Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2019

01-05-2019 | Knee

Over-voluming predicted by pre-operative planning in 24% of total knee arthroplasty

Authors: Simon Marmor, Eric Renault, Jeremy Valluy, Mo Saffarini

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2019

Login to get access

Abstract

Purpose

Numerous studies demonstrated that prosthetic overhang and over-sizing cause pain and stiffness following total knee arthroplasty (TKA), but none considered volume changes within the joint capsule. This study was designed to investigate differences in volumes of resected bone compared to implanted components in TKA, and to determine the incidence and factors related to ‘over-voluming’.

Methods

Three-dimensional reconstructions were created from 100 magnetic resonance imaging scans taken to design patient-specific instruments for TKA. The preoperative simulations were used to calculate the volume ratio (VR) by dividing volume of planned components by that of planned bone resections. Uni- and multi-variable linear regressions were performed to determine associations between ‘over-voluming’ (VR > 1.0) and gender, implant size and version (standard versus narrow), osteophytes, resection levels, external rotation of the femoral component, hip–knee–ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA).

Results

The overall implant/bone volume ratio was 0.91 ± 0.11 (range 0.63–1.16) with ‘over-voluming’ observed in 24 knees. Multi-variable regression confirmed over-voluming to be associated with lower mLDFA (OR 0.66; CI 0.45–0.93; p = 0.026) and extensive osteophytes (OR 0.14; CI 0.03–0.61; p = 0.014), but not HKA angle (OR 0.98; CI 0.76–1.26; p = n.s.).

Conclusions

Over-voluming was observed in 24% of knees, in which the implant volume exceeded the resected volume by up to 16%. Over-voluming was associated with intra-articular femoral valgus (low mLDFA), but not directly associated with tibial deformity (mMPTA) or HKA angle. Over-voluming could be associated with prosthetic overhang or excessive tensions within the joint capsule, and, therefore, contribute to unexplained pain and stiffness following TKA.

Level of evidence

IV, Retrospective cohort study.
Literature
1.
Barrett DS, Cobb AG, Bentley G (1991) Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Jt Surg Br 73(1):53–56CrossRef
2.
Bonnin MP, de Kok A, Verstraete M, Van Hoof T, Van Der Straten C, Saffarini M, Victor J (2017) Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc 25(6):1720–1730CrossRefPubMed
3.
Bonnin MP, Saffarini M, Bossard N, Dantony E, Victor J (2016) Morphometric analysis of the distal femur in total knee arthroplasty and native knees. Bone Jt J 98-b(1):49–57CrossRef
4.
Bonnin MP, Saffarini M, Nover L, van der Maas J, Haeberle C, Hannink G, Victor J (2017) External rotation of the femoral component increases asymmetry of the posterior condyles. Bone Jt J 99-b(7):894–903CrossRef
5.
Bonnin MP, Saffarini M, Shepherd D, Bossard N, Dantony E (2016) Oversizing the tibial component in TKAs: incidence, consequences and risk factors. Knee Surg Sports Traumatol Arthrosc 24(8):2532–2540CrossRefPubMed
6.
Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E (2013) Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 21(10):2314–2324CrossRefPubMedPubMedCentral
7.
Eberbach H, Mehl J, Feucht MJ, Bode G, Sudkamp NP, Niemeyer P (2017) Geometry of the valgus knee: contradicting the dogma of a femoral-based deformity. Am J Sports Med 45(4):909–914CrossRefPubMed
8.
Gibon E, Goodman MJ, Goodman SB (2017) Patient satisfaction after total knee arthroplasty: a realistic or imaginary goal? Orthop Clin N Am 48(4):421–431CrossRef
9.
Gibon E, Mouton A, Passeron D, Le Strat V, Graff W, Marmor S (2014) Doctor, what does my knee arthroplasty weigh? J Arthroplasty 29(11):2091–2094CrossRefPubMed
10.
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32(12):3854–3860CrossRefPubMed
11.
Hatayama K, Terauchi M, Saito K, Higuchi H (2017) Does residual varus alignment cause increasing varus laxity at a minimum of five years after total knee arthroplasty? J Arthroplasty 32(6):1808–1813CrossRefPubMed
12.
13.
Kawahara S, Matsuda S, Fukagawa S, Mitsuyasu H, Nakahara H, Higaki H, Shimoto T, Iwamoto Y (2012) Upsizing the femoral component increases patellofemoral contact force in total knee replacement. J Bone Jt Surg Br 94(1):56–61CrossRef
14.
15.
Kohn MD, Sassoon AA, Fernando ND (2016) Classifications in brief: Kellgren–Lawrence classification of osteoarthritis. Clin Orthop Relat Res 474(8):1886–1893CrossRefPubMedPubMedCentral
16.
Le DH, Goodman SB, Maloney WJ, Huddleston JI (2014) Current modes of failure in TKA: infection, instability, and stiffness predominate. Clin Orthop Relat Res 472(7):2197–2200CrossRefPubMedPubMedCentral
17.
Lombardi AV Jr, Berend KR, Adams JB (2014) Why knee replacements fail in 2013: patient, surgeon, or implant? Bone Jt J 96-b(11 Supple A):101–104CrossRef
18.
Magnussen RA, Weppe F, Demey G, Servien E, Lustig S (2011) Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res 469(12):3443–3450CrossRefPubMedPubMedCentral
19.
Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Jt Surg Am 92(5):1115–1121CrossRef
20.
Manrique J, Gomez MM, Parvizi J (2015) Stiffness after total knee arthroplasty. J Knee Surg 28(2):119–126CrossRefPubMed
21.
Meneghini RM, Grant TW, Ishmael MK, Ziemba-Davis M (2017) Leaving residual varus alignment after total knee arthroplasty does not improve patient outcomes. J Arthroplasty 32(9s):S171–S176CrossRefPubMed
22.
Mihalko W, Fishkin Z, Krackow K (2006) Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. Clin Orthop Relat Res 449:283–287CrossRefPubMed
23.
Nishida K, Matsumoto T, Takayama K, Ishida K, Nakano N, Matsushita T, Kuroda R, Kurosaka M (2017) Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 25(11):3488–3494CrossRefPubMed
24.
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin N Am 25(3):425–465
25.
Pugh L, Ruel A, Lipman J, Wright T, Gessell M, Westrich G (2013) Reduction in bone volume resection with a newer posterior stabilized total knee arthroplasty design. HSS J 9(2):157–160CrossRefPubMedPubMedCentral
26.
Seah RB, Lim WSR, Lo NN, Yew AKS, Chong HC, Yeo SJ (2017) Unexplained pain post total knee arthroplasty with an oxford knee score>/=20 at 6 months predicts good 2-year outcome. J Arthroplasty 32(3):807–810CrossRefPubMed
27.
Sorin G, Pasquier G, Drumez E, Arnould A, Migaud H, Putman S (2016) Reproducibility of digital measurements of lower-limb deformity on plain radiographs and agreement with CT measurements. Orthop Traumatol Surg Res 102(4):423–428CrossRefPubMed
28.
Vanlommel L, Vanlommel J, Claes S, Bellemans J (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21(10):2325–2330CrossRefPubMed
29.
Zaffagnini S, Bignozzi S, Saffarini M, Colle F, Sharma B, Kinov PS, Marcacci M, Dejour D (2014) Comparison of stability and kinematics of the natural knee versus a PS TKA with a ‘third condyle’. Knee Surg Sports Traumatol Arthrosc 22(8):1778–1785CrossRefPubMed
Metadata
Title
Over-voluming predicted by pre-operative planning in 24% of total knee arthroplasty
Authors
Simon Marmor
Eric Renault
Jeremy Valluy
Mo Saffarini
Publication date
01-05-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4998-z

Other articles of this Issue 5/2019

Knee Surgery, Sports Traumatology, Arthroscopy 5/2019 Go to the issue

Knee

Dual-energy CT and ceramic or titanium prostheses material reduce CT artifacts and provide superior image quality of total knee arthroplasty

KNEE

Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion

Knee

The native coronal orientation of tibial plateaus may limit the indications to perform a kinematic aligned total knee arthroplasty

Knee

Blackburne–Peel ratio predicts patients’ outcomes after total knee arthroplasty

Knee

Due to great variability fixed HKS angle for alignment of the distal cut leads to a significant error in coronal TKA orientation

KNEE

Two-dimensional measurement misidentifies alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements