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Published in: Journal of Orthopaedic Surgery and Research 1/2014

Open Access 01-12-2014 | Technical Note

Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation

Authors: Pier Francesco Indelli, Massimiliano Marcucci, Angelo Graceffa, Sophie Charlton, Leonardo Latella

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2014

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Abstract

Background

Intercondylar femoral bone removal during posterior stabilized (PS) total knee arthroplasty (TKA) makes many cruciate substituting implant designs less appealing than cruciate retaining implants. Bone stock conservation is considered fundamental in the prevision of future revision surgeries. The purpose of this study was to compare the quantity of intercondylar bone removable during PS housing preparation using three contemporary PS TKA instrumentations.

Method

We compared different box cutting jigs which were utilized for the PS housing of three popular PS knee prostheses. The bone removal area from every PS box cutting jig was three-dimensionally measured.

Results

Independently from the implant size, the cutting jig for a specific PS TKA always resected significantly less bone than the others: this difference was statistically significant, especially for small- to medium-sized total knee femoral components.

Conclusion

This study does not establish a clinical relevance of removing more or less bone at primary TKA, but suggests that if a PS design is indicated, it is preferable to select a model which possibly resects less distal femoral bone.
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Literature
1.
go back to reference Indelli PF, Aglietti P, Buzzi R, Baldini A: The Insall-Burstein II prosthesis: a 5- to 9-year follow-up study in osteoarthritic knees. J Arthroplasty. 2002, 17 (5): 544-549. 10.1054/arth.2002.32186.CrossRefPubMed Indelli PF, Aglietti P, Buzzi R, Baldini A: The Insall-Burstein II prosthesis: a 5- to 9-year follow-up study in osteoarthritic knees. J Arthroplasty. 2002, 17 (5): 544-549. 10.1054/arth.2002.32186.CrossRefPubMed
2.
go back to reference Wragg R, Khan RJZ, Damasena ITW: A comparison of bone loss at total knee replacement: posterior stabilized versus cruciate retaining. J Orthopaedics. 2012, 9 (1): e1- Wragg R, Khan RJZ, Damasena ITW: A comparison of bone loss at total knee replacement: posterior stabilized versus cruciate retaining. J Orthopaedics. 2012, 9 (1): e1-
3.
go back to reference Becher C, Heyse TJ, Kron N, Ostermeier S, Hurschler C, Schofer MD, Fuchs-Winkelmann S, Tibesku CO: Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro. Knee Surg Sports Traumatol Arthrosc. 2009, 17 (10): 1159-1165. 10.1007/s00167-009-0768-2.CrossRefPubMed Becher C, Heyse TJ, Kron N, Ostermeier S, Hurschler C, Schofer MD, Fuchs-Winkelmann S, Tibesku CO: Posterior stabilized TKA reduce patellofemoral contact pressure compared with cruciate retaining TKA in vitro. Knee Surg Sports Traumatol Arthrosc. 2009, 17 (10): 1159-1165. 10.1007/s00167-009-0768-2.CrossRefPubMed
4.
go back to reference Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB: Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris. J Bone Joint Surg Am. 2001, 83-A (3): 390-397.PubMed Puloski SK, McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB: Tibial post wear in posterior stabilized total knee arthroplasty. An unrecognized source of polyethylene debris. J Bone Joint Surg Am. 2001, 83-A (3): 390-397.PubMed
5.
go back to reference Indelli PF, Marcucci M, Pipino G, Charlton S, Carulli C, Innocenti M: The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty. Arch Orthop Trauma Surg. 2013, 134: 59-64. 10.1007/s00402-013-1877-4. [Epub ahead of print]CrossRefPubMed Indelli PF, Marcucci M, Pipino G, Charlton S, Carulli C, Innocenti M: The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty. Arch Orthop Trauma Surg. 2013, 134: 59-64. 10.1007/s00402-013-1877-4. [Epub ahead of print]CrossRefPubMed
7.
go back to reference Bono JV, Scott RD (Eds): Revision total knee arthroplasty. 2005, Springer, New York Bono JV, Scott RD (Eds): Revision total knee arthroplasty. 2005, Springer, New York
8.
go back to reference Huten D: Femorotibial bone loss during revision total knee arthroplasty. Orthop Traumatol Surg Res. 2013, 99S: S22-S33. 10.1016/j.otsr.2012.11.009.CrossRef Huten D: Femorotibial bone loss during revision total knee arthroplasty. Orthop Traumatol Surg Res. 2013, 99S: S22-S33. 10.1016/j.otsr.2012.11.009.CrossRef
9.
go back to reference Pagnano MW, Cushner FD, Scott WN: The role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg. 1998, 6: 176-187.PubMed Pagnano MW, Cushner FD, Scott WN: The role of the posterior cruciate ligament in total knee arthroplasty. J Am Acad Orthop Surg. 1998, 6: 176-187.PubMed
10.
go back to reference Joglekar S, Gioe TJ, Yoon P, Schwartz MH: Gait analysis comparison of cruciate retaining and substituting TKA following PCL sacrifice. Knee. 2012, 19 (4): 279-285. 10.1016/j.knee.2011.05.003.CrossRefPubMed Joglekar S, Gioe TJ, Yoon P, Schwartz MH: Gait analysis comparison of cruciate retaining and substituting TKA following PCL sacrifice. Knee. 2012, 19 (4): 279-285. 10.1016/j.knee.2011.05.003.CrossRefPubMed
11.
go back to reference Zimlitski M, Bhokray KK, Rajan BM, Nachkebia L, Loria G: Total knee arthroplasty with NexGen legacy posterior stabilized. Georgian Med News. 2011, 199: 14-20.PubMed Zimlitski M, Bhokray KK, Rajan BM, Nachkebia L, Loria G: Total knee arthroplasty with NexGen legacy posterior stabilized. Georgian Med News. 2011, 199: 14-20.PubMed
12.
go back to reference Li G, Zayontz S, Most E, Otterberg E, Sabbag K, Rubash HE: Cruciate-retaining and cruciate-substituting total knee arthroplasty: an in vitro comparison of the kinematics under muscle loads. J Arthroplasty. 2001, 16 (8 Suppl 1): 150-156. 10.1054/arth.2001.28367.CrossRefPubMed Li G, Zayontz S, Most E, Otterberg E, Sabbag K, Rubash HE: Cruciate-retaining and cruciate-substituting total knee arthroplasty: an in vitro comparison of the kinematics under muscle loads. J Arthroplasty. 2001, 16 (8 Suppl 1): 150-156. 10.1054/arth.2001.28367.CrossRefPubMed
13.
go back to reference Lee SM, Seong SC, Lee S, Choi WC, Lee MC: Outcomes of the different types of total knee arthroplasty with the identical femoral geometry. Knee Surg Relat Res. 2012, 24 (4): 214-220. 10.5792/ksrr.2012.24.4.214.PubMedCentralCrossRefPubMed Lee SM, Seong SC, Lee S, Choi WC, Lee MC: Outcomes of the different types of total knee arthroplasty with the identical femoral geometry. Knee Surg Relat Res. 2012, 24 (4): 214-220. 10.5792/ksrr.2012.24.4.214.PubMedCentralCrossRefPubMed
14.
go back to reference Hanusch B, Lou TN, Warriner G, Hui A, Gregg P: Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomized controlled trial. Int Orthop. 2010, 34: 349-354. 10.1007/s00264-009-0901-3.PubMedCentralCrossRefPubMed Hanusch B, Lou TN, Warriner G, Hui A, Gregg P: Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomized controlled trial. Int Orthop. 2010, 34: 349-354. 10.1007/s00264-009-0901-3.PubMedCentralCrossRefPubMed
15.
go back to reference Ranawat AS, Ranawat CS, Slamin JE, Dennis DA: Patellar crepitation in the P.F.C. sigma total knee system. Orthopedics. 2006, 29 (9 Suppl): 68-70. Ranawat AS, Ranawat CS, Slamin JE, Dennis DA: Patellar crepitation in the P.F.C. sigma total knee system. Orthopedics. 2006, 29 (9 Suppl): 68-70.
16.
go back to reference Stiehl JB, Dennis DA, Komistek RD, Keblish PA: In vivo kinematic comparison of posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg. 2000, 13 (1): 13-18.PubMed Stiehl JB, Dennis DA, Komistek RD, Keblish PA: In vivo kinematic comparison of posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty. Am J Knee Surg. 2000, 13 (1): 13-18.PubMed
17.
go back to reference Kievit AJ, Schafroth MU, Blankevoort L, Sierevelt IN, van Dijk CN, van Geenen RC: Early experience with the Vanguard complete total knee system: 2-7 years of follow-up and risk factors for revision. J Arthroplasty. 2013, 29: 348-354. 10.1016/j.arth.2013.05.018. [Epub ahead of print]CrossRefPubMed Kievit AJ, Schafroth MU, Blankevoort L, Sierevelt IN, van Dijk CN, van Geenen RC: Early experience with the Vanguard complete total knee system: 2-7 years of follow-up and risk factors for revision. J Arthroplasty. 2013, 29: 348-354. 10.1016/j.arth.2013.05.018. [Epub ahead of print]CrossRefPubMed
18.
go back to reference Moynihan A, Varadarajan K, Hanson GR, Park S, Nha KW, Suggs JF, Johnson T, Li G: In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty. Int Orthop. 2010, 34 (4): 497-503. 10.1007/s00264-009-0777-2.PubMedCentralCrossRefPubMed Moynihan A, Varadarajan K, Hanson GR, Park S, Nha KW, Suggs JF, Johnson T, Li G: In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty. Int Orthop. 2010, 34 (4): 497-503. 10.1007/s00264-009-0777-2.PubMedCentralCrossRefPubMed
19.
go back to reference Seon JK, Park JK, Shin YJ, Seo HY, Lee KB, Song EK: Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs. Knee Surg Sports Traumatol Arthrosc. 2011, 19 (12): 2016-2022. 10.1007/s00167-011-1434-z.CrossRefPubMed Seon JK, Park JK, Shin YJ, Seo HY, Lee KB, Song EK: Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs. Knee Surg Sports Traumatol Arthrosc. 2011, 19 (12): 2016-2022. 10.1007/s00167-011-1434-z.CrossRefPubMed
20.
go back to reference Haas SB, Nelson CL, Laskin RS: Posterior stabilized knee arthroplasty: an assessment of bone resection. Knee. 2000, 7: 25-29. 10.1016/S0968-0160(99)00038-1.CrossRef Haas SB, Nelson CL, Laskin RS: Posterior stabilized knee arthroplasty: an assessment of bone resection. Knee. 2000, 7: 25-29. 10.1016/S0968-0160(99)00038-1.CrossRef
Metadata
Title
Primary posterior stabilized total knee arthroplasty: analysis of different instrumentation
Authors
Pier Francesco Indelli
Massimiliano Marcucci
Angelo Graceffa
Sophie Charlton
Leonardo Latella
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2014
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-014-0054-y

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