Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty

( Goki Kamei ),( Shigeki Ishibashi ),( Koki Yoshioka ),( Satoru Sakurai ),( Hiroyuki Inoue ),( Yu Mochizuki ),( Masakazu Ishikawa ),( Nobuo Adachi ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA. Materials and methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PSTKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination. Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158). Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.

무시멘트 해부학형 대퇴삽입물을 사용한 인공고관절 전치환술의 임상적 및 방사선학적 결과 -외측 미세포말 pad 여부에 따른 비교-

김영호(Young Ho Kim),박기철(Kee Cheol Park),김경식(Kyong Sik Kim),최일용(Il Yong Choi) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.3

The purposes of this study were to identify the overall clinical and radiographic results of 192 unce-mented anatomically designed femoral stem associated with the uncemented Harris-Galante acetabu-lar cup and to identify the differences in the clinical and radiographic results according to the pres-ence of a lateral porous pad of the femoral stem. Mean follow up period was 5 years 11 months. Final mean HHS was 92.1 increased from 42.5 preoperatively. The incidences of thigh pain and groin pain were 13.5% and 7.7%, respectively. The overall incidence of radiolucency including Gruen zone 1 in the femoral component in group without the lateral pad was significantly higher compared to that in group with the lateral pad. The incidence of osteolysis in the femoral and acetabular component was similar in both groups except the osteolysis in the distal portion of the stem was found in 2 cases only in the group without the lateral pad. Mean linear wear rate was 0.21mm/year. Revisions were per-formed in 6 cases(11.5%), i.e. 2 polyethylene liner dissociation, 1 polyethylene liner dissociation associated with massive osteolysis in the femoral component and 3 massive osteolysis in the acetabu-lar and femoral component. In conclusion, although the overall clinical and radiographic results of an uncemented anatomically designed femoral component associated with the Harris-Galante acetabular component were favorable, the relatively high linear wear rate of polyethylene and relatively high incidence of osteolysis are worrisome. Also, the use of an Anatomic femoral component without a lat-eral pad should be avoided due to a higher incidence of radiolucency and distal osteolysis around the femoral component compare to that with a lateral pad.

전후 활주형 가동형 슬관절 전치환술 후 발생한 대퇴 치환물의 파손

정광환,나성천,최소연,박기봉 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.4

The authors diagnosed femoral component fracture after total knee arthroplasty (TKA) using an anterior-posterior glide mobile-bearing system in a 78-year-old female patient who visited with severe pain and flexion limitations in the left knee and performed revision TKA. The fracture of the femoral component after TKA is a rare complication, and various factors cause the fracture of the femoral component. This case is reported along with a literature review. 저자들은 내원 7년 전 전후 활주형 가동형을 이용한 슬관절 전치환술을 받고 4주 전 극심한 좌측 슬관절 통증과 굴곡 제한이 발생한 78세 여자 환자에서 대퇴 치환물의 파손을 진단하고 재치환술을 시행하였다. 슬관절 전치환술 후 대퇴 치환물의 파손은 드문합병증으로 알려져 있으며, 다양한 인자들이 대퇴 치환물의 파손의 원인으로 이해되고 있기에 문헌 고찰과 함께 보고하는 바이다.

Comparison of Revision Rates Due to Aseptic Loosening between High-Flex and Conventional Knee Prostheses

( Young-joon Choi ),( Ki Won Lee ),( Jung-ki Ha ),( Joo-yul Bae ),( Suk Kyu Lee ),( Sang-bum Kim ),( Dong-kyo Seo ) 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.2

Purpose: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis. Materials and Methods: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component. Results: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (p<0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001). Conclusions: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.

Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

( Raj Kanna ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Purpose: In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods: We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results: Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9% and 0.98 mm versus 1.53 mm, respectively. Notching was very high (61.8%) in FBRD limbs when the anterior bowing was severe (DCA > 3°) in the contralateral (FBRE) limbs. Conclusion: Notching was less when femoral component sagittal positioning was planned perpendicular to DCX, in navigated TKA. Level of evidence: Therapeutic level II.

슬관절 전치환술 후 대퇴 치환물의 회전각 및 슬개골 경사각과 임상 결과의 상관관계

정재욱 ( Jae Wook Jung ),천상호 ( Sang Ho Cheon ),경희수 ( Hee Soo Kyung ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.2

목적: 슬관절 전치환술 후 대퇴 치환물의 회전각 및 슬개골 경사각과 임상 결과와의 연관성에 대해 분석 하고자 하였다. 대상 및 방법: 2002년 3월부터 2010년 2월까지 양측 슬관절 전치환술을 시행한 환자 48명, 96예를 대상으로 하였다. 대퇴 치환물의 회전각 및 슬개골 경사각은 컴퓨터단층촬영을 이용하여 측정하였으며, 임상 결과는 미국 슬관절 학회의 슬관절 점수 및 기능 점수와 Feller의 슬개골 점수로 평가하였다. 대퇴 치환물의 회전각, 슬개골 경사각과 임상 결과 간의 상관 관계를 분석하였고, 부가적으로 PFC(R) Sigma 군과 Scorpio NRG(R)군, 슬개-대퇴 증상군과 비증상군 사이를 비교하였다. 결과: 대퇴 치환물의 회전각은 평균 1.40˚ 내회전, 슬개골 경사각은 평균 3.79˚ 외측 경사였다. 그리고 슬관절 점수는 평균 90.5점, 기능 점수는 평균 77.4점, 슬개골 점수는 평균 23.9점이었다. 대퇴 치환물의 회전각과 슬관절 점수 사이에 유의한 상관관계가 있었고(p=0.031, r=-0.284), 기능 점수 및 슬개골 점수와의 상관관계는 유의하지 않았다. 슬개골 경사각과 임상 결과들 사이의 상관관계는 유의하지 않았다. 대퇴 치환물의 회전각은 PFC(R) Sigma 군에서 평균 2.00˚ 내회전, Scorpio NRG(R) 군에서 평균 0.81˚ 내회전 이었으며, 양 군 간에 유의한 차이가 있었으나(p=0.004), 임상 결과에서는 차이가 없었다. 슬개-대퇴 증상군과 비증상군을 비교할 때 대퇴 치환물의 평균 회전각은 증상이 있는 군에서 전체 평균보다 좀 더 벗어나는 값을 보였다. 결론: 슬관절 전치환술 시 술 후 대퇴 치환물의 회전각이 내회전될수록 낮은 슬관절 점수를 보였다. 그러나 슬개골 경사각과 임상 결과들 사이의 상관관계는 유의하지 않았다. Purpose: The aim of this study was to analyze the correlation of postoperative femoral component rotation angle and patella tilt angle with clinical results for total knee arthroplasty. Materials and Methods: Ninety-six cases in 48 patients who underwent total knee arthroplasty between March 2002 and February 2010 were enrolled. Femoral component rotation angle (FRA) and patella tilt angle (PTA) were measured with postoperative computed tomography. Clinical results were evaluated using American Knee Society knee score & function score and Feller`s patella score. We analyzed the correlation of FRA and PTA with clinical outcomes. We also compared clinical results between the PFC(R) Sigma group and the Scorpio NRG(R) group, and the patello-femoral symptom group and a symptom-free group. Results: The mean FRA was 1.40˚ of internal rotation. The patellar tilt angle was 3.79˚ of lateral tilt. The mean knee score was 90.5, the function score was 77.4, and the patella score was 23.9. There was a significant difference between FRA and knee scores (p=0.031, r=-0.284). There were no significant differences between FRA and function score or patella score. The correlation of PTA and clinical results was not significant. The mean FRA was 2.00˚ of internal rotation in the PFC(R) Sigma group, and it was significantly different than for the Scorpio NRG(R) group which had 0.81˚ of internal rotation; but there were no significant differences between the two groups in clinical results. The patello-femoral symptom group deviated more from the mean FRA than did the symptom-free group. Conclusion: Internal rotation of the femoral component is correlated with poor clinical results after total knee arthroplasty. The correlation of patella tilt angle and clinical results was not significant.

Comparison of an Accelerometer-Based Portable Navigation System, Patient-Specific Instrumentation, and Conventional Instrumentation for Femoral Alignment in Total Knee Arthroplasty

Kohei Kawaguchi,Kazuhiko Michishita,Takeshi Manabe,Yoshiyuki Akasaka,Junya Higuchi 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.4

Purpose: The KneeAlign2 (KA2, OrthoAlign Inc.) accelerometer-based portable navigation system and patient-specific instrumentation (PSI; Signature, ZimmerBiomet) are widely used for ideal femoral component alignment in total knee arthroplasty (TKA). However, there has been no comparative study of the KA2 system, PSI, and conventional intramedullary instrumentation (CON). The purpose of this study was to compare the accuracy in achieving proper femoral component alignment and clinical features by using the KA2 navigation system, PSI, and CON. Materials and Methods: We retrospectively compared the accuracy of femoral component alignment of 34 TKAs performed with the KA2 system for implantation of the femoral component, 32 TKAs with PSI, and 33 TKAs with CON. Results: In the coronal plane, use of the KA2 system was more likely to result in optimal femoral component alignment than the CON and PSI (p<0.01). In the sagittal plane, use of the KA2 system was more likely to result in optimal component alignment than PSI, but the difference between the KA2 and CON was insignificant. Conclusions: The portable accelerometer-based KA2 navigation system enabled ideal femoral implantation in the coronal and sagittal planes, as compared to the PSI or CON.

Intentionally Increased Flexion Angle of the Femoral Component in Mobile Bearing Unicompartmental Knee Arthroplasty

Kye-Youl Cho,Kang-Il Kim,송상준,Kyu-Jin Kim 대한슬관절학회 2018 대한슬관절학회지 Vol.30 No.1

Purpose: The purpose of this study was to determine the results of mobile bearing unicompartmental knee arthroplasty (UKA) with an intentionally increased flexion angle of the femoral component in patients requiring high flexion. Materials and Methods: We investigated 45 knees treated by UKA. Clinically, we measured the range of motion (ROM) and the American Knee Society (AKS) score preoperatively and at final follow-up and investigated complications. Radiologically, we measured the flexion angle of the femoral component, the posterior slope angle of the tibial component, the femorotibial angle and mechanical axis of the limb postoperatively. Results: The ROM was increased from 123° preoperatively to 139° at the final follow-up. The AKS knee and function scores increased from 59 and 68, respectively, preoperatively to 94 and 96, respectively, at the final follow-up. The flexion angle of the femoral component was 9.1°, and the posterior slope angle of the tibial component was 8.6°. There was one case of bearing dislocation in the largest femoral flexion angle case. Conclusions: The results might reflect the positive effect of an increased flexion angle of the femoral component up to 10° on ROM in mobile bearing UKA, which would contribute to better quality of life after UKA especially in populations requiring deep knee flexion.

슬관절 전치환술에서 후방십자인대 보존 여부와 대퇴 삽입물 크기의 상관 관계 분석

서재곤(Jai-Gon Seo),문영완(Young-Wan Moon),황찬하(Chan-Ha Hwang),강홍제(Hong-Je Kang) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

목적: 슬관절 전치환술 시 후방십자인대의 보존 유무에 따른 굴곡 간격의 차이가 대퇴 삽입물의 크기에 미치는 영향을 연구하고자 하였다. 대상 및 방법: 2003년 1월에서 2004년 1월까지 157명, 222예를 대상으로 scorpio®을 사용하여 슬관절 전치환술을 시행하였다. 후방십자인대 보존형은 81명, 118예였고 후방십자인대 대치형은 76명, 104예였다. 수술 시 먼저 연부조직 균형을 맞춘 후 눈금자가 장착된 기구(Linker®)를 사용하여 일정한 신전 및 굴곡 간격을 맞추고 간격이 같게 절골하였고, 경골 후경사각은 3° 이내로 하여 양 군의 차이를 최소화 한 상태에서 대퇴 삽입물의 크기를 계측하였다. 수술 후 단순 측면 방사선 검사를 시행하여 경골 후경사각을 측정하였고, 후방십자인대 보존형과 후방십자인대 대치형의 대퇴 삽입물 크기를 비교하였다. 결과: 경골 후경사각을 3° 이내로 일정하게 제한한 경우, 대퇴 삽입물의 크기는 후방십자인대 보존형을 사용한 경우 후방십자인대 대치형에 비하여 평균 2.4 ㎜ 작은 경향을 보였다(p<0.05). 결론: 대퇴 삽입물의 크기는 후방십자인대 보존 여부에 영향을 받으며 후방십자인대 보존 시 작아지는 경향을 보였다. Purpose: How PCl preservation affects the selection of femoral component size in total knee arthroplasty. Materials and Methods: One hundred and fifty-seven patients, two-hundred and twenty-two knees, underwent total knee arthroplasties with Scorpio®. One hundred and eighteen knees underwent PCL-preserving procedures, and one-hundred and four knees underwent PCL-substituting procedures. For minimization of error, we performed soft tissue balancing and then bone cutting by a Linker system with certain posterior slope (≤3°). We compared the sizes of the femoral components between the PCL-preserving and PCL-substituting procedures in order to determine how flexion gap differences affect femoral component sizes (Wilcoxon signed rank test). Results: With a certain minimal posterior slope (≤3°), the PCL-preservation procedure led to selection of a 2.4 ㎜ smaller femoral component than the PCL substituting procedure (p<0.05). Conclusion: Selection of femoral component size was affected by PCL preservation, and the size of the femoral component was decreased in the PCL preservation group.

Efficacy of Extramedullary Femoral Component Alignment Guide System for Blood Saving after Total Knee Arthroplasty

( Suk Ha Jeon ),( Ji Hun Kim ),( Jung Myung Lee ),( Eun Seok Seo ) 대한슬관절학회 2012 대한슬관절학회지 Vol.24 No.2

Purpose: To compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for bleeding and transfusion rate after total knee arthroplasty (TKA). Materials and Methods: Forty-nine female TKA patients were randomized into two groups: intramedullary (IM) group vs. extramedullary (EM) group. Drained volume of blood, hemoglobin concentration, hemoglobin drop, and transfusion rate were compared between the two groups. Wound problems, bleeding-related problems and thromboembolic complications were collected. Results: The mean drained volume via vacuum drainage was less in the EM group than that in the IM group (482.9mL vs. 266.8mL, p=0.001). Hemoglobin at 5 days after surgery was higher in the EM group (9.3g/dL vs. 9.9g/dL, p=0.002) than that in the IM group. The drop in hemoglobin after 5 days was smaller in the EM group (3.5g/dL vs. 2.9g/dL, p=0.003) than that in the IM group. The EM group had a lower prevalence of allogeneic transfusion (45.0% vs. 20.5%, p=0.026) than that in the IM group. No significant complications developed in either group. Conclusions: The results suggest that the extramedullary femoral alignment guide technique is an advantageous method that can reduce the drained volume of blood and the allogeneic transfusion rate.