Primary ArthroplastyThe Evolution of Implant Design Decreases the Incidence of Lateral Release in Primary Total Knee Arthroplasty
Section snippets
Methods
We retrospectively abstracted the operative notes and patient charts of all patients who underwent a primary TKA performed by a single senior surgeon between 1980 and 2015. Patients were included if they had undergone unilateral or bilateral primary TKA. We grouped implants in 3 categories: cruciate retaining, posterior sacrificing, and rotating platform (RP). Exclusion criteria were age below 18 years, the use of revision style implants for a primary TKA, and patient charts lacking essential
Sample Characteristics and Bivariate Associations
We reviewed 2547 patients' records from one single senior surgeon's operative reports and patient charts between 1982 and 2015. Two thousand sixty-five patients had primary TKAs. Seventy-four records were excluded because of missing essential clinical and surgical information. Our final study sample included 1991 primary TKAs. There were 65% women and 35% men. The mean patient age was 67.0 (SD ± 10.5) years at the time of surgery. Preoperative diagnosis was osteoarthritis in 82% followed by
Discussion
The PFJ remains an important aspect of a successfully performed TKA. If not adequately balanced or assessed, there is an increased risk for anterior knee pain, subluxation and instability, fracture, loosening of the patellar button, and lower patient satisfaction 9, 10. Revision for anterior knee pain and dysfunction has been cited by many as a common cause for revision, and historically some authors have noted up to 20% of patients having issues with instability in older designs 3, 11, 12, 13.
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Cited by (23)
Loading on Attune® fixed-bearing cruciate-substituting total knee implant in knee malalignment during activities of daily living: A finite element analysis
2021, Journal of OrthopaedicsCitation Excerpt :Recent TKA implants, such as the Attune ® TKA implant (DePuy Synthes, Warsaw, IN), were introduced to offer greater biomechanical advantage and functional benefits with improvement in implant design and material when compared to older designs such as the PFC Sigma® TKA implant (DePuy Synthes, Warsaw, IN). The Attune® TKA implant had several new design features which included a distal trochlear groove with reduced intercondylar box ratio, a gradually changing multiradii femoral condyle, smaller femoral component profile, S-shaped cam post articulation, central polyethylene locking mechanism, and an antioxidant incorporated ultra-high molecular polyethylene (UHMWPE) insert.9–11 Although recent studies have reported good short-term clinical outcomes with the Attune® TKA implant,12–15 some investigators have reported an increased incidence of radiolucencies and loosing with the Attune® TKA implant.14–18
Modern femoral component design in total knee arthroplasty shows a lower patellar contact force during knee flexion compared with its predecessor
2021, KneeCitation Excerpt :The theoretical advantages of Attune suggested by the provider are increased conformity between the femoral component and the polyethylene insert with a gradually reducing femoral radius, an innovative S-curve design of the posteriorly stabilized cam for gradual femoral rollback and stability, an extensive range of sizes for a diverse population, an improved polyethylene insert locking mechanism and incorporation of an antioxidant polyethylene insert. Besides, the provider focused on the optimization of the patellofemoral tracking, thus the Attune knee system was designed to provide a higher degree of anatomical conformity regarding the trochlear groove and patella [2,3,21]. A recent study has demonstrated a 3° flatter trochlear groove in the Attune compared with the PFC Sigma [12,22].
Attune total knee arthroplasty: is there evidence of early tibial component de-bonding? A prospective cohort study with a minimum two year follow-up
2021, Journal of Arthroscopy and Joint SurgeryCitation Excerpt :Carey and Harty found that more Attune knees achieved the minimum clinically important difference in Patient Related Outcome Measure (PROM) score compared with control implants in the contralateral knee of the same patient.8 Webb et al. described a reduced incidence of lateral release in Attune TKA as compared with the Press-Fit Condylar (PFC) and Sigma knees,9 and Whittaker et al. showed that learning curve had no effect on PROM whilst using the Attune system.10 However, concerns have been raised of high rates of early tibial loosening.
Higher Activity Level Following Total Knee Arthroplasty Is Not Deleterious to Mid-Term Implant Survivorship
2020, Journal of ArthroplastyPreoperative Radiological Parameters Predicting the Need for Lateral Retinacular Release in Total Knee Arthroplasty
2019, Journal of ArthroplastyCitation Excerpt :Webb et al [20] found a 4-fold decrease in the incidence of lateral release with PFC Sigma implant compared to older PFC designs. PFC Sigma implant improves the patellofemoral kinematics by deepening the trochlear groove, proximally extending the groove to engage the patella early and decreasing the trochlear angle compared to older PFC design [20]. They also emphasized decreased incidence of lateral release in rotating platform designs.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.11.050.