Improving Radiographic Patello-femoral Tracking in Total Knee Arthroplasty with the Use of a Flexion Spacer: a Case-control Study

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2020 Apr 13

PMID 32279109

Citations 3

Authors

Davide Giuseppe DElicio

Marco Attanasio

Gaetano Ruffo

Stefan Mogos

Nicola Ursino

Riccardo DAmbrosi

Franco Parente

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to compare the effectiveness of a flexion spacer in the clinical and radiological outcomes of patients who underwent total knee arthroplasty (TKA) and to compare these patients to a group of patients subjected to the same type of surgery but without the use of a flexion spacer. It was hypothesized that patients who underwent TKA using a flexion spacer would have better clinical and radiological outcomes than those without a flexion spacer in both short- and medium-term follow-ups.

Methods: A consecutive series of patients undergoing TKA were included, yielding 20 patients in the study group. The control group was identified from the consultant database of the senior author, yielding 21 patients who underwent the same operation. All 41 patients received a Vanguard Knee System (Zimmer-Biomet, Warsaw, Indiana, USA). Cases were defined as those patients who had undergone TKA using a flexion spacer device for gap balancing; controls were defined as patients who had undergone TKA without the support of a flexion spacer device. Patients were clinically and radiographically evaluated at two consecutive follow-ups: T-13.1 ± 1.3 months and T-108 ± 6 months. Clinical evaluation was performed using the Knee Society Scoring System and the Western Ontario, McMaster Universities Osteoarthritis Index score. Radiographic evaluation included the femoral angle (α), the tibial angle (β), the sagittal femoral (γ) angle and the tibial slope (δ). Furthermore, the lateral patellofemoral angle (LPFA) and the Caton-Deschamps index were evaluated.

Results: No statistically significant clinical differences were found between the two groups at T and T; moreover, the clinical outcomes of the two groups were stable between the two follow-ups, with no significant improvement or worsening. Radiographic evaluation showed no difference in the two groups between T and T; the only significant radiographic difference between the two groups concerned the LPFA (both at 30° and 60°) at each follow-up, which was significantly greater in cases than in controls (p = 0.001).

Conclusions: The current study demonstrates that the use of a flexion spacer significantly improves radiographic patello-femoral tracking, although no significant clinical differences were found between the two groups.

Level Of Evidence: Case-control study, level III.

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References

Bonnin M, Beckers L, Leon A, Chauveau J, Muller J, Tibesku C . Correction to: Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment. Knee Surg Sports Traumatol Arthrosc. 2020; 30(2):476. PMC: 8866254. DOI: 10.1007/s00167-020-06238-4. View

Easterlin M, Chang D, Talamini M, Chang D . Older age increases short-term surgical complications after primary knee arthroplasty. Clin Orthop Relat Res. 2013; 471(8):2611-20. PMC: 3705042. DOI: 10.1007/s11999-013-2985-8. View

Fitz W, Jager S, Rieger J, Seebach E, Bitsch R . Femoral rotation in total knee arthroplasty: a comparison of patient individualized jigs with gap balancing in relation to anatomic landmarks. Knee Surg Sports Traumatol Arthrosc. 2015; 25(6):1712-1719. DOI: 10.1007/s00167-015-3836-9. View

Gao F, Ma J, Sun W, Guo W, Li Z, Wang W . Radiographic assessment of knee-ankle alignment after total knee arthroplasty for varus and valgus knee osteoarthritis. Knee. 2016; 24(1):107-115. DOI: 10.1016/j.knee.2016.09.023. View

Grassi A, Compagnoni R, Ferrua P, Zaffagnini S, Berruto M, Samuelsson K . Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc. 2018; 26(11):3206-3218. DOI: 10.1007/s00167-018-4831-8. View

Heller G, Manuguerra M, Chow R . How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain. 2017; 13:67-75. DOI: 10.1016/j.sjpain.2016.06.012. View

Inoue A, Arai Y, Nakagawa S, Inoue H, Yoshihara Y, Yamazoe S . Differences in patellofemoral alignment as a result of patellar shape in cruciate-retaining total knee arthroplasty without patellar resurfacing at a minimum three-year follow-up. Knee. 2017; 24(6):1448-1453. DOI: 10.1016/j.knee.2017.08.050. View

Ip D, Wu W, Tsang W . Comparison of two total knee prostheses on the incidence of patella clunk syndrome. Int Orthop. 2002; 26(1):48-51. PMC: 3620851. DOI: 10.1007/s00264-001-0316-2. View

Kavolus C, Hummel M, Barnett K, Jennings Jr J . Comparison of the Insall-Burstein II and NexGen legacy total knee arthroplasty systems with respect to patella complications. J Arthroplasty. 2008; 23(6):822-5. DOI: 10.1016/j.arth.2007.07.016. View

10.

Kumar N, Yadav C, Raj R, Anand S . How to interpret postoperative X-rays after total knee arthroplasty. Orthop Surg. 2014; 6(3):179-86. PMC: 6583264. DOI: 10.1111/os.12123. View

11.

Leichtle U, Wunschel M, Leichtle C, Muller O, Kohler P, Wulker N . Increased patellofemoral pressure after TKA: an in vitro study. Knee Surg Sports Traumatol Arthrosc. 2013; 22(3):500-8. DOI: 10.1007/s00167-013-2372-8. View

12.

Manning W, Ghosh K, Blain A, Longstaff L, Rushton S, Deehan D . Internal femoral component rotation adversely influences load transfer in total knee arthroplasty: a cadaveric navigated study using the Verasense device. Knee Surg Sports Traumatol Arthrosc. 2017; 26(5):1577-1585. PMC: 5907629. DOI: 10.1007/s00167-017-4640-5. View

13.

Matsumoto K, Ogawa H, Yoshioka H, Akiyama H . Postoperative Anteroposterior Laxity Influences Subjective Outcome After Total Knee Arthroplasty. J Arthroplasty. 2017; 32(6):1845-1849. DOI: 10.1016/j.arth.2016.12.043. View

14.

Nagai K, Muratsu H, Kanda Y, Tsubosaka M, Kamenaga T, Miya H . Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique. Knee Surg Sports Traumatol Arthrosc. 2018; 26(11):3474-3481. DOI: 10.1007/s00167-018-4945-z. View

15.

Prudhon J, Caton J, Aslanian T, Verdier R . How is patella height modified after total knee arthroplasty?. Int Orthop. 2017; 42(2):311-316. DOI: 10.1007/s00264-017-3539-6. View

16.

Scuderi G, Bourne R, Noble P, Benjamin J, Lonner J, Scott W . The new Knee Society Knee Scoring System. Clin Orthop Relat Res. 2011; 470(1):3-19. PMC: 3237971. DOI: 10.1007/s11999-011-2135-0. View

17.

Tanikawa H, Tada M, Harato K, Okuma K, Nagura T . Influence of Total Knee Arthroplasty on Patellar Kinematics and Patellofemoral Pressure. J Arthroplasty. 2016; 32(1):280-285. DOI: 10.1016/j.arth.2016.06.044. View

18.

Tian F, Zang X, Sun Y . Impact of knee varus and valgus deformity on alignment in lower extremities after total knee arthroplasty (TKA). Eur Rev Med Pharmacol Sci. 2018; 22(1 Suppl):83-89. DOI: 10.26355/eurrev_201807_15368. View

19.

van Duren B, Pandit H, Pechon P, Hart A, Murray D . The role of the patellar tendon angle and patellar flexion angle in the interpretation of sagittal plane kinematics of the knee after knee arthroplasty: A modelling analysis. Knee. 2018; 25(2):240-248. DOI: 10.1016/j.knee.2018.01.006. View

20.

Westerman R, Bhangoo N, James P . When and How Is Patella Tracking Best Assessed in Total Knee Arthroplasty Surgery?. J Knee Surg. 2015; 29(4):337-40. DOI: 10.1055/s-0035-1554924. View