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Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty? A single centre study on two hundred and ninety seven patients

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Abstract

Purpose

Total knee arthroplasty (TKA) is a cost-effective surgery with a survival rate higher than 90% after 15 years. Nevertheless, patients are unsatisfied in more than 15% of cases. Medial pivot (MP) prosthetic designs were introduced in late 90’s with the aim to reproduce natural knee kinematics. The purpose of this study is to evaluate the survivorship and clinical outcomes of a novel design of MP knee with a minimum follow-up of five years.

Methods

This is a retrospective review of all patients who underwent primary TKA using the K-Mod dynamic congruence implant (Gruppo Bioimpianti, Peschiera Borromeo, Milan, Italy) between 2012 and 2013 at a single institution. A total of 339 patients (351 knees) were included with a mean age of 74 years (range 41–89). The Knee Society score, the global range of movement, the Western Ontario and McMaster Universities Osteoarthritis score, Forgotten Joint score, and the short-term form 12 health survey were collected. FJS and SF-12 were collected only post-operatively. Radiographic outcomes were evaluated according to the Knee Society’s roentgenographic evaluation system. Kaplan-Meyer (KM) curves were performed to evaluate implant survivorship. A two-tailed paired t test was performed to evaluate the differences between pre-operative and post-operative score.

Results

A total 297 patients (315 knees) were available for clinical and radiographic analysis, and the mean follow-up was 66.4 months. A total of 17 patients (17 knees 5.4%) experienced a post-operative complication, and a reoperation was performed in five patients (5 knees 1.6%). Four patients had a periprosthetic joint infection, and two patients had a post-traumatic periprosthetic femoral fracture. The KM survivorship at five years was 98.2% (95% CI 0.96 to 0.99) for revision for any reason. There was a statistically significant improvement (p < 0.05) in all the objective and subjective outcomes measured.

Conclusion

The K-Mod dynamic congruence design has shown an excellent clinical, radiographic, and patient-reported outcome in primary TKAs.

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References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785

    Article  Google Scholar 

  2. Vaishya R, Pariyo GB, Agarwal AK, Vijay V (2016) Non-operative management of osteoarthritis of the knee joint. J Clin Orthop Trauma 7(3):170–176. https://doi.org/10.1016/j.jcot.2016.05.005

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mahendira L, Jones C, Papachristos A, Waddell J, Rubin L (2019) Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis. Int Orthop (2019). https://doi.org/10.1007/s00264-019-04405-y

    Article  Google Scholar 

  4. Australian Orthopeaedic Association National Joint Replacement Registry (2018) 2018 annual report https://aoanjrr.sahmri.com/annual-reports-2018

  5. Gunaratne R, Pratt DN, Banda J et al (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplast 32(12):3854–3860. https://doi.org/10.1016/j.arth.2017.07.021

    Article  Google Scholar 

  6. Liebensteiner M, Wurm A, Gamper D et al (2018) Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse. Int Orthop (2018). https://doi.org/10.1007/s00264-018-4185-3

    Article  Google Scholar 

  7. Lützner J, Kirschner S et al (2012) Patients with no functional improvement after total knee arthroplasty show different kinematics. Int Orthop 36(9):1841–1847. https://doi.org/10.1007/s00264-012-1584-8

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fritzsche H, Beyer F, Postler A et al (2018) Different intraoperative kinematics, stability, and range of motion between cruciate-substituting ultracongruent and posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26(5):1465–1470. https://doi.org/10.1007/s00167-017-4427-8

    Article  PubMed  Google Scholar 

  9. Núñez-Cortés R, Chamorro C, Ortega-Palavecinos M, Mattar G, Paredes O, Besoaín-Saldaña Á, Cruz-Montecinos C (2019, 2019) Social determinants associated to chronic pain after total knee arthroplasty. Int Orthop. https://doi.org/10.1007/s00264-019-04370-6

    Article  Google Scholar 

  10. Arauz P, Peng Y, Kwon YM (2018) Knee motion symmetry was not restored in patients with unilateral bi-cruciate retaining total knee arthroplasty-in vivo three-dimensional kinematic analysis. Int Orthop 42(12):2817–2823. https://doi.org/10.1007/s00264-018-3986-8

    Article  PubMed  Google Scholar 

  11. Freeman MA, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38(2):197–208

    Article  CAS  Google Scholar 

  12. Blaha JD (2002) A medial pivot geometry. Orthopedics. 25(9):963–964

    PubMed  Google Scholar 

  13. Macheras GA, Galanakos SP, Lepetsos P, Anastasopoulos PP, Papadakis SA (2017) A long term clinical outcome of the medial pivot knee arthroplasty system. Knee 24(2):447–453. https://doi.org/10.1016/j.knee.2017.01.008

    Article  PubMed  Google Scholar 

  14. Chinzei N, Ishida K, Matsumoto T, Kuroda Y, Kitagawa A, Kuroda R, Akisue T, Nishida K, Kurosaka M, Tsumura N (2014) Evaluation of patellofemoral joint in ADVANCE medial-pivot total knee arthroplasty. Int Orthop 38(3):509–515. https://doi.org/10.1007/s00264-013-2043-x

    Article  PubMed  Google Scholar 

  15. Ishida K, Matsumoto T, Tsumura N, Chinzei N, Kitagawa A, Kubo S, Chin T, Iguchi T, Akisue T, Nishida K, Kurosaka M, Kuroda R (2012) In vivo comparisons of patellofemoral kinematics before and after ADVANCE Medial-Pivot total knee arthroplasty. Int Orthop. 36(10):2073–2077. https://doi.org/10.1007/s00264-012-1634-2

    Article  PubMed  PubMed Central  Google Scholar 

  16. World Medical Association (2013) World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310(20):2191–2194. https://doi.org/10.1001/jama.2013.281053

    Article  CAS  Google Scholar 

  17. Cacciola G, De Meo F, Cavaliere P (2018) Mechanical and elution properties of G3 low viscosity bone cement loaded up to three antibiotics. J Orthop 15(4):1004–1007. https://doi.org/10.1016/j.jor.2018.08.035

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cacciola G, De Meo F, Cavaliere P (2019) Does Negative Pressure Intrusion Cementing Technique Improve the cement penetration under the tibial component? A comparative retrospective study. J Orthop. (Accepted Article) https://doi.org/10.1016/j.jor.2019.11.025

  19. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    Google Scholar 

  20. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee injury and osteoarthritis outcome score (KOOS)--development of a self-administered outcome measure. J Orthop sports Phys Ther 28(2):88–96

    Article  CAS  Google Scholar 

  21. Behrend H, Giesinger K, Giesinger JM, Kuster MS (2012) The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 227(3):430–436.e1. https://doi.org/10.1016/j.arth.2011.06.035

    Article  Google Scholar 

  22. Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. MedCare. 34(3):220–233

    Google Scholar 

  23. Ewald FC (1989) The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12

    Google Scholar 

  24. Murray DW, Carr AJ, Bulstrode C (1993) Survival analysis of joint replacements. J Bone Joint Surg Br 75(5):697–704

    Article  CAS  Google Scholar 

  25. Choi NY, In Y, Bae JH, Do JH, Chung SJ, Koh IJ (2017) Are midterm patient-reported outcome measures between rotating-platform Mobile-bearing prosthesis and medial-pivot prosthesis different? A minimum of 5-year follow-up study. J Arthroplast 32(3):824–829. https://doi.org/10.1016/j.arth.2016.08.028

    Article  Google Scholar 

  26. Katchky AM, Jones CW, Walter WL, Shimmin AJ (2019) Medial ball and socket total knee arthroplasty. Bone Joint J 101-B(1_Supple_A):59–65. https://doi.org/10.1302/0301620X.101B1.BJJ-2018-0434.R1

  27. Rouquette L, Erivan R, Pereira B, Boisgard S, Descamps S, Villatte G (2019) Tibiofemoral dislocation after primary total knee arthroplasty: a systematic review. Int Orthop 43(7):1599–1609. https://doi.org/10.1007/s00264-019-04287-0

    Article  PubMed  Google Scholar 

  28. Fitch DA, Sedacki K, Yang Y (2014) Mid- to long-term outcomes of a medial-pivot system for primary total knee replacement: a systematic review and meta-analysis. Bone Joint Res 3(10):297–304. https://doi.org/10.1302/2046-3758.310.2000290

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. National Joint Registry for England, Wales, Northern Island and the Isle of Man (2018) 15th annual report. https://www.hqip.org.uk/resource/national-joint-registry-15th-annual-report-2018/#.XZYMLudKjxg

  30. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE (2018) Patient satisfaction after total knee replacement: a systematic review. HSS J 14(2):192–201. https://doi.org/10.1007/s11420-018-9614-8

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schmidt R, Ogden S, Blaha JD, Alexander A, Fitch DA, Barnes CL (2014) Midterm clinical and radiographic results of the medial pivot total knee system. Int Orthop. 38(12):2495–2498. https://doi.org/10.1007/s00264-014-2444-5

    Article  PubMed  Google Scholar 

  32. Behrend H, Zdravkovic V, Giesinger J, Giesinger K (2016) Factors predicting the forgotten joint score after total knee arthroplasty. J Arthroplast 31(9):1927–1932. https://doi.org/10.1016/j.arth.2016.02.035

    Article  Google Scholar 

  33. Ferreira MC, Silva G, Zidan FF, Franciozi CE, Luzo MVM, Abdalla RJ (2018) Forgotten joint score - Portuguese translation and cultural adaptation of the instrument of evaluation for hip and knee arthroplasties. Rev Bras Ortop 53(2):221–225. https://doi.org/10.1016/j.rboe.2018.02.006

    Article  PubMed  PubMed Central  Google Scholar 

  34. Robinson PG, Rankin CS, Lavery J, Anthony I, Blyth M, Jones B (2018) The validity and reliability of the modified forgotten joint score. J Orthop 15(2):480–485. https://doi.org/10.1016/j.jor.2018.03.029

    Article  PubMed  PubMed Central  Google Scholar 

  35. Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ (2018) A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplast 33(5):1379–1383. https://doi.org/10.1016/j.arth.2017.11.049

    Article  Google Scholar 

  36. Kamenaga T, Muratsu H, Kanda Y, Miya H, Kuroda R, Matsumoto T (2018) The influence of postoperative knee stability on patient satisfaction in cruciate-retaining total knee arthroplasty. J Arthroplast 33(8):2475–2479. https://doi.org/10.1016/j.arth.2018.03.017

    Article  Google Scholar 

  37. Thienpont E, Zorman D (2016) Higher forgotten joint score for fixed-bearing than for mobile-bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24(8):2641–2645. https://doi.org/10.1007/s00167-015-3663-z

    Article  CAS  PubMed  Google Scholar 

  38. Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res (259):146–156

  39. Ramappa M (2015) Midflexion instability in primary total knee replacement: a review. SICOT J 1:24. https://doi.org/10.1051/sicotj/2015020

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kono K, Tomita T, Futai K, Yamazaki T, Tanaka S, Yoshikawa H, Sugamoto K (2018) In vivo three-dimensional kinematics of normal knees during different high-flexion activities. Bone Joint J 100-B(1):50–55. https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0553.R2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Shimmin A, Martinez-Martos S, Owens J, Iorgulescu AD, Banks S (2015) Fluoroscopic motion study confirming the stability of a medial pivot design total knee arthroplasty. Knee 22(6):522–526. https://doi.org/10.1016/j.knee.2014.11.011

    Article  PubMed  Google Scholar 

  42. Minoda Y, Kobayashi A, Iwaki H, Miyaguchi M, Kadoya Y, Ohashi H, Takaoka K (2005) Polyethylene wear particle generation in vivo in an alumina medial pivot total knee prosthesis. Biomaterials. 26(30):6034–6040

    Article  CAS  Google Scholar 

  43. Anderson MJ, Kruse RL, Leslie C, Levy LJ Jr, Pritchett JW, Hodge J (2010) Medium-term results of total knee arthroplasty using a medially pivoting implant: a multicenter study. J Surg Orthop Adv 19(4):191–195

    PubMed  Google Scholar 

  44. Fan CY, Hsieh JT, Hsieh MS, Shih YC, Lee CH (2010) Primitive results after medial-pivot knee arthroplasties: a minimum 5-year follow-up study. J Arthroplast 25(3):492–496. https://doi.org/10.1016/j.arth.2009.05.008

    Article  Google Scholar 

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Correspondence to Giorgio Cacciola.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. This work was performed at the “Unità di Chirurgia Protesica” at Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Messina, Italy

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Cacciola, G., De Martino, I. & De Meo, F. Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty? A single centre study on two hundred and ninety seven patients. International Orthopaedics (SICOT) 44, 291–299 (2020). https://doi.org/10.1007/s00264-019-04462-3

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