Intraoperative medial pivot affects deep knee flexion angle and patient-reported outcomes after total knee arthroplasty.

The aim of this study was to evaluate the relationship between clinical results including patient-reported outcomes and intraoperative knee kinematic patterns after total knee arthroplasty (TKA). A cross-sectional survey of forty consecutive medial osteoarthritis patients who had a primary TKA using a CT-based navigation system was conducted. Subjects were divided into two groups based on intraoperative kinematic patterns: a medial pivot group (n = 20) and a non-medial pivot group (n = 20). Subjective outcomes with the new Knee Society Score and clinical outcomes were evaluated. The functional activities, patient satisfaction and the knee flexion angle of the medial pivot group were significantly better than those of the non-medial pivot group. An intraoperative medial pivot pattern positively influences deep knee flexion and patient-reported outcomes.

[1]  G. Scott,et al.  The Medial Rotation total knee replacement: a clinical and radiological review at a mean follow-up of six years. , 2009, The Journal of bone and joint surgery. British volume.

[2]  Masao Akagi,et al.  The functional flexion-extension axis of the knee corresponds to the surgical epicondylar axis: in vivo analysis using a biplanar image-matching technique. , 2005, The Journal of arthroplasty.

[3]  V Pinskerova,et al.  The movement of the normal tibio-femoral joint. , 2005, Journal of biomechanics.

[4]  M. Marcacci,et al.  Knee functional flexion axis in osteoarthritic patients: comparison in vivo with transepicondylar axis using a navigation system , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[5]  Wenbao Wang,et al.  Comparison of total hip and knee arthroplasty cohorts and short-term outcomes from a single-center joint registry. , 2012, The Journal of arthroplasty.

[6]  V Pinskerova,et al.  The knee in full flexion: an anatomical study. , 2009, The Journal of bone and joint surgery. British volume.

[7]  D. Dennis,et al.  In Vivo Fluoroscopic Analysis of the Normal Human Knee , 2003, Clinical orthopaedics and related research.

[8]  Naoto Endo,et al.  Three-dimensional in vivo motion analysis of normal knees employing transepicondylar axis as an evaluation parameter , 2013, Knee Surgery, Sports Traumatology, Arthroscopy.

[9]  Naoto Endo,et al.  Three-dimensional in vivo motion analysis of normal knees using single-plane fluoroscopy , 2011, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[10]  R. Brouwer,et al.  Long-term follow-up of anatomic graduated component total knee arthroplasty: a 15- to 20-year survival analysis. , 2012, The Journal of arthroplasty.

[11]  P. Noble,et al.  The New Knee Society Knee Scoring System , 2012, Clinical orthopaedics and related research.

[12]  G. Engh,et al.  Preoperative flexion. Does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty? , 1992, Clinical orthopaedics and related research.

[13]  S A Banks,et al.  In vivo kinematics of cruciate-retaining and -substituting knee arthroplasties. , 1997, The Journal of arthroplasty.

[14]  Takashi Nakamura,et al.  Analysis of the kinematics of total knee prostheses with a medial pivot design. , 2011, The Journal of arthroplasty.

[15]  A. Davis,et al.  Comparing Patient Outcomes After THA and TKA: Is There a Difference? , 2010, Clinical orthopaedics and related research.

[16]  D. Bae,et al.  Twenty-year survival analysis in total knee arthroplasty by a single surgeon. , 2012, The Journal of arthroplasty.

[17]  G. Bannister,et al.  Patient-reported outcomes after total hip and knee arthroplasty: comparison of midterm results. , 2009, The Journal of arthroplasty.

[18]  Mohamed R Mahfouz,et al.  A Multicenter Analysis of Axial Femorotibial Rotation after Total Knee Arthroplasty , 2004, Clinical orthopaedics and related research.

[19]  Mohamed R Mahfouz,et al.  Multicenter Determination of In Vivo Kinematics After Total Knee Arthroplasty , 2003, Clinical orthopaedics and related research.

[20]  H. Gill,et al.  How effective are added constraints in improving TKR kinematics? , 2007, Journal of biomechanics.

[21]  Ming-Shium Hsieh,et al.  Primitive results after medial-pivot knee arthroplasties: a minimum 5-year follow-up study. , 2010, The Journal of arthroplasty.

[22]  V. Pinskerova,et al.  Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee , 2000 .

[23]  D. Bae,et al.  Clinical outcome of total knee arthroplasty with medial pivot prosthesis a comparative study between the cruciate retaining and sacrificing. , 2011, The Journal of arthroplasty.

[24]  J. Callaghan,et al.  Durability of a Cruciate-retaining TKA With Modular Tibial Trays at 20 Years , 2013, Clinical orthopaedics and related research.

[25]  H. Labelle,et al.  The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation. , 1978, The Journal of bone and joint surgery. American volume.

[26]  Johan Bellemans,et al.  In Vivo Kinematics after a Cruciate-substituting TKA , 2010, Clinical orthopaedics and related research.

[27]  S. Banks,et al.  2003 Hap Paul Award Paper of the International Society for Technology in Arthroplasty. Design and activity dependence of kinematics in fixed and mobile-bearing knee arthroplasties. , 2004, The Journal of arthroplasty.