Total knee arthroplasty with an oxidised zirconium femoral component: ten-year survivorship analysis. Patient-specific instrumentation improves tibial component rotation in TKA Is TKA Using Patient-specific Instruments Comparable to Conventional TKA? A Randomized Controlled Study of One System A systematic review of psychological interventions in total hip and knee arthroplasty Clinical value of SPECT/CT in the painful total knee arthroplasty (TKA): a prospective study in a consecutive series of 100 TKA Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: a 2-year follow-up study. Coronal femoral TKA position significantly influences in vivo patellar loading in unresurfaced patellae after primary total knee arthroplasty Results of cementless total knee arthroplasty in an older rheumatoid arthritis population. Reliability of templating with patient-specific instrumentation in total knee arthroplasty. Quadriceps-sparing, minimal-incision total knee arthroplasty: a comparative study. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty Two continuous femoral nerve block strategies after TKA The influence of patella height on soft tissue balance in cruciate-retaining and posterior-stabilised total knee arthroplasty Local infiltration anesthesia with steroids in total knee arthroplasty: A systematic review of randomized control trials. Cemented versus uncemented fixation of the femoral component of the NexGen CR total knee replacement in patients younger than 60 years: a prospective randomised controlled RSA study. Staged bilateral mobile-bearing and fixed-bearing total knee arthroplasty in the same patients: a prospective comparison of a posterior-stabilized prosthesis Oxidized zirconium femoral component for TKA: a follow-up note of a previous report at a minimum of 10 years. Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty. Does A Kinematically Aligned Total Knee Arthroplasty Restore Function Without Failure Regardless of Alignment Category? Minimally invasive and computer-assisted total knee arthroplasty versus conventional technique: a prospective, randomized study [Comparing the analgesic efficacy of continuous femoral nerve blockade and continuous intravenous analgesia after total knee arthroplasty].
AIMS Oxidised zirconium was introduced as a material for femoral components in total knee arthroplasty ( TKA ) as an attempt to reduce polyethylene wear . However , the long-term survival of this component is not known . METHODS We performed a retrospective review of a prospect ively collected data base to assess the ten year survival and clinical and radiological outcomes of an oxidised zirconium total knee arthroplasty with the Genesis II prosthesis . The Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and a patient satisfaction scale were used to assess outcome . RESULTS A total of 303 consecutive TKAs were performed in 278 patients with a mean age of 68 years ( 45 to 89 ) . The rate of survival ten years post-operatively as assessed using Kaplan-Meier analysis was 97 % ( 95 % confidence interval 94 to 99 ) with revision for any reason as the endpoint . There were no revisions for loosening , osteolysis or failure of the implant . There was a significant improvement in all components of the WOMAC score at final follow-up ( p < 0.001 ) . The mean individual components of the KOOS score for symptoms ( 82.4 points ; 36 to 100 ) , pain ( 87.5 points ; 6 to 100 ) , activities of daily life ( 84.9 points ; 15 to 100 ) and quality of life ( 71.4 points ; 6 to 100 ) were all at higher end of the scale . DISCUSSION This study provides further supportive evidence that the oxidised zirconium TKA gives comparable rates of survival with other implants and excellent functional outcomes ten years post-operatively . TAKE HOME MESSAGE Total knee arthroplasty with an oxidised zirconium femoral component gives comparable long-term rates of survival and functional outcomes with conventional implants Purpose To compare the femoral and tibial components rotational alignment in total knee arthroplasty ( TKA ) performed either with conventional or with patient-specific instrumentation . Methods Forty-five patients underwent primary TKA and were prospect ively r and omized into two groups : 22 patients into the conventional instrumentation group ( group A ) and 23 patients into the Signature ™ patient-specific instrumentation group ( group B ) . All patients underwent computed tomography of the operated knee in the first week after surgery to measure  the components rotation . Results The femoral component rotation was 0.0 ° ( −0.25 , 1.0 ) in group A , and 0.0 ° ( 0.0 , 1.0 ) in group B. The tibial component rotation was −16.0 ° ( −18.5 , 11.8 ) in group A , and −16.0 ° ( −19.0 , −14.0 ) in group B. There were no significant differences between the two groups in tibial and femoral components rotation . The difference between the tibial component rotation and the neutral tibial rotation was similar in both groups [ 2.0 ° ( −0.5 , 6.3 ) in group A and 2.0 ° ( −1.0 , 4.0 ) in group B ] , but the dispersion around the median was different between the two groups . The amplitude of the difference between tibial rotation and neutral position was 27 ° ( −13 , 14 ) in group A and 9 ° ( −3 , 6 ) in group B. Conclusions There is a smaller chance of internal malrotation of the tibial component with the Signature ™ patient-specific instrumentation system , with less dispersion and amplitude of the tibial component rotation around the neutral position . Level of evidence II Background Patient-specific CT-based instrumentation may reduce implant malpositioning and improve alignment in TKA . However , it is not known whether this innovation is an advance that benefits patients . Questions / purpose sWe evaluated ( 1 ) the precision of  patient-specific TKA by comparing the incidence of outliers in postoperative alignment between TKAs using  patient-specific instruments  and TKAs using conventional instruments , and ( 2 ) the reliability of patient-specific instruments by intraoperatively investigating whether the surgery could be completed with patient-specific instruments alone . Methods In this r and omized controlled trial , we compared  patient-specific TKA instruments from one manufacturer ( n = 50 ) with conventional TKA instruments ( n = 50 ) . Postoperative hip-knee-ankle angles , femoral component rotation , and coronal and sagittal alignments of each component were measured . The validity of the patient-specific instrument was examined using cross-checking procedures with conventional instruments during the surgeries . When the procedure could not be completed accurately with patient-specific instruments , the procedure was converted to TKA using conventional instruments , and the frequency of this occurrence was tallied . Results Outliers in the hip-knee-ankle angle were comparable between groups ( 12 % in the patient-specific instrument group and 10 % in the conventional instrument group ) . Other parameters such as sagittal alignment and femoral component rotation did not differ in terms of outliers . Patient-specific guides were ab and oned in eight knees ( 16 % ) during the surgery because of malrotation of the femoral components and decreased slope of the tibia . Conclusions Accuracy was comparable between TKAs done with patient-specific instruments and those done with conventional instruments . However , the patient-specific instrument procedures had to be aborted frequently , incurring expenses that did not benefit patients .Level of Evidence Level II , therapeutic study . See Instructions for Authors for a complete description of levels of evidence Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA Purpose Bone single photon emission computed tomography (SPECT)/CT is considered as beneficial in unhappy patients with pain , stiffness or swelling after total knee arthroplasty ( TKA ) . The purpose of this study was to identify typical patterns of bone tracer uptake ( BTU ) , distribution and intensity values in patients after TKA . The above findings were correlated with the type and fixation of TKA , the time from TKA and intraoperative findings at revision surgery . Methods A total of 100 knees of 84 consecutive patients ( mean age ± SD 70 ± 11 years ) after TKA with persistent knee pain were prospect ively included . All patients underwent clinical examination , st and ardized radiographs and 99mTc-hydroxymethane diphosphonate ( HDP ) SPECT/CT as part of a routine diagnostic algorithm . The diagnosis before and after SPECT/CT and final treatment were recorded . TKA component position was determined on 3-D reconstructed images . Intensity and anatomical distribution of BTU was determined . Maximum intensity values were recorded as well as ratios in relation to the proximal midshaft of the femur . Univariate analyses ( chi-square test , Pearson ’s correlation and t test for independent sample s ) were performed ( p < 0.05 ) . Results SPECT/CT changed the clinical diagnosis and final treatment in 85/100 ( 85 % ) knees . Intraoperative findings confirmed the preoperative SPECT/CT diagnosis in 32/33 knees ( 97 % ) . TKA loosening as well as progression of patellofemoral osteoarthritis ( OA ) was correctly diagnosed in 100 % of knees . Typical patterns of BTU for specific pathologies were identified . Loose femoral TKA components significantly correlated with increased BTU at the lateral femoral regions ( p < 0.05 ) . Loose tibial TKA components significantly correlated with increased BTU at all tibial regions ( p < 0.05 ) and around the tibial peg ( p > 0.01 ) . Conclusion The diagnostic benefits of SPECT/CT in patients after TKA have been proven . Typical pathology-related BTU patterns were identified , which will improve reporting quality . Due to the benefits in establishing the correct diagnosis , SPECT/CT should be part of the routine diagnostic algorithm for patients with pain after TKA BACKGROUND / PURPOSE Quadriceps-sparing minimally invasive total knee arthroplasty ( TKA ) has been proposed to limit surgical dissection without compromising surgical outcome . We conducted a prospect i ve and r and omized study to compare the outcomes of patients who underwent quadriceps-sparing TKA  with the outcomes of those who underwent st and ard medial parapatellar TKA  , after a 2-year follow-up period . METHODS Eighty primary TKA procedures that were to be performed in 60 osteoarthritis patients were r and omly assigned to either a  quadriceps-sparing ( 40 knees ) or a  st and ard medial parapatellar ( 40 knees ) group . All surgeries were design ed to set the prosthesis with a femoral component alignment of 7 ° valgus and a tibial component alignment that was perpendicular to the tibial shaft . Surgical time and  tourniquet time were recorded . Outcome variables included knee function , as defined by a hospital for special surgery knee score ; quadriceps muscle strength , which was measured by an isokinetic dynamometer ; pain , as indicated on a visual analog scale ; prosthetic position , which was measured on plain radiograph ; and range of motion . RESULTS Patients who underwent the 38 quadriceps-sparing and 37 st and ard TKA  procedures completed the 2-year follow-up period without any infection or revision . The mean surgical time and tourniquet time were significantly longer in the quadriceps-sparing group . The mean peak quadriceps muscle strength , hamstring muscle strength , normalized muscle balance ( hamstring/quadriceps ratio ) , pain score , function score , and range of motion were comparable in both groups at 2 months and 2 years . In the quadriceps-sparing group , both the femoral and the tibial components were significantly more varus-deviated from the expected position . CONCLUSIONS Patients undergoing quadriceps-sparing and st and ard medial parapatellar TKA  had comparable outcomes for quadriceps muscle strength , hamstring-quadriceps balance , and knee function ; however , the quadriceps-sparing TKA was more time consuming surgically and result ed in a less accurate prosthesis position Purpose As patellar tracking and loading is influenced by tibial tuberosity and trochlear groove ( TT – TG ) distance , patellar height , thickness and tilt as well as TKA component position , it was our hypothesis that these parameters significantly correlate with patellar BTU intensity and localization in SPECT/CT . The purpose of the study was to investigate whether TKA component position as well as the height , thickness and tilt of the unresurfaced patella influences the intensity and the distribution pattern of BTU in SPECT/CT . Methods A total of 62 consecutive patients who underwent primary TKA without patellar resurfacing were prospect ively included . Demographic data such as age , gender , side and type of primary TKA were noted . All patients underwent clinical and radiological examination  in a specialized knee clinic , including st and ardized radiographs ( anterior – posterior and lateral weight bearing , patellar skyline view ) and Tc-99m-HDP-SPECT/CT before , 12 and 24 months after TKA . SPECT/CT images were analysed on 3D reconstructed images . Rotational , sagittal and coronal position of the tibial and femoral TKA components was assessed using a previously vali date d analysis software . Measurements of BTU including intensity and anatomical distribution pattern were also performed from 3D data . The patellar height , thickness and tilt were measured , and the distance between TT and TG was measured using axial CT images . Univariate analysis was performed to identify any correlations between BTU and TKA component position and patellar measurements ( p < 0.05 ) . Results The highest median BTU was measured in the superior posterior parts of the patella . A statistically significant correlation was found between valgus alignment of the femoral TKA and increased BTU at the lateral patellar regions ( p < 0.05 ) . External rotation of the tibial TKA correlated with increased BTU at the lateral superior joint adjacent part ( p < 0.05 ) . No correlation was found between the tibial TKA  position ( varus – valgus , anterior and posterior slope ) , TT – TG distance , patellar height and patellar BTU values . Conclusions A significant correlation of increased patellar BTU was found with femoral valgus TKA alignment . These findings highlight the importance of femoral TKA position in coronal plane with regard to post-operative patellar tracking . Moreover , these facts might explain anterior knee pain in unhappy TKA with femoral valgus alignment . Level of evidence Diagnostic study , Level II Fifty-five total knee arthroplasties ( TKAs ) in thirty-nine adult ( mean age , 62 years ) patients with rheumatoid arthritis were studied prospect ively for a period of 1 - 7 years . All of the procedures were performed using cementless fixation of the tibial and femoral components . The Knee Society clinical rating system mean knee scores increased 56 points after operation ( mean , 88 points ) , and the mean functional scores increased 28 points ( mean , 64 points ) . Two revisions ( 4 % ) have been required , one for secondary late infection and one for failure of a cementless metal-backed patellar component . Good bone stock was retained in both , allowing for uneventful cementless revision . Forty-two arthroplasties ( 76 % ) were completely pain-free , twelve ( 22 % ) had mild , occasional discomfort with weight-bearing , and one ( 2 % ) had moderate pain at last examination . In this older rheumatoid population , cementless TKA offers good or excellent early clinical results and excellent preservation of bone stock should revision become necessary Magnetic resonance imaging ( MRI ) or computed tomography-based patient-specific instrumentation ( PSI ) may allow for reliable alignment and fewer outliers when compared with conventionally instrumented total knee arthroplasty ( TKA ) . However , some authors have suggested that frequent intraoperative surgeon-directed changes may still be required . This study evaluated the accuracy of  PSI  to predict component sizing and alignment during TKA . A total of 84 patients ( 89 knees ) who underwent a TKA using a PSI system were evaluated . An MRI-based preoperative plan of every knee was provided and approved by the surgeons . This demonstrated the proposed prosthetic component alignment , as well as the femoral , tibial , and bearing insert component size and position . Intraoperative changes to these components were prospect ively recorded and compared with the computerized preoperative plan . Major changes were defined as any changes in femoral or tibial resection , size , and position of the components . Minor changes were defined as any change in the size of the polyethylene bearing insert . The preoperative plan was able to correctly predict the size of the implanted tibial and femoral component in 93 and 95.5 % of the cases , respectively . Thirteen major intraoperative changes were made . In one knee , the proposed femoral resection was not acceptable ( because of the presence of significant amount of osteophytes ) and was ab and oned in favor of a manual extramedullary guide . In another patient , the proposed femoral and tibial components were upsized . In two other patients , the femoral components were downsized , in four patients , the tibial components were downsized , and in another patient , it was upsized . There were also 16 minor changes , which included 2-mm upsizing of the polyethylene liner in 13 knees and 4-mm upsizing in 3 knees . Surgical experience is necessary to recognize improper component size , incorrect surgical resection , or nonideal alignment when performing TKA using PSI . The authors believe that the design and manufacture of PSI combined with a comprehensive templating result ed in excellent intraoperative concordance of the preoperative plan at the default setting s with minimal changes Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty ( TKA ) : the minimal-incision medial parapatellar ( MP ) approach and the quadriceps-sparing ( QS ) approach with side-cutting instruments . Sixty patients ( 80 knees ) with primary osteoarthritis were r and omly assigned to receive MP or QS TKA .  Postoperative alignment of the femoral component was significantly less valgus , and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach . One tibial outlier and 3 femoral outliers were observed with QS TKA . The overall postoperative hip-knee-ankle axis was more varus , and surgical time was longer with QS TKA .  Short-term isokinetic peak muscle torque , postoperative pain , and functional outcomes did not differ between the approaches Restoration of neutral alignment of the leg is an important factor affecting the long-term results of total knee arthroplasty ( TKA ) . Recent developments in computer-assisted surgery have focused on systems for improving TKA . In a prospect i ve study two groups of 80 patients undergoing TKA had operations using either a computer-assisted navigation system or a conventional technique .  Alignment of the leg and the orientation of components were determined on post-operative long-leg coronal and lateral films . The mechanical axis of the leg was significantly better in the computer-assisted group ( 96 % , within + /- 3 degrees varus/valgus ) compared with the conventional group ( 78 % , within + /- 3 degrees varus/valgus ) . The coronal alignment of the femoral component was also more accurate in the computer-assisted group . Computer-assisted TKA gives a better correction of alignment of the leg and orientation of the components compared with the conventional technique . Potential benefits in the long-term outcome and functional improvement require further investigation Purpose Tibiofemoral contact kinematics or knee implant motions have a direct influence on patient function and implant longevity and should be evaluated for any new alignment technique such as kinematically aligned total knee arthroplasty ( TKA ) . Edge loading of the tibial liner and external rotation ( reverse of normal ) and adduction of the tibial component on the femoral component are undesirable contact kinematics that should be minimized . Accordingly , this study determined whether the overall prevalence of undesirable contact kinematics during st and ing , mid kneeling near 90 degrees and full kneeling with kinematically aligned TKA are minimal and not different between groups of consecutive patients treated by different surgeons . Methods Three surgeons were asked to perform cemented , kinematically aligned TKA with patient-specific guides in a consecutive series of patients with their preferred cruciate-retaining ( CR ) implant .  In vivo tibiofemoral contact positions were obtained using a 3- to 2-dimensional image registration technique in 69 subjects ( Vanguard CR – TKA N = 22 , and Triathlon CR – TKA N = 47 ) . Results Anterior or posterior edge loading of the tibial liner was not observed . The overall prevalence of external rotation of the tibial component on the femoral component of 6 % was low and not different between surgeons ( n.s . ) . The overall prevalence of adduction of the tibial component on the femoral component of 4 % was low and not different between surgeons ( n.s . ) . Conclusions Kinematically aligned TKA minimized the undesirable contact kinematics of edge loading of the tibial liner , and external rotation and adduction of the tibial component on the femoral component during st and ing and kneeling , which suggests an optimistic prognosis for durable long-term function . Level of evidence III Abstract Purpose The aim of this study was to investigate the post-operative radiological outcomes of patient-specific instrumentation ( PSI ) surgery versus conventional total knee arthroplasty ( TKA ) . Methods Sixty patients scheduled for a primary TKA were prospect ively divided into PSI or conventional technique . Coronal and sagittal radiographic long limb films were taken post-operatively . The accepted values for normal alignment were 180 ° ± 3 ° for hip-knee-ankle angle ; 90 ° ± 3 ° for coronal femoral component angle or coronal tibia component angle ; 0 ° to 3 ° flexion for sagittal femoral component angle and 0 ° to 7 ° posterior slope for sagittal tibia component angle . Results For hip-knee-ankle angle , there were 21 % more outliers in the PSI group compared to the conventional group ( p = 0.045 ) . Most of these outliers had valgus deformity in the PSI group and varus deformity in the conventional group ( p = 0.045 ) . For implant placement , there was no difference in the proportion of outliers between the two groups . There was also no difference in the duration of surgery . Conclusions This study showed that PSI surgery is associated with a larger proportion of outliers for lower limb alignment . PSI surgery as an alternative to conventional TKA is not advisable . Level of evidence II Purpose The purpose s of this study were to compare the pain score , systemic opioid consumption , and range of motion ( ROM ) between the group where the use of continuous femoral nerve block ( CFNB ) was discontinued on postoperative day 3 ( POD 3 ) and the group where it was discontinued on POD 7 within an established clinical pathway for postoperative recovery after total knee arthroplasty ( TKA ) and to assess the treatment-related side effects and complications , as well as the functional status of these two groups of patients at 2 years after surgery . Methods This prospect i ve , r and omized , double-blinded trial compared the analgesic efficacy and the functional outcomes between group A ( n = 30 ) where continuous femoral nerve block was performed until POD 3 ( discontinued prior to the initiation of range of motion ( ROM ) exercises ) and group B ( n = 33 ) , where the continuous femoral nerve block was performed until POD 7 ( discontinued during the ROM exercise ) after TKA . Results The resting pain scores of group B were lower than those of group A but there was no significant difference between the two groups ( n.s . , P = 0.387 ) . However , the peak pain scores during ROM exercise , beginning on POD3 through to POD14 , were significantly lower in group B than in group A ( P = 0.001 ) . The cumulative morphine IV-PCA requirements through the POD 2 were similar in the two groups ( n.s . , P = 0.811 ) . However , the cumulative oral oxycodone consumption during hospitalization was significantly lower in group B than in group A , P < 0.0001 . Group B showed significantly greater satisfaction with their method of analgesia than group A ( P = 0.001 ) . Group A scored 2.0 ( 2.0–3.0 ) , whereas group B scored 1.0 ( 1.0–2.0 ) . At 2 years , there was no significant difference in the functional outcomes ( the knee flexion and extension angle , the Knee Society Score , and WOMAC pain , stiffness , and function scale ) . Conclusion The study group who received 7-day continuous femoral nerve block after TKA showed superior analgesia and higher patient satisfaction during the hospital stay than those given 3-day continuous femoral nerve block . Despite the additional time , effort and cost to place and manage continuous femoral nerve catheters , the 7-day continuous femoral nerve block can be recommended as an effective and safe regional component of a multimodal analgesia strategy after TKA.Level of evidence II Purpose Although the patella reduced or everted position has recently been recognised as an important factor influencing soft tissue balance during assessment in total knee arthroplasty ( TKA ) , the influence of patella height on soft tissue balance has not been well addressed . Therefore , the relationship between soft tissue balance and patella height was investigated and differences between cruciate-retaining ( CR ) and posterior-stabilised ( PS ) TKA were compared . Methods Forty consecutive patients blinded to the type of implant received , were r and omised prospect ively . Using lateral radiographs , pre-operative patella height was measured . Using an offset-type tensor design ed to measure the soft tissue balance with a reduced patellofemoral ( PF ) joint and femoral component in place , soft tissue balance was intra-operatively assessed in CR TKA ( n = 20 ) and PS TKA ( n = 20 ) in osteoarthritic patients . The joint component gap and varus ligament balance at zero , ten , 45 , 90 and 135 ° of knee flexion with the patella reduced were measured . Results In PS TKA , the joint component gap positively correlated with patella height at 90 and 135 ° of knee flexion . However , there was no correlation between joint component gap and patella height at other flexion angles in PS TKA and any flexion angle in CR TKA . Varus ligament balance showed no significant correlation with patella height in either CR or PS TKA . Conclusion Analysis of soft tissue balance and patella height only showed a positive correlation in joint component gap at a high flexion angle ( 90 and 135 ° ) in PS TKA but not in other parameters examined . Pre-operative measurement of patella height may be an important factor for predicting an intra-operative flexion gap in PS TKA Local infiltration anesthesia ( LIA ) with anesthetics , steroids , NSAIDS , and epinephrine has been shown to be effective in reducing total knee arthroplasty ( TKA ) postoperative pain . This systematic review explores the functional outcomes of r and omized control trials that have compared the use of LIA with and without steroids during TKA . Five studies with 412 patients met the inclusion criteria , 228 received local infiltration anesthesia with steroids ( LIAS ) and 184 received local infiltration anesthesia without steroids ( LIAWS ) . The use of LIAS in management of postoperative TKA pain has been shown to decrease the length of hospital stay , time required to achieve straight leg raise , and pro-inflammatory signals in patients . Although there is no overwhelming data to suggest LIAS  improves postoperative TKA pain , current literature does support its effectiveness in producing other favorable surgical outcomes The optimal mode of femoral fixation in total knee arthroplasty ( TKA ) remains controversial , especially for the young patient . In a prospect i ve r and omised study we compared the magnitude and pattern of the fixation of cemented versus uncemented femoral components during 2 years in patients younger than 60 years . Forty-one knees in 41 patients were r and omised to receive a NexGen ( Zimmer , Warsaw , USA  ) cruciate-retaining TKA with either a cemented or an uncemented non HA-coated femoral component . The patients were examined by radiostereometric analysis ( RSA ) , as well as clinical and radiological evaluation . The magnitude and pattern of migration as measured by RSA did not differ significantly between the cemented and uncemented fixation during the 2-year follow-up , nor were there any differences between the groups in clinical parameters . These findings suggest that an uncemented and non HA-coated femoral component may behave equally as well as a cemented one in the long-term Mobile-bearing total knee arthroplasty ( TKA ) has several theoretical advantages over fixed-bearing TKA . We conducted a prospect i ve r and omized trial to compare the results of mobile-bearing and fixed-bearing posterior-stabilized TKA in the same patients using the same femoral component design of a mobile-bearing prosthesis in one knee and a fixed-bearing prosthesis in the other knee in 25 patients with osteoarthritis . The mean follow-up was 40 months . No significant differences were found in the mobile-bearing and fixed-bearing knees in terms of clinical and radiographic results . No osteolysis , loosening , or revision occurred . One knee with a mobile-bearing prosthesis had a dislocation of the rotating bearing ; however , spontaneous reduction occurred and the dislocation did not recur . Satisfactory early results can be achieved in both mobile-bearing and fixed-bearing knees . We could not demonstrate an advantage of a mobile-bearing TKA BACKGROUND New bearing surfaces for  total knee replacement  have been described in an attempt to reduce polyethylene wear and secondary osteolysis and improve longevity of implants .  Oxidized zirconium is a new material that combines the strength of a metal with the wear properties of a ceramic . However , there are no reports as to who documents the long term results . We report a 10 year follow-up note of a selected series of TKAs with an oxidized zirconium femoral component . METHODS We prospect ively follow 98 TKAs performed in 94 patients with an oxidized zirconium femoral component . Five patients ( 5 knees ) had died and 6 ( 6 knees ) were lost to follow-up at a minimum of 2 years ( mean , 6.3 years ; range , 2 - 9 years ) after the operation . For the remaining 83 patients ( 87 knees ) , the minimum follow-up was 10 years ( mean , 11.3 years ; range , 10.0 - 12.6 years ) . In 51 cases ( 58.6 % ) , a cruciate-retaining implant with a deep-dished , more conforming PE was used , and in 36 cases ( 41.4 % ) , a posterior-stabilized design was used . The patellae were resurfaced in 32 cases ( 36.7 % ) and in 55 cases ( 63.3 % ) were left unresurfaced . RESULTS Survivorship was 97.8 % at 10 years postoperatively . Two knees were revised for aseptic loosening of the femoral component . No major complication was observed clinical ly or radiologically . Mean Knee Society score improved from 36 to 84 and functional score from 37 to 83 . CONCLUSIONS Oxidized zirconium femoral component in TKA performs well over the first 10 years following implantation , with excellent survival rates and good clinical and radiological outcomes . LEVEL OF EVIDENCE Level IV , therapeutic study A total of 208 patients were enrolled in a multicenter , prospect i ve r and omized , institutional review board-approved study that compared preoperative surgical plan to postoperative 2-dimensional radiographic alignment measured by a blinded review er for  primary total knee arthroplasty ( TKA ) implanted using computer-assisted surgery ( CAS ) compared with conventional TKA instrumentation . The results demonstrated a statistically significant improvement in the coronal tibial component alignment ( P < .03 ) and failed to demonstrate a statistically significant improvement in the mechanical axis , femoral coronal/sagittal , and tibial sagittal alignment . Knee Society Score knee and function scores and 6-minute walk test were equivalent between the 2 treatment groups at all postoperative intervals . There was a statistically significant increase in the skin-skin time ( P < .0001 ) and the time until first bone cut ( P < .0001 ) for the CAS knees compared with those implanted with conventional instrumentation . The use of CAS in this r and omized clinical trial conducted at high-volume centers did not offer a clinical ly meaningful improvement in postoperative alignment , clinical , functional , or safety outcomes compared with conventional TKA Background Kinematically aligned TKA restores function by aligning the femoral and tibial components to the normal or prearthritic joint lines of the knee . However , aligning the components to the joint lines of the normal knee also aligns the tibial component in varus , creating concern that varus alignment might result in poor function and early catastrophic failure . Questions / Purpose sWe therefore determined whether function and the incidence of catastrophic failure were different when the tibial component , knee , and limb alignment were in a specified normal range , varus outlier , or valgus outlier . Methods We prospect ively followed all 198 patients ( 214 knees ) who underwent TKAs between February and October 2008 . We treated each knee in this cohort of patients with a kinematically aligned , cruciate-retaining prosthesis implanted using patient-specific guides . From a long-leg scanogram , we measured and categorized alignment of the tibial component as in range ( ≤ 0 ° ) or a varus outlier ( > 0 ° ) , alignment of the knee as in range ( between −2.5 ° to −7.4 ° valgus ) or a varus ( > −2.5 ° ) or valgus ( < −7.4 ° ) outlier , and alignment of the limb as in range ( 0 ° ± 3 ° ) or a varus ( > 3 ° ) or valgus ( < −3 ° ) outlier . We assessed function using the Oxford Knee Score and WOMAC ™ score , and reported catastrophic failure as the incidence of revision attributable to loosening , wear , and instability of the femoral or tibial components . The minimum followup was 31 months ( mean , 38 months ; range , 31–43 months ) . Results The mean Oxford Knee Score of 43 and WOMAC ™ score of 92 were similar between the three alignment categories . The incidence of catastrophic failure in each alignment category was zero . Conclusions Kinematically aligned TKA restores function without catastrophic failure regardless of the alignment category . Because 75 % of patients had their tibial component categorized as a varus outlier and also had high function and a zero incidence of catastrophic failure , the concern that kinematic alignment compromises function and places the components at a high risk for catastrophic failure is unfounded and should be of interest to surgeons committed to cutting the tibia perpendicular to the mechanical axis of the tibia . Level of Evidence Level IV , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence We conducted a prospect i ve , r and omized study to compare the short-term results of minimally invasive and computer-assisted total knee arthroplasty ( MICA-TKA ) with those of conventional total knee arthroplasty ( C-TKA ) for 12-month follow-up . A total of 87 subjects who met the inclusion and exclusion criteria of the study were prospect ively r and omized consecutively into two groups : the C-TKA group ( Group A , n = 44 ) and the MICA-TKA technique ( Group B , n = 43 ) . All the operations were performed by the same senior surgeon . Before surgery and at follow-up , patients were evaluated by the same observer . Tourniquet time as well as total blood loss was compared . Knee Society scores ( KSSs ) , Knee Society functional scores ( KSFSs ) , range of motion ( ROM ) , and radiographic results were assessed and reported preoperatively and at 12-month follow-up . Of these patients , 82 ( Group A 42 ; Group B 40 ) were available for 12-month evaluation . The two groups were found to be similar in terms of coronal mechanical axis . Similarly , the femoral rotational profile revealed that the prosthesis in Group A was implanted with similar internal rotation to Group B. The average blood loss in patients of Group B was significantly reduced as compared to patients of Group A. No significant difference was detected in terms of tourniquet time . Clinical results in Group B , with regard to ROMs and KSSs , as well as KSFSs were significantly superior to that in Group A. Based on the results obtained from this study , it is demonstrated that MICA-TKA leads to a similarly accurate restoration of leg alignment and component orientation compared to the C-TKA . Moreover , MICA-TKA produces superior clinical results to that of C-TKA . However , there is clearly a need for additional high- quality clinical trials with long-term follow-up to confirm the clinical benefits of MICA-TKA OBJECTIVE To compare the analgesic efficacy of continuous femoral nerve blockade ( CFNB ) and continuous intravenous analgesia ( CIA )  after total knee arthroplasty ( TKA ) . METHODS 126 patients undergoing TKA under combined epidural-spinal anesthesia were r and omized to receive either a femoral infusion of ropivacaine 0.2 % ( median infusion rate 5 ml/h ) ( n = 63 ) or an intravenous infusion of fentanyl 30 µg/kg ( 2 ml/h ) ( n = 63 ) . Adjuvant analgesics were oral celebrex or IM pethidine . In the CFNB group , CFNB was established before combined epidural-spinal anesthesia and 20 ml 0.5%ropivacaine was infused through the catheter placed near femoral nerve . Visual analogue scale ( VAS ) scores were assessed at rest and on passive mobilization by acute pain service blinded to analgesic treatment . Nausea and vomiting , dizziness , satisfaction and other side-effects were assessed postoperatively . RESULTS There was significantly less VAS scores in the CFNB group comparing the CIA group at rest 4 , 8 , 12 , 16 , 24 , 36 , 48 h after surgery ( P < 0.01 ) . A significant difference in VAS scores was found in CFNB group vs CIA group on passive mobilization 24 , 36 , 48 h after operation ( P < 0.01 ) . There was significantly less dizziness , nausea and vomiting in the CFNB group ( P < 0.01 ) . Patient satisfaction was higher in the CFNB group ( 92.1 % ) than the CIA group ( 20.6 % ) ( P < 0.01 ) . CONCLUSION CFNA with ropivacaine 0.2 % is more effective in controlling postoperative pain than CIA and CFNB is an effective regional component of a multimodal analgesic strategy after TKA
The EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation , but surgeons mostly prefer the measured resection technique using at least two l and marks for cross-checking the rotation .
Malrotation of the femoral component after primary total knee arthroplasty ( TKA ) is one of the most important problems leading to painful TKA requiring revision surgery .
A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA .