Objectives Preservation of both anterior and posterior cruciate ligaments in total knee arthroplasty (TKA) can lead to near-normal post-operative joint mechanics and improved knee function We hypothesised that a patient-specific bicruciate-retaining prosthesis preserves near-normal kinematics better than standard off-the-shelf posterior cruciate-retaining and bicruciate-retaining prostheses in TKA Methods We developed the validated models to evaluate the post-operative kinematics in patient-specific bicruciate-retaining, standard off-the-shelf bicruciate-retaining and posterior cruciate-retaining TKA under gait and deep knee bend loading conditions using numerical simulation Results Tibial posterior translation and internal rotation in patient-specific bicruciate-retaining prostheses preserved near-normal kinematics better than other standard off-the-shelf prostheses under gait loading conditions Differences from normal kinematics were minimised for femoral rollback and internal-external rotation in patient-specific bicruciate-retaining, followed by standard off-the-shelf bicruciate-retaining and posterior cruciate-retaining TKA under deep knee bend loading conditions Moreover, the standard off-the-shelf posterior cruciate-retaining TKA in this study showed the most abnormal performance in kinematics under gait and deep knee bend loading conditions, whereas patient-specific bicruciate-retaining TKA led to near-normal kinematics Conclusion This study showed that restoration of the normal geometry of the knee joint in patient-specific bicruciate-retaining TKA and preservation of the anterior cruciate ligament can lead to improvement in kinematics compared with the standard off-the-shelf posterior cruciate-retaining and bicruciate-retaining TKA Cite this article : Y-G Koh, J Son, S-K Kwon, H-J Kim, O-R Kwon, K-T Kang Preservation of kinematics with posterior cruciate-, bicruciate- and patient-specific bicruciate-retaining prostheses in total knee arthroplasty by using computational simulation with normal knee model Bone Joint Res 2017;6:557–565 DOI: 101302/2046-375869BJR-2016-0250R1

Preservation of kinematics with posterior cruciate-, bicruciate- and patient-specific bicruciate-retaining prostheses in total knee arthroplasty by using computational simulation with normal knee model

Objectives Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty for patients who require treatment of single-compartment osteoarthritis, especially for young patien...

Influence of tibiofemoral congruency design on the wear of patient-specific unicompartmental knee arthroplasty using finite element analysis

Posterior-stabilized (PS)-total knee arthroplasty (TKA) can be applied in any of several variations in terms of the tibiofemoral conformity and post-cam mechanism. However, previous studies have not evaluated the effect of the condylar surface radii (tibiofemoral conformity) on wear in a customized PS-TKA. The present study involved evaluating the wear performance with respect to three different conformities of the tibiofemoral articular surface in a customized PS-TKA by means of a computational simulation. An adaptive computational simulation method was developed that conduct wear simulation for tibial insert to predict kinematics, weight loss due to wear, and wear contours to results. Wear predictions using computational simulation were performed for 5 million gait cycles with force-controlled inputs. Customized PS-TKA designs were developed and categorized as conventional conformity (CPS-TKA), medial pivot conformity (MPS-TKA), and anatomical conformity (APS-TKA). The post-cam design in the customized PS-TKA is identical. We compared the kinematics, contact mechanics, and wear performance. The findings revealed that APS-TKA exhibited the highest internal tibial rotation relative to other TKA designs. Additionally, the higher contact area led to there being less contact stress although it did not directly affect the wear performance. Specifically, MPS-TKA exhibited the lowest volumetric wear. The results of the present study showed that tibiofemoral articular surface conformity should be considered carefully in customized PS-TKA design. Different wear performances were observed with respect to different tibiofemoral conformities. Even though APS-TKA exhibited an inferior wear performance compared to MPS-TKA, it proved to be better in terms of kinematics so its functionality may be improved through the optimization of the tibiofemoral articular surface conformity. Additionally, it should be carefully designed since any changes may affect the post-cam mechanism.

Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty.

Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants

Background The amount of total knee arthroplasty (TKA) procedures performed in the United States has been increasing steadily and is projected to reach 3 million procedures annually by 2030 in patients aged ≥65 years. A rise in TKA procedures will increase spending on osteoarthritis treatments, which is currently the second highest category of spending for Medicare patients. Because TKA procedures account for a substantial amount of total osteoarthritis spending, payers and providers are examining methods to reduce spending on the procedure while improving clinical outcomes. Customized individually made implants have been shown to improve clinical outcomes, such as physical function and limb alignment, compared with off-the-shelf implants; however, the economic impact of customized implants has yet to be established. Objective To analyze TKA episode expenditures among Medicare fee-for-service (FFS) members who received a customized or an off-the-shelf implant. Methods Members undergoing a TKA procedure using the customized implant technology were identified in the Medicare FFS database and were propensity matched (1:5) to a cohort of members who received off-the-shelf implants. Reimbursement for the initial procedure (ie, customized and off-the-shelf procedure), a preoperative computed tomography scan, and 12-month postoperative healthcare utilization were analyzed. The overall episode expenditures were used to construct a budget impact model to calculate the per-member per-month (PMPM) spending for Medicare FFS beneficiaries. Results The average total episode spending was significantly lower among the customized implant cohort ($18,585) compared with the off-the-shelf implant cohort ($20,280; a $1695 difference; P <.0001). This savings resulted in $0.08 PMPM savings for the Medicare FFS program when a portion (10%) of eligible members received the customized implant technology. A sensitivity analysis, which varied with the customized implant market penetration and the percent of customized implant-eligible procedures, indicated that the savings could be as great as $0.28 PMPM. Conclusion The results of this analysis demonstrate that the use of customized implants in TKA procedures can achieve substantial savings versus off-the-shelf procedures for the Medicare FFS program, and this savings is primarily driven by a lower average initial procedure cost and lower postoperative spendings for inpatient services and skilled-nursing facility costs.

The Economic Value of Customized versus Off-the-Shelf Knee Implants in Medicare Fee-for-Service Beneficiaries.

Background: The volume of total knee arthroplasty procedures is growing rapidly and, correspondingly, it is expected that the volume of revision procedures will grow rapidly as well.  Revision surgery is most successful when adequate bone remains on both the tibia and femur to allow for the least invasive revision.  We hypothesized that total knee arthroplasty with a patient-specific implant would result in significant bone preservation as compared to standard total knee arthroplasty with “off-the-shelf” implants. Methods: We evaluated 100 total knee arthroplasties which utilized patient-specific implants, versus 37 standard posterior stabilized and 32 standard posterior cruciate retaining total knee arthroplasties.  Bone resection was quantified utilizing intra-operative measurements of actual resected bone. Additionally we performed a virtual, CAD-based analysis of resections via CT imaging on 15 knees.  Findings: We found that patients had significantly less bone resected in all zones measured, on both the femur and tibia, when patient-specific implants with patient-specific jigs were used.  When assessed volumetrically with CAD imaging, standard implants resected 12-49% more bone than did patient-specific implants, depending on the size of the implant utilized. Interpretations: Utilizing patient-specific implants in total knee arthroplasty results in significant bone sparing as compared to standard total knee arthroplasty. This has the potential for less invasive revision surgery in the future, possibly obviating the need for dedicated revision implants or augments and other bone substituting devices.

/pdf/bone-preservation-in-a-novel-patient-specific-total-knee-3v38rihsbq.pdf

Bone Preservation in a Novel Patient Specific Total Knee Replacement.

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Bone Preservation in a Novel Patient Specific Total Knee Replacement.