Cemented and ingrowth fixation of the Miller-Galante prosthesis. Clinical and roentgenographic comparison after three- to six-year follow-up studies.
ABSTRACT One hundred thirty-nine cemented and 132 cementless Miller-Galante total knee prostheses were followed between three and six years (average, 43-44 months). The fixation technique was based on patient age, bone quality, and ability to delay full-weight bearing. Clinical follow-up studies were possible on 116 cemented knees. Fifteen knees were lost because of death before the three-year follow-up study, and eight knees required component removal. One hundred twenty-three cementless knees were available for clinical follow-up studies; there were three deaths, and six failures required component removal. No cemented failure was due to fixation, and three cementless failures were due to lack of tibial ingrowth in two and pain of undetermined etiology in one. Preoperative knee scores were slightly significant with cemented knees averaging 48 points and cementless knees averaging 52 points. A similar significant difference was maintained at the final follow-up study. No significant differences were noted for pain, limp, or support scores. Average range of motion was similar in the two groups. Radiolucent lines about the femoral component were rare. Cementless tibial radiolucencies were partial in up to 20% of examined zones, and complete tibial tray radiolucency was seen in only three patients. No correlation between radiolucency and knee scores was seen.
- SourceAvailable from: jbjs.org.ukJournal of Bone and Joint Surgery-british Volume - J BONE JOINT SURG-BRIT VOL. 01/2003; 85(8):1123-1127.
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ABSTRACT: Thesis (Sc. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2007. Includes bibliographical references (p. 240-271). While contempary total knee arthroplasty has been successful in improving the quality of life for those suffering from severe osteoarthritis, the function of these patients has not reached normal levels for their age group. Thus, there is an increasing need to improve total knee arthroplasty techniques to allow patients to function normally. We currently have limited knowledge about how current knee arthroplasties behave in-vivo, but this information could be pivotal in designing new implants and surgical techniques. Therefore, the objective of this work was to develop the Dual Fluoroscopic Imaging System, a non-invasive imaging system capable of measuring in-vivo knee kinematics in all degrees of freedom. This system was used to investigate factors that may affect patient function after total knee arthroplasty. The feasibility of using kinematic data obtained using this system to analyze wear of the polyethylene insert was also explored The system was shown to be repeatable and accurate in determining the pose of the TKA components in all degrees of freedom. Six degree-of-freedom kinematics and articular contact motion were measured in-vivo. Data was obtained for patients with two typical classes of TKA, cruciate-retaining and cruciate-substituting, and the function of conventional implants was compared to that of more recent high flexion designs. In general, no differences were detected between these groups. Further, no factors such as age, weight, PCL management, or kinematics, were found to correlate with flexion capability. Future studies should investigate changes in knee structures from the preoperative state to the postoperative state. Preliminary estimates of polyethylene stresses suggested great potential in using the Dual Fluoroscopic Imaging System in developing a model of in-vivo polyethylene wear. by Jeremy F. Suggs. Sc.D.
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ABSTRACT: The purpose of this study was to determine whether high flexion leads to improved benefits in patient satisfaction, perception, and function after total knee arthroplasty (TKA). Data were collected on 122 primary TKAs. Patients completed a Total Knee Function Questionnaire. Knees were classified as low (≤ 110°), mid (111°-130°), or high flexion (>130°). Correlation between knee flexion and satisfaction was not statistically significant. Increased knee flexion had a significant positive association with achievement of expectations, restoration of a "normal" knee, and functional improvement. In conclusion, although the degree of postoperative knee flexion did not affect patient satisfaction, it did influence fulfillment of expectations, functional ability, and knee perception. This suggests that increased knee flexion, particularly more than 130°, may lead to improved outcomes after TKA.The Journal of arthroplasty 02/2011; 26(2):178-86. · 1.79 Impact Factor