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https://www.readbyqxmd.com/read/28644188/surgical-techniques-for-total-knee-arthroplasty-measured-resection-gap-balancing-and-hybrid
#1
Neil P Sheth, Adeel Husain, Charles Lenwood Nelson
Total knee arthroplasty (TKA) is effective in managing end-stage degenerative joint disease. Achieving favorable clinical outcomes is predicated on proper implant alignment, sizing, and rotation as well as adequate soft-tissue balancing. Modern TKA implants are designed to address the fundamental needs of attaining stability in both flexion and extension and of optimizing patellar tracking. Measured resection and gap balancing are the two different techniques used to implant the TKA components used today. Both techniques have been validated as durable and successful, and each has unique advantages and disadvantages...
July 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28594500/patellofemoral-arthroplasty-an-evolving-science
#2
Jess H Lonner
Patellofemoral arthroplasty (PFA) has long been a clinical option for patients with isolated patellofemoral arthritis. However, a high rate of failure as a result of patellar instability related to component malposition, soft-tissue imbalance, errant surgical techniques, and poor trochlear implant designs contributed to the underutilization of PFA. The evolution of surgical indications, trochlear implant design, component positioning, and soft-tissue balance has led to improved patellar tracking, fewer failures related to patellar instability, and improved functional outcomes...
February 15, 2017: Instructional Course Lectures
https://www.readbyqxmd.com/read/28585997/diagnosis-and-management-of-traumatic-patellar-instability-in-the-pediatric-patient
#3
Steven F DeFroda, Joseph A Gil, Alex Boulos, Aristides I Cruz
Instability of the patella is a common cause of knee pain and dysfunction in pediatric and adolescent patients and can be due to several factors. Although some patients will recall a specific traumatic event others may not, requiring the diagnosis to be made on the basis of physical examination and imaging. Congenital dislocation and connective tissue disorders should also be considered, even in the setting of trauma. There are radiographic parameters that may identify causes of instability such as trochlear and patellar abnormalities, and magnetic resonance imaging can identify signs of trauma such as bony edema, loose osteochondral fragments, and increased tibial tubercle-trochlear groove distance...
June 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28580253/arthroscopic-patellar-lateral-facetectomy
#4
Marcio B Ferrari, George Sanchez, Jorge Chahla, Gilbert Moatshe, Robert F LaPrade
Isolated patellofemoral osteoarthritis is relatively prevalent, with the lateral facet of the patella being the most commonly affected portion. This pathology can be a result of a patellar maltracking syndrome, patella instability, or idiopathic degenerative changes. A thorough diagnostic work-up with a physical examination and imaging studies are mandatory for a proper diagnosis and to rule out other causes of patellofemoral knee pain. These patients are often treated nonoperatively with exercises for patella mobility, intra-articular injections, braces, patellar tracking, quadriceps balance and strength, and activity modification...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28554493/statistical-shape-modeling-predicts-patellar-bone-geometry-to-enable-stereo-radiographic-kinematic-tracking
#5
Lowell M Smoger, Kevin B Shelburne, Adam J Cyr, Paul J Rullkoetter, Peter J Laz
Complications in the patellofemoral (PF) joint of patients with total knee replacements include patellar subluxation and dislocation, and remain a cause for revision. Kinematic measurements to assess these complications and evaluate implant designs require the accuracy of dynamic stereo-radiographic systems with 3D-2D registration techniques. While tibiofemoral kinematics are typically derived by tracking metallic implants, PF kinematic measurements are difficult as the patellar implant is radiotransparent and a representation of the resected patella bone requires either pre-surgical imaging and precise implant placement or post-surgical imaging...
May 17, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28528349/high-wear-resistance-of-femoral-components-coated-with-titanium-nitride-a-retrieval-analysis
#6
Christian Fabry, Carmen Zietz, Axel Baumann, Reinhard Ehall, Rainer Bader
PURPOSE: The objective of this study was to evaluate the in vivo wear resistance of cobalt-chromium femoral components coated with titanium nitride (TiN). Our null hypothesis was that the surface damage and the thickness of the TiN coating do not correlate with the time in vivo. METHODS: Twenty-five TiN-coated bicondylar femoral retrievals with a mean implantation period of 30.7 ± 11.7 months were subjected to an objective surface damage analysis with a semi-quantitative assessment method...
May 20, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28465849/mobile-bearing-total-knee-arthroplasty-for-valgus-knee-osteoarthritis-with-permanent-patellar-dislocation-a-case-report-and-review-of-the-literature
#7
Kohei Kamada, Tomoyuki Matsumoto, Koji Takayama, Daisuke Araki, Shingo Hashimoto, Shinya Hayashi, Takehiko Matsushita, Ryosuke Kuroda
Permanent patellar dislocation with tibiofemoral joint osteoarthritis is a relatively rare condition. To treat this condition, total knee arthroplasty with proximal or distal realignment of the extensor mechanism has been reported. We report a challenging case of an 80-year-old woman diagnosed with permanent patellar dislocation with tibiofemoral joint osteoarthritis treated by a mobile bearing total knee arthroplasty utilizing navigation system. Lateral retinaculum release was performed to improve patellar tracking; other proximal or distal realignment of the extensor mechanism was not necessary...
2017: Case Reports in Orthopedics
https://www.readbyqxmd.com/read/28459754/rehabilitation-after-medial-patellofemoral-ligament-reconstruction
#8
Terrence G McGee, Andrew J Cosgarea, Kevin McLaughlin, Miho Tanaka, Ken Johnson
Patellar instability resulting from subluxation or dislocation is a painful and commonly recurring condition. Retinacular restraints control patellar tracking, limiting the movement of the patella in the trochlear groove. The medial patellofemoral ligament (MPFL) is considered the main soft tissue stabilizer against lateral displacement. Few studies of patellar instability discuss rehabilitation after MPFL reconstruction. In this review, we discuss the phases of rehabilitation after MPFL reconstruction, typical interventions by rehabilitation specialists, and patient-specific guidelines for return to prior level of function...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28459747/biomechanical-analysis-of-tibial-tuberosity-medialization-and-medial-patellofemoral-ligament-reconstruction
#9
John J Elias, Bradley W Smith, Blake T Daney
Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking...
June 2017: Sports Medicine and Arthroscopy Review
https://www.readbyqxmd.com/read/28454908/accuracy-of-mobile-biplane-x-ray-imaging-in-measuring-6-degree-of-freedom-patellofemoral-kinematics-during-overground-gait
#10
Hans A Gray, Shanyuanye Guan, Marcus G Pandy
The aim of this study was to evaluate the accuracy with which mobile biplane X-ray imaging can be used to measure patellofemoral kinematics of the intact knee during overground gait. A unique mobile X-ray imaging system tracked and recorded biplane fluoroscopic images of two human cadaver knees during simulated overground walking at a speed of 0.7m/s. Six-degree-of-freedom patellofemoral kinematics were calculated using a bone volumetric model-based method and the results then compared against those derived from a gold-standard bead-based method...
April 19, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28419810/the-relationship-of-static-tibial-tubercle-trochlear-groove-measurement-and-dynamic-patellar-tracking
#11
Victor R Carlson, Frances T Sheehan, Aricia Shen, Lawrence Yao, Jennifer N Jackson, Barry P Boden
BACKGROUND: The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension; however, the predictive ability of this measure for dynamic patellar tracking patterns is unknown. PURPOSE: To determine whether the static TT-TG distance can predict dynamic lateral displacement of the patella...
April 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28378002/total-knee-arthroplasty-for-treatment-of-osteoarthritis-with-prolonged-patellar-dislocation
#12
Kosuke Kumagai, Mitsuhiko Kubo, Tsutomu Maeda, Susumu Araki, Suguru Shioji, Noriaki Okumura, Hitomi Fujikawa, Taku Kawasaki, Shinji Imai, Yoshitaka Matsusue
Prolonged dislocation of the patella is a rare condition and is often related to severe osteoarthritis (OA) of the femorotibial (FT) joint. For this condition's treatment, numerous surgical techniques using total knee arthroplasty (TKA) have been published. To the best of our knowledge, this case report is the first description of the use of lateral release alone to treat recurrent patellar subluxation with TKA. An interesting point in this case is that the patient had a good recovery after TKA in spite of quite a long-term (a duration of almost 55 years) dislocation of her patella and development of secondary OA...
March 2017: Arthroplasty Today
https://www.readbyqxmd.com/read/28373624/the-posterior-condylar-cartilage-affects-rotational-alignment-of-the-femoral-component-in-varus-knee-osteoarthritis
#13
Daisuke Hamada, Keizo Wada, Hiroshi Mikami, Shunichi Toki, Tomohiro Goto, Takahiko Tsutsui, Tomoya Takasago, Akihiro Nagamachi, Koichi Sairyo
Rotational alignment of the femoral component in total knee arthroplasty (TKA) is important for patellar tracking and ligament balance. Preoperative planning based on radiography might have a potential risk for over-rotation because these X-ray based measurements can not detect asymmetric cartilage wear on posterior condyle. The purpose of this study is to evaluate the effect of the posterior condylar cartilage of varus osteoarthritic knee on rotational alignment of the femoral component in TKA. We established two different condylar twist angles (CTA) from intraoperative multiplanar reconstruction (MPR) images and intraoperative information of navigation system...
2017: Journal of Medical Investigation: JMI
https://www.readbyqxmd.com/read/28355673/the-extensor-mechanism-imaging-and-intervention
#14
Colm J McMahon, Arun Ramappa, Kenneth Lee
We present an overview of imaging and intervention of the extensor mechanism of the knee. Particular focus is placed on the evaluation of patellofemoral tracking disorders, patellar and quadriceps tendinosis and tears, patellar fracture, lateral patellar condyle patellar friction syndrome, and prepatellar bursitis. Anatomical and biomechanical factors contributing to these disorders are considered. Imaging evaluation is presented in a clinical context, and therapeutic options for these disorders are discussed...
April 2017: Seminars in Musculoskeletal Radiology
https://www.readbyqxmd.com/read/28347597/does-standing-limb-alignment-after-total-knee-arthroplasty-predict-dynamic-alignment-and-knee-loading-during-gait
#15
Charles Rivière, Matthieu Ollivier, Damien Girerd, Jean Noël Argenson, Sébastien Parratte
BACKGROUND: A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait...
March 24, 2017: Knee
https://www.readbyqxmd.com/read/28298067/incidence-of-second-anterior-cruciate-ligament-tears-1990-2000-and-associated-factors-in-a-specific-geographic-locale
#16
Nathan D Schilaty, Nathaniel A Bates, Thomas L Sanders, Aaron J Krych, Michael J Stuart, Timothy E Hewett
BACKGROUND: Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee. PURPOSE: To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period. STUDY DESIGN: Descriptive epidemiological study. METHODS: International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000...
June 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28244917/in-vivo-three-dimensional-patellar-mechanics-normal-knees-compared-with-domed-and-anatomic-patellar-components
#17
Adrija Sharma, Trevor F Grieco, Sumesh M Zingde, Douglas A Dennis, Matthew R Anderle, Richard D Komistek
BACKGROUND: Patellofemoral complications are a major cause of revision surgery following total knee arthroplasty (TKA). High forces occurring at the patellofemoral articulation coupled with a small patellofemoral contact area pose substantial design challenges. In this study, the three-dimensional (3D) in vivo mechanics of domed and anatomically shaped patellar components were compared with those of native patellae. METHODS: Ten normal knees, 10 treated with an LCS-PS (low contact stress-posterior stabilized) TKA (anatomically shaped patellar component), and 10 treated with a PFC Sigma RP-PS (press-fit condylar Sigma rotating platform-posterior stabilized) TKA (domed patellar component) were analyzed under fluoroscopic surveillance while the patient performed a weight-bearing deep knee bend from full knee extension to maximum knee flexion...
March 1, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28210658/patellar-maltracking-persists-in-adolescent-females-with-patellofemoral-pain-a-longitudinal-study
#18
Victor R Carlson, Barry P Boden, Aricia Shen, Jennifer N Jackson, Katharine E Alter, Frances T Sheehan
BACKGROUND: Patellofemoral pain is one of the most common conditions seen in sports medicine practices, particularly among adolescent females. However, the natural history of the underlying pathology in patellofemoral pain during puberty remains poorly understood. PURPOSE: The purpose of this longitudinal study is to assess changes in patellar maltracking patterns in subjects with patellofemoral pain as they mature from mid- to late adolescence. STUDY DESIGN: Cohort study; Level of evidence, 3...
February 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/28160369/comparative-t2-and-t1%C3%AF-mapping-of-patellofemoral-cartilage-under-in-situ-mechanical-loading-with-prospective-motion-correction
#19
Thomas Lange, Benjamin R Knowles, Michael Herbst, Kaywan Izadpanah, Maxim Zaitsev
PURPOSE: To demonstrate improved T2 and T1ρ mapping of patellofemoral cartilage with in situ loading by means of prospective motion correction and to assess load-induced changes in healthy subjects. MATERIALS AND METHODS: Established T2 and T1ρ mapping sequences were augmented with prospective motion correction based on optical tracking. Protocols were optimized for robust imaging of the patellofemoral cartilage at a field strength of 3T. Subjects were positioned in the scanner with knee flexion and in situ loading of the patellofemoral joint was performed with a pneumatic loading device...
February 3, 2017: Journal of Magnetic Resonance Imaging: JMRI
https://www.readbyqxmd.com/read/28061515/spacer-based-gap-balancing-in-total-knee-arthroplasty-clinical-success-with-a-reproducible-technique
#20
Frédéric Lavoie
Purpose Proper coronal and transverse ligament balancing is an important aspect of total knee arthroplasty (TKA) and has an impact on postoperative outcome. Many variations of the gap balancing technique were described to address this challenge, most of them using various tensioning devices, but none for which the use is widespread. The aim of this paper is to describe a gap technique variant for TKA using spacer blocks and report the clinical results for a cohort of patients on which it was used. Methods A total of 114 TKAs were performed in 101 patients using a standardized surgical technique that integrates ligament balancing with sizing and positioning of the femoral component...
January 6, 2017: Journal of Knee Surgery
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