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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-10-2013 | Knee

Mediolateral oversizing influences pain, function, and flexion after TKA

Authors: Michel P. Bonnin, Axel Schmidt, Luca Basiglini, Nadine Bossard, Emmanuelle Dantony

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2013

Abstract

Purpose

Manufacturers of total knee arthroplasty (TKA) have introduced narrower femurs to improve bone-implant fit. However, few studies have reported the clinical consequences of mediolateral oversizing. Our hypothesis was that component oversizing negatively influences the results after TKA.

Methods

One hundred and twelve prospectively followed patients with 114 consecutive TKA (64 females and 50 males) were retrospectively assessed. The mean age of the patients was 72 years (range, 56 to 85 years). The dimensions of the femur and tibia were measured on a preoperative CT-scan and were compared with those of the implanted TKA. The influence of size variation on the clinical outcomes 1 year after surgery was assessed.

Results

Mediolateral overhang was observed in at least one area in 66 % of the femurs (84 % in females and 54 % in males) and 61 % of the tibia (81 % in females and 40 % in males). Twenty-two patients presented no overhang in any area and 16 had overhang in all studied zones. The increase in the Pain and KOOS scores were 43 ± 21 and 36 ± 18 in the patients without overhang and 31 ± 19 and 25 ± 13 in patients with overhang (p = 0.033; p = 0.032). Knee flexion was 127° ± 7 and 121° ± 11, respectively. Regression and latent class analysis showed a significant negative correlation between overall oversizing and overall outcome.

Conclusions

This study confirms that oversizing may lead to worse clinical results in TKA. The clinical consequences are that surgeons should pay attention not to oversize implants during implantation nd that oversizing should be ruled out in case of so called unexplained pain.

Level of evidence

IV.

Available only for authorised users

Barrett WP (2006) The need for gender-specific prostheses in TKA: does size make a difference? Orthopedics 29(9 Suppl):53–55

Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A (2002) Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 84(1):50–53PubMedCrossRef

Bellemans J, Carpentier K, Vandenneucker H, Vanlauwe J, Victor J (2010) The John Insall Award: both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res 468:29–36PubMedCrossRef

Bollen K (1989) Structural Equations with Latent Variables. University of Michigan, Wiley, pp 1–514

Bonnin M, Westphal M (2008) Rehabilitaton in total knee arthroplasty. In: Bonnin M, Chambat P (eds) Osteoarthritis of the knee. Springer, Paris, France, pp 225–238CrossRef

Bonnin MP, Saffarini M, Mercier PE, Laurent JR, Carrillon Y (2011) Is the anterior tibial tuberosity a reliable rotational landmark for the tibial component in total knee arthroplasy? J Arthroplasty 26(2):260–267PubMedCrossRef

Booth RE Jr (2006) The gender-specific (female) knee. Orthopedics 29(9):768–769PubMed

Booth RE Jr (2006) Sex and the total knee: gender-sensitive designs. Orthopedics 29(9):836–838PubMed

Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63PubMedCrossRef

10.

Bourne RB, McCalden RW, MacDonald SJ, Mokete L, Guerin J (2007) Influence of patient factors on TKA outcomes at 5 to 11 years followup. Clin Orthop Relat Res 464:27–31PubMed

11.

Charlton WP, St John TA, Ciccotti MG, Harrison N, Schweitzer M (2002) Differences in femoral notch anatomy between men and women: a magnetic resonance imaging study. Am J Sports Med 30(3):329–333PubMed

12.

Chin KR, Dalury DF, Zurakowski D, Scott RD (2002) Intraoperative measurements of male and female distal femurs during primary total knee arthroplasty. J Knee Surg 15(4):213–217PubMed

13.

Clarius M, Hauck C, Seeger JB, Pritsch M, Merle C, Aldinger PR (2010) Correlation of positioning and clinical results in Oxford UKA. Int Orthop 34(8):1145–1151PubMedCrossRef

14.

Clarke HD, Hentz JG (2008) Restoration of femoral anatomy in TKA with unisex and gender-specific components. Clin Orthop Relat Res 466:2711–2716PubMedCrossRef

15.

Conley S, Rosenberg A, Crowninshield R (2007) The female knee: anatomic variations. J Am Acad Orthop Surg 15(Suppl 1):S31–S36PubMed

16.

Daluga D, Lombardi AV Jr, Mallory TH, Vaughn BK (1991) Knee manipulation following total knee arthroplasty. Analysis of prognostic variables. J Arthroplasty 6(2):119–128PubMedCrossRef

17.

Dalury DF, Mason JB, Murphy JA, Adams MJ (2009) Analysis of the outcome in male and female patients using a unisex total knee replacement system. J Bone Joint Surg Br 91(3):357–360PubMed

18.

Elson D, Brenkel I (2006) Predicting pain after total knee arthroplasty. J Arthroplasty 21(7):1047–1053PubMedCrossRef

19.

Emerson RH Jr, Martinez J (2008) Men versus women: does size matter in total knee arthroplasty? Clin Orthop Relat Res 466:2706–2710PubMedCrossRef

20.

Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, Mangione CM (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum 51(1):100–109PubMedCrossRef

21.

Greenberg RL, Kenna RV, Hungerford DS, Krackow KA (1984) Instrumentation for total knee arthroplasty. In: Hungerford DS, Krackow KA, Kenna RV (eds) Total knee arthroplasty: a comprehensive approach. Williams & Wilkins, Baltimore, Maryland, pp 35–70

22.

Greene KA (2007) Gender-specific design in total knee arthroplasty. J Arthroplasty 22(7 Suppl 3):27–31PubMedCrossRef

23.

Harwin SF, Greene KA, Hitt K (2007) Early experience with a new total knee implant: maximizing range of motion and function with gender-specific sizing. Surg Technol Int 16:199–205PubMed

24.

Hitt K, Shurman JR II, Greene K, McCarthy J, Moskal J, Hoeman T, Mont MA (2003) Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am 85-A(Suppl 4):115–122PubMed

25.

Ho WP, Cheng CK, Liau JJ (2006) Morphometrical measurements of resected surface of femurs in Chinese knees: correlation to the sizing of current femoral implants. Knee 13(1):12–14PubMedCrossRef

26.

Insall JN (1993) Surgical techniques and instrumentation in total knee arthroplasty. In: Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti PA (eds) Surgery of the Knee, vol 2. Churchill Livingstone, Edinburgh, New york, pp 739–804

27.

Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME (2001) The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med 161(3):454–460PubMedCrossRef

28.

Lesh ML, Schneider DJ, Deol G, Davis B, Jacobs CR, Pellegrini VD Jr (2000) The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am 82-A (8):1096–1101

29.

Liebs TR, Herzberg W, Roth-Kroeger AM, Ruther W, Hassenpflug J (2011) Women recover faster than men after standard knee arthroplasty. Clin Orthop Relat Res 469:2855–2865PubMedCrossRef

30.

Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 86-A(10):2179–2186PubMed

31.

Lo CS, Wang SJ, Wu SS (2003) Knee stiffness on extension caused by an oversized femoral component after total knee arthroplasty: a report of two cases and a review of the literature. J Arthroplasty 18(6):804–808PubMedCrossRef

32.

Lonner JH, Jasko JG, Thomas BS (2008) Anthropomorphic differences between the distal femora of men and women. Clin Orthop Relat Res 466:2724–2729PubMedCrossRef

33.

Lord SJ, Gebski VJ, Keech AC (2004) Multiple analyses in clinical trials: sound science or data dredging? Med J Aust 181(8):452–454PubMed

34.

Lotke PA (1995) Primary total knees: standard principles and techniques. In: Lotke PA (ed) Knee arthroplaty. Master techniques in orthopaedic surgery. Raven Press, New York, pp 65–92

35.

MacDonald SJ, Charron KD, Bourne RB, Naudie DD, McCalden RW, Rorabeck CH (2008) The John Insall Award: gender-specific total knee replacement: prospectively collected clinical outcomes. Clin Orthop Relat Res 466:2612–2616PubMedCrossRef

36.

Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 92(5):1115–1121PubMedCrossRef

37.

Merchant AC, Arendt EA, Dye SF, Fredericson M, Grelsamer RP, Leadbetter WB, Post WR, Teitge RA (2008) The female knee: anatomic variations and the female-specific total knee design. Clin Orthop Relat Res 466:3059–3065PubMedCrossRef

38.

Matziolis G, Hube R, Perka C, Matziolis D (2012) Increased flexion position of the femoral component reduces the flexion gap in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20(6):1092–1096PubMedCrossRef

39.

Minoda Y, Kobayashi A, Iwaki H, Mitsuhiko I, Kadoya Y, Ohashi H, Takaoka K, Nakamura H (2010) The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18(6):718–722PubMedCrossRef

40.

Murshed KA, Cicekcibasi AE, Karabacakoglu A, Seker M, Ziylan T (2005) Distal femur morphometry: a gender and bilateral comparative study using magnetic resonance imaging. Surg Radiol Anat 27(2):108–112PubMedCrossRef

41.

O’Brien PC, Fleming TR (1979) A multiple testing procedure for clinical trials. Biometrics 35(3):549–556PubMedCrossRef

42.

Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson JN, Roos EM, Guillemin F, Maillefert JF (2008) Cross-cultural adaptation and validation of the French version of the knee injury and osteoarthritis outcome score (KOOS) in knee osteoarthritis patients. Osteoarthr Cartil 16(4):423–428PubMedCrossRef

43.

Pagnano MW, Hanssen AD, Lewallen DG, Stuart MJ (1998) Flexion instability after primary posterior cruciate retaining total knee arthroplasty. Clin Orthop Relat Res 356:39–46PubMedCrossRef

44.

Parratte S, Pagnano MW (2008) Instability after total knee arthroplasty. Instr Course Lect 57:295–304PubMed

45.

Parsley BS, Bertolusso R, Harrington M, Brekke A, Noble PC (2010) Influence of gender on age of treatment with TKA and functional outcome. Clin Orthop Relat Res 468:1759–1764PubMedCrossRef

46.

Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE (1996) Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop Relat Res 331:35–46PubMedCrossRef

47.

Ritter M, Wing J, Berend M, Davis K, Meding J (2008) The clinical effect of gender on outcome of total knee arthroplasty. J Arthroplasty 23(3):331–336PubMedCrossRef

48.

Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P (2007) Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Res Manag 12(3):185–194PubMed

49.

Royston PaA DG (1994) Regression using fractional polynomials of continuous covariates : parsimonious parametric modelling. Appl Stat 43:429–467CrossRef

50.

Schwab JH, Haidukewych GJ, Hanssen AD, Jacofsky DJ, Pagnano MW (2005) Flexion instability without dislocation after posterior stabilized total knees. Clin Orthop Relat Res 440:96–100PubMedCrossRef

51.

Singh JA, Gabriel S, Lewallen D (2008) The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res 466:2717–2723PubMedCrossRef

52.

Watkins MA, Riddle DL, Lamb RL, Personius WJ (1991) Reliability of goniometric measurements and visual estimates of knee range of motion obtained in a clinical setting. Phys Ther 71(2):90–96PubMed

53.

Zalzal P, Backstein D, Gross AE, Papini M (2006) Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses. J Arthroplasty 21(5):737–743PubMedCrossRef

Title: Mediolateral oversizing influences pain, function, and flexion after TKA
Authors: Michel P. Bonnin
Axel Schmidt
Luca Basiglini
Nadine Bossard
Emmanuelle Dantony
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2443-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mediolateral oversizing influences pain, function, and flexion after TKA

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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