POD1. Intraoperative loss did not correlate with total loss at POD2. Blood transfusion was more likely if the patient was female (odds ratio [OR], 6.8) or if they had preoperative anemia (OR, 8.3) than if there was a high-volume blood loss (OR, 1.6).ConclusionsApproximately 90% of blood loss occurs between skin closure and the first postoperative 24 hours. “Intraoperative blood loss” and “transfusion rate” are not reliable markers of total blood loss. The full potential of TXA could be harnessed by using it during the period of greatest blood loss, that is, during the first postoperative 24 hours.

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“…In the first 8 years of this series the incidence of spinout was 0.58%; during this period the authors routinely released collateral ligaments in both varus and valgus knees to achieve soft-tissue balance in extension. In the last 16 years they stopped releasing the collateral ligaments [ 9 , 10 ] and the incidence fell to 0.2% (12 out 5994).…”

Section: Introductionmentioning

confidence: 99%

Polyethylene spinout in the Attune® Cruciate-Retaining Rotating-Platform (CR RP) total knee arthroplasty performed with a cruciate-sacrificing and measured-resection technique

Keogh

Mulcahy

Reidy

et al. 2020

Knee Surg & Relat Res

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Introduction Polyethylene (PE) spinout is a known but uncommon complication when using a mobile-bearing (MB) total knee arthroplasty (TKA) design. Sacrificing the posterior cruciate ligament (PCL) is within the manufacturer’s recommendations for the Attune® Cruciate-Retaining Rotating-Platform (CR RP) knee design. Aim To discuss the potential aetiology and prevention of spinout in the Attune® CR RP knee. Methods We used a retrospective radiological review from two centres reporting a higher rate of spinout in the Attune® CR RP knee using a cruciate-sacrificing and measured-resection technique when compared to a gap-balancing technique. Three hundred and thirty-two patients were evaluated over a 3-year period. Results There were 8 out of 279 (2.86%) cases of spinout in our first cohort of patients using a measured-resection technique. There were 0 out of 53 cases of spinout in our second cohort of patients where a gap-balancing technique was used. One spinout was reduced closed, the other seven were initially revised to a thicker RP insert of the same design. Of these seven, three underwent a further revision TKA and one patient required a knee fusion/arthrodesis. Conclusions This study reports a higher incidence of PE spinout in the Attune® CR RP TKA when a measured-resection technique in combination with PCL resection is performed. We recommend a gap-balancing technique with conservative soft-tissue release if the surgeon is planning to sacrifice the PCL in the Attune® CR RP.

show abstract

Unconstrained total knee arthroplasty in significant valgus deformity: a modified surgical technique to balance the knee and avoid instability

Abstract: Adequate correction of valgus knee deformity was successfully achieved using this modified technique with satisfactory medium-term outcome and avoidance of instability.

Cited by 13 publications

References 46 publications

The use of mobile bearing TKA in valgus deformities – A clinical study

The use of mobile bearing TKA in valgus deformities – A clinical study

Identifying the period of greatest blood loss after lower limb arthroplasty

Polyethylene spinout in the Attune® Cruciate-Retaining Rotating-Platform (CR RP) total knee arthroplasty performed with a cruciate-sacrificing and measured-resection technique

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