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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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References

  1. Barrett DS, Cobb AG, Bentley G (1991) Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Jt Surg Br 73(1):53–56

    Article  CAS  Google Scholar 

  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):1720–1730

    Article  PubMed  Google Scholar 

  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):49–57

    Article  CAS  Google Scholar 

  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):894–903

    Article  CAS  Google Scholar 

  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):2532–2540

    Article  PubMed  Google Scholar 

  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):2314–2324

    Article  PubMed  PubMed Central  Google Scholar 

  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):909–914

    Article  PubMed  Google Scholar 

  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):421–431

    Article  Google Scholar 

  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):2091–2094

    Article  PubMed  Google Scholar 

  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):3854–3860

    Article  PubMed  Google Scholar 

  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):1808–1813

    Article  PubMed  Google Scholar 

  12. Heyse TJ, Decking R, Davis J, Boettner F, Laskin RS (2009) Varus gonarthrosis predisposes to varus malalignment in TKA. HSS J 5(2):143–148

    Article  PubMed  PubMed Central  Google Scholar 

  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):56–61

    Article  CAS  Google Scholar 

  14. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kohn MD, Sassoon AA, Fernando ND (2016) Classifications in brief: Kellgren–Lawrence classification of osteoarthritis. Clin Orthop Relat Res 474(8):1886–1893

    Article  PubMed  PubMed Central  Google Scholar 

  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):2197–2200

    Article  PubMed  PubMed Central  Google Scholar 

  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):101–104

    Article  Google Scholar 

  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):3443–3450

    Article  PubMed  PubMed Central  Google Scholar 

  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):1115–1121

    Article  Google Scholar 

  20. Manrique J, Gomez MM, Parvizi J (2015) Stiffness after total knee arthroplasty. J Knee Surg 28(2):119–126

    Article  PubMed  Google Scholar 

  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–S176

    Article  PubMed  Google Scholar 

  22. Mihalko W, Fishkin Z, Krackow K (2006) Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. Clin Orthop Relat Res 449:283–287

    Article  PubMed  Google Scholar 

  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):3488–3494

    Article  PubMed  Google Scholar 

  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

    CAS  Google Scholar 

  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):157–160

    Article  PubMed  PubMed Central  Google Scholar 

  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):807–810

    Article  PubMed  Google Scholar 

  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):423–428

    Article  CAS  PubMed  Google Scholar 

  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):2325–2330

    Article  PubMed  Google Scholar 

  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):1778–1785

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to Mr. Toufik Zakaria for his assistance with data collection and interpretation of findings, to Ms. Marine Rachail for assistance with the preliminary statistical analyses, to Mr. Luca Nover for performing the final statistical analyses, and to Mr. Antoine Barnaud for producing illustrations (Fig. 5).

Funding

This study was funded by Corin-Tornier SAS (Montbonnont, France).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Croix-Saint-Simon Teaching Hospital, Paris, France

    Simon Marmor

  2. Department of Research and Development, Corin-Tornier, Montbonnot, France

    Eric Renault

  3. ReSurg SA, ch. de la Vuarpilliere 35, 1260, Nyon, Switzerland

    Jeremy Valluy & Mo Saffarini

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  1. Simon Marmor
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  2. Eric Renault
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  3. Jeremy Valluy
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  4. Mo Saffarini
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Contributions

SM participated in study design, data collection, and manuscript editing. ER participated in study design, data collection, and manuscript editing. JV participated in literature review, statistical analysis, and manuscript writing. MS participated in statistical analysis and manuscript writing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mo Saffarini.

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Conflict of interest

SM received fees for consulting and education from Corin-Tornier (France) and DePuy Synthes (France). ER is employee of Employee of Corin-Tornier (France). JV and MS received fees for support in study design and manuscript preparation from ReSurg SA (Switzerland).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Marmor, S., Renault, E., Valluy, J. et al. Over-voluming predicted by pre-operative planning in 24% of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 27, 1544–1551 (2019). https://doi.org/10.1007/s00167-018-4998-z

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  • DOI: https://doi.org/10.1007/s00167-018-4998-z

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