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      A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait

      research-article
      Author(s): , MBBS, MS (Ortho), Ch.M Ortho & Trauma) (Edin), MFSEM (Ireland) 1 , , MBBCh, FC Orth (SA) 1 , , BSc 1 , , BSc MD (Res), FRCS (Tr&Orth) 2
      Publication date (Electronic):
      Journal: The Bone & Joint Journal
      Publisher: British Editorial Society of Bone and Joint Surgery
      Keywords: Medial pivot knee, Gait, Clinical scores

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          Abstract

          Aims

          The outcome of total knee arthroplasty (TKA) is not always satisfactory. The purpose of this study was to identify satisfaction and biomechanical features characterising the gait of patients who had undergone TKA with either an anatomical single radius design or a medial pivot design. We hypothesised that the latter would provide superior function.

          Patients and Methods

          This is a study of a subset of patients recruited into a prospective randomised study of a single radius design versus a medial pivot design, with a minimum follow-up of one year. Outcome measurements included clinical scores (Knee Society Score (KSS) and Oxford Knee Score (OKS)) and gait analysis using an instrumented treadmill.

          Results

          There was no statistically significant difference between the two groups for both the KSS and OKS. There was also no statistical significance in cadence, walking speed, stride length and stance time, peak stride, mid support and push-off forces.

          Conclusion

          This study corroborates a previous study by the same authors that showed equally good results in clinical outcome and gait between the conventional single radius and medial pivot designs under stringent testing conditions.

          Cite this article: Bone Joint J 2018;(1 Supple A)100-B:76–82.

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          Most cited references42

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          The John Insall Award: Patient expectations affect satisfaction with total knee arthroplasty.

          Philip C. Noble, Michael A. Conditt, Karon Cook … (2006)
          Satisfaction with the outcome of total knee arthroplasty is highly variable, with a small but significant percentage of patients reporting dissatisfaction with the procedure. The purpose of this study was to determine which factors contribute to patient satisfaction with total knee replacement (TKR), and their relative importance. At a minimum of 1 year post unilateral primary TKR, 253 patients completed a self-administered, validated "Knee Function Questionnaire," which examined each patient's participation in a broad range of activities involving the knee, their level of satisfaction, and the extent to which TKR had fulfilled their expectations. The association between function, expectation and satisfaction was examined using univariate and multivariate logistic regression. Seventy-five percent of patients were either "satisfied" or "very satisfied" with their knee replacement, while 14% were "dissatisfied" or "very dissatisfied." Satisfaction correlated significantly (p < 0.001) with age less than 60, absence of residual symptoms, fulfillment of expectations, and absence of functional impairment. Satisfaction with TKR is primarily determined by patients' expectations, and not their absolute level of function. Real improvements in the outcome of TKA must address prevention of residual pain, stiffness and swelling, and each patient's preoperative concept of the likely outcome of these procedures.
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            Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.

            Steven Kurtz, Fionna Mowat, Kevin Ong … (2005)
            The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time. The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaedic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender. Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time. The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty. The reported prevalence trends have important ramifications with regard to the number of joint replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.
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              Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden.

              L. Lidgren, Robin I. M. Dunbar, T Pehrsson … (2000)
              During a validation process of the Swedish Knee Arthroplasty Register (SKAR), living registered patients were sent a questionnaire to ask if they had been reoperated on. This gave an opportunity to pose a simple four-point question with respect to patient satisfaction which 95% of patients answered. We analyzed the answers of patients operated on between 1981 and 1995 and found that only 8% of the patients were dissatisfied regarding their knee arthroplasty 2-17 years postoperatively. The satisfaction rate was constant, regardless of when the operation had been performed during the 15-year period. The proportion of satisfied patients was affected by the preoperative diagnosis, patients operated on for a long-standing disease more often being satisfied than those with a short disease-duration. There was no difference in proportions of satisfied patients, whether they had primarily been operated on with a total knee arthroplasty (TKA) or a medial unicompartmental arthroplasty (UKA). For TKAs performed with primary patellar resurfacing, there was a higher ratio of satisfied patients than for TKAs not resurfaced, but this increased ratio diminished with time passed since the primary operation. Unrevised knees had a higher proportion of satisfied patients than knees that had been subject to revision, and among patients revised for medial UKA, the proportion of satisfied patients was higher than among patients revised for TKA. We conclude that satisfaction after knee arthroplasty is stable and long-lasting in unrevised cases and that even after revision most patients are satisfied.
              Article 0 comments Cited 131 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                B. Benjamin: Role: Department of Trauma and Orthopaedics
                J. R. T. Pietrzak: Role: Department of Trauma and Orthopaedics
                J. Tahmassebi: Role: Research Physiotherapist
                F. S. Haddad: Role: Professor of Orthopaedic Surgery
                Journal
                Journal ID (nlm-ta): Bone Joint J
                Journal ID (iso-abbrev): Bone Joint J
                Title: The Bone & Joint Journal
                Publisher: British Editorial Society of Bone and Joint Surgery
                ISSN (Print): 2049-4394
                ISSN (Electronic): 2049-4408
                Publication date Collection: January 2018
                Publication date (Electronic): 01 January 2018
                Volume: 100-B
                Issue: 1 Supple A
                Pages: 76-82
                Affiliations
                [1 ]University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK.
                [2 ]University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and NIHR University College London Hospitals Biomedical Research Centre, UK.
                Author notes
                Correspondence should be sent to B. Benjamin; email: bijuben@ 123456yahoo.com
                Article
                Publisher ID: BJJ-2017-0605.R1
                DOI: 10.1302/0301-620X.100B1.BJJ-2017-0605.R1
                PMC ID: 6424433
                PubMed ID: 29292344
                SO-VID: c1dc096b-983e-4511-b565-fd7d8a6236ec
                Copyright © ©2018 Author(s) et al
                History
                Date received : 13 May 2017
                Date accepted : 07 July 2017
                Categories
                Subject: Knee Arthroplasty: Management Factorials
                Subject: 2
                Subject: Medial Pivot Knee
                Subject: Gait
                Subject: Clinical Scores
                Custom metadata
                odf2nlm-version 1.0
                price $2.00
                principal-institution University College London Hospitals, London, United Kingdom
                article-type Knee arthroplasty
                coi-statement None declared

                Keywords: medial pivot knee,gait,clinical scores
                Data availability:
                Keywords: medial pivot knee, gait, clinical scores

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