Do Medial Pivot Kinematics Correlate With Patient-Reported Outcomes After Total Knee Arthroplasty?

被引:46
作者
Warth, Lucian C. [1 ,2 ]
Ishmael, Marshall K. [2 ]
Deckard, Evan R. [2 ]
Ziemba-Davis, Mary [2 ]
Meneghini, R. Michael [1 ,2 ]
机构
[1] Indiana Univ Sch Med, Dept Orthopaed Surg, Indianapolis, IN 46202 USA
[2] Indiana Univ, Hlth Saxony Hosp, Indiana Univ Hlth Phys Orthoped & Sports Med, Fishers, IN USA
关键词
total knee arthroplasty; medial pivot; kinematics; patient-reported outcomes; computer navigation; 20-YEAR SURVIVAL ANALYSIS; LONG-TERM SURVIVAL; FOLLOW-UP; SCORING SYSTEM; REPLACEMENT; REVISION; FLEXION; JOINT; MRI; HIP;
D O I
10.1016/j.arth.2017.03.019
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Many total knee arthroplasty (TKA) implants are designed to facilitate a medial pivot kinematic pattern. The purpose of this study was to determine whether intraoperative medial pivot kinematic patterns are associated with improved patient outcomes. Methods: A retrospective review of consecutive primary TKAs was performed. Sensor-embedded tibial trials determined kinematic patterns intraoperatively. The center of rotation (COR) was identified from 0 degrees to 90 degrees and from 0 degrees to terminal flexion, and designated medial-pivot or non-medial pivot based on accepted criteria. Patient-reported outcomes were measured preoperatively and at minimum one-year follow-up. Results: The analysis cohort consisted of 141 TKAs. Mean age and median BMI were 63.7 years and 33.8 kg/m(2), respectively. Forty-percent of TKAs demonstrated a medial pivot kinematic pattern intraoperatively. A medial pivot pattern was more common with posterior cruciate-retaining (CR) and posterior cruciate-substituting/anterior lipped (CS) implants when compared to posterior stabilized (PS) TKAs (P <=.0150). Regardless of bearing type, minimum one-year Knee Society scores and UCLA activity level did not significantly differ based on medial vs non-medial pivot patterns (P >=.292). For patients with posterior cruciate-sacrificing implants, there were trends for greater median improvement in Knee Society objective (46 vs 31.5 points, P=.057) and satisfaction (23 vs 14 points, P=.067) scores in medial pivot knees. Conclusion: A medial pivot pattern may not significantly govern clinical success after TKA based on intraoperative kinematics and modern outcome measures. Further research is warranted to determine if a particular kinematic pattern promotes optimal clinical outcomes. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:2411 / 2416
页数:6
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