Dieu Donne Niesten’s research while affiliated with Reinier de Graaf Groep and other places

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Publications (4)


Overview of articles presenting continu- ous migration in UKAs
Patient characteristics and surgical details (N = 26). Values are mean (SD), count, or otherwise specified
Clinical outcomes. Values are mean points/score (SD) unless otherwise specified
Early migration in unicompartmental knee arthroplasty: a radiostereometric study of 26 patients with 24 months of follow-up
  • Article
  • Full-text available

December 2022

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58 Reads

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2 Citations

Acta Orthopaedica

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Nicole De Esch

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Background and purpose: Aseptic loosening, mainly caused by migration, is one of the most common indications for revisions in unicompartmental knee arthroplasty (UKA). In this study, we investigated the early migration of the Persona Partial Knee (PPK, Zimmer Biomet, Warsaw, IN), a cemented medial fixed-bearing unicompartmental knee prosthesis, and evaluated the clinical results. Patients and methods: 26 primary PPKs were implanted. Radiographs were obtained direct postoperatively, at 6 weeks, 6, 12 and 24 months postoperatively. Migration of the femoral and tibial component was calculated using model-based radiostereophotogrammetric analysis (mRSA) in terms of translations and rotations. Patient-reported outcome measures (PROMs) were also registered. Results: At 24 months postoperatively, we found low migration of both the femoral and tibial component in the first 6 months, after which both components stabilized. Only the rotation of the tibial component about the z-axis did not stabilize. All PROMs improved after 24 months compared with preoperative PROMs. Conclusion: The Persona Partial Knee shows low migration of both the femoral and tibial component and PROMs were improved at 24 months follow-up. Long-term follow-up is needed to investigate the performance of the prosthesis compared with other prostheses.

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Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

June 2020

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122 Reads

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4 Citations

Abstract Background To evaluate the reliability of two different techniques for measuring penetration and distribution of the cement mantle in the proximal tibia after total knee arthroplasty (TKA) with Computer Tomography (CT) in vivo. Methods Standardized CT scans of the proximal tibia were taken 1 to 2 years after total knee arthroplasties implanted with a surface cementing technique. These prospectively acquired transversal CT images of the surface of the proximal tibia were divided into four quadrants and were assessed once manually and once with a numerical computing program (MATLAB® Update 2, The MathWorks, Inc.) based on Hounsfield Units by one of the researchers. The assessments were repeated by the same and a second researcher. The ratio cement/trabecular bone was calculated 1, 3 and 5 mm distal of the tibia tray per quadrant. Kruskall-Wallis tests with multiple pairwise comparisons (Dunn’s test) were used to determine differences between the quadrants. Intra- and inter-rater reliability as well as the inter method reliability were assessed with the Intraclass Correlation Coefficient (ICC) per level of depth and with Bland-Altman plots. Results A total of 92 CT scans were included. The intra- and inter-rater reliability of the manual method ranged from 0.22 and 0.52. The intra- and inter-rater reliability of the matlab method varied between 0.98 to 0.99. The median percentage cement measured with the matlab method 1 mm underneath the tibial tray varied between 82 and 88%; at 3 mm depth between 38 and 54% and at 5 mm between 15 and 25%. There was significantly (p



Fig. 2 Results pain during rest and during activity
Fig. 3 Results knee function
Abbreviations HA: Hyaluronic acid; HMW: High molecular weight; K&L: Kellgren & Lawrence; KOOS: Knee injury and Osteoarthritis Outcome Score; NRS: Numeric rating scale; NSAIDs: Non-steroidal anti-inflammatory drugs; OA: Osteoarthritis; PGA: Patients global assessment; RCT: Randomized controlled trials; TKA: Total knee arthroplasty; UC: Usual care; VISK study: VIScosupplementation for Knee osteoarthritis study
Flowchart
Results patients’ global assessment
The effectiveness of high molecular weight hyaluronic acid for knee osteoarthritis in patients in the working age: A randomised controlled trial

May 2019

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323 Reads

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56 Citations

Background High molecular weight (HMW) hyaluronic acid (HA) is a treatment option for knee osteoarthritis (OA). The efficacy of HMW-HA in knee OA is investigated extensively, but the effectiveness in patients in the working age is unknown. Nevertheless, the number knee OA patients in the working age is increasing. Surgical treatment options are less eligible in these patients and productivity losses are high. In this study the effectiveness of intra-articular HMW-HA added to regular non-surgical usual care in everyday clinical practice (UC) compared to UC over 52 weeks in symptomatic knee OA patients in the working age was investigated. Methods In this open labelled randomized controlled trial, subjects aged between 18 and 65 years with symptomatic knee OA (Kellgren and Lawrence I-III) were enrolled and randomized to UC + 3 weekly injections with HMW-HA (intervention) or UC only (control). The primary outcome was the between group difference in responders to therapy according to OMERACT-OARSI criteria after 52 weeks. These criteria include the domains pain, knee related function and patient’s global assessment (PGA). Function was evaluated with the KOOS questionnaire. Pain was assessed with the Numeric Rating Scale. Secondary outcome comprised the between group difference on the individual responder domains, as analysed with a random effects model. Odds Ratios (OR) were calculated by logistic regression analysis. Sensitivity analyses were performed. Results In total, 156 subjects were included (intervention group 77, control group 79). Subjects in the intervention group (HMW-HA + UC) were more often responder compared to the controls (UC). Depending on whether pain during rest or pain during activity was included in the responder domains, 57.1% versus 34.2% (p = 0.006) and 54.5% versus 34.2% (p = 0.015) was responder to therapy respectively. The results of the secondary outcome analyses show that scores on individual responder domains over all follow-up moments were statistically significant in favour of the intervention group in the domains pain during rest (δ 0.8, 95%CI 0.2; 1.4, p = 0.010), knee related function (δ − 6.8, 95%CI -11.9; − 1.7, p = 0.010) and PGA (δ − 0.7, 95%CI -0.9; − 0.4, p < 0.0001). Conclusions Intra-articular HMW-HA added to usual care is effective for knee OA in patients in the working age. Trial registration www.trialregister.nl, NTR1651, registered 2009-3-3. Electronic supplementary material The online version of this article (10.1186/s12891-019-2546-8) contains supplementary material, which is available to authorized users.

Citations (2)


... Failure of tibial implants is more frequent at the interface between the implant and cement [28,29]. The volume of cement below the tibial tray decreases with increasing distance from the implant, and the distribution differs by tibia quadrant [30]. The volume of applied cement decreases with increasing application times for both cements, with significantly higher volume observed for Simplex P at 3 minutes. ...

Reference:

Cement Viscosity and Application Time Lead to Significant Changes in Cement Penetration and Contact Surface Area
Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

... Given the lack of quantitative data, it was not possible to analyse additional follow-ups. As pointed out by Hermans et al. [104], most studies included populations over 60, while a benefit for the working-age population could be shown. ...

The effectiveness of high molecular weight hyaluronic acid for knee osteoarthritis in patients in the working age: A randomised controlled trial