Multi radius (MR) total knee arthroplasty (TKA) has been associated with mid-flexion instability.Single radius (SR) TKA may provide better anteroposterior stability through single flexion axis and biomechanical advantage for quadriceps function.Medial pivot (MP) TKA and gradually reducing (GR) radius TKA produce better knee kinematics.Clinical outcomes are equivalent for SR, MR and MP TKA.Short-term studies have shown better clinical outcomes and kinematics for GR TKA.Thinner and narrow anterior flange, deeper trochlea groove and more anatomical trochlea design reduces patellofemoral complications in TKAUltracongruent inserts provide comparable clinical outcomes to posterior-stabilized TKA and cruciate retaining TKA. Cite this article: EFORT Open Rev 2019;4:519-524. DOI: 10.1302/2058-5241.4.180083.

Sagittal radius of curvature, trochlea design and ultracongruent insert in total knee arthroplasty.

Background Total knee arthroplasty (TKA) is commonly performed with proprietary, manual instrumentation provided by the surgical implant manufacturer. Registry studies and meta-analysis, with few outliers, have consistently shown similar functional outcomes and implant survival after TKA regardless of implant manufacturer, implant design, or surgical technique. We hypothesized that process mapping could identify areas for improvement in TKA instrumentation. Methods Seventeen TKA implant systems from 10 companies representing over 90% of all TKAs performed in the United States were evaluated. Instrumentation required for femoral, tibial, and patellar preparation was compared. The number of steps including surgical technician assembly steps, instrument handoffs, and surgeon steps were tabulated based off application of a standardized surgical flow, adjusted for manufacturer-recommended steps during completion of a TKA operation. Results Cruciate-retaining (CR) knee instrumentation in studied systems required 158-225 discrete steps and posterior-stabilized (PS) knees required 181-230 steps. With the fewest steps for femoral, tibial, and patellar instrumentation, CR and PS knee systems could be improved to 145 and 163 steps, respectively. The Arthrex iBalance and the Biomet Vanguard Microplasty required fewest steps among CR systems; the OrthoDevelopment Balanced and the Corin Unity required fewest steps among PS systems. Conclusions Process mapping identified potential areas for improved instrumentation in all studied systems, suggesting the possibility to reduce operative steps broadly across the TKA industry. Patient outcomes were not evaluated by system. Future implant system design changes may do well to reduce unnecessary steps and instrumentation.

Process Mapping Total Knee Arthroplasty: A Comparison of Instrument Designs.

Retrieval analysis of two contemporary total knee designs: Influence of femoral component roughness and type of polyethylene.

Whether there was clinical superiority for the single‐radius prosthesis over the multi‐radius prothesis in total knee arthroplasty (TKA) still remains to be clarified. We updated a meta‐analysis including prospective randomized controlled trials (RCTs) to compare the clinical prognosis of patients receiving single‐radius TKA (SR‐TKA) or multi‐radius TKA (MR‐TKA).

Comparison of Single‐Radius with Multiple‐Radius Femur in Total Knee Arthroplasty: A Meta‐Analysis of Prospective Randomized Controlled Trials

Purpose The main objective of this study was to compare quality of life and functional outcome in patients who have undergone a single-radius (SR) or multi-radius (MR) total knee arthroplasty (TKA). The secondary objective was to observe changes in knee range of movement (ROM) and standardized knee scores (KSCs) in these patients. The hypothesis was that there would be no statistically significant difference between the two patient groups in quality of life and functional outcome. Methods One hundred three SR TKAs were performed by a single surgeon between August 2008 and December 2012. A propensity score matching algorithm was used to select 103 MR TKAs performed during the same period. Preoperative and postoperative variables such as standardized knee and quality of life scores were captured prospectively and then analyzed via both the Student's t-test and paired t-test to look for statistically significant differences between the SR and MR patient groups. Results At 2 years postoperatively, there was no statistically significant difference between the SR and MR patient populations in knee extension, Oxford Knee Score, Knee Society Clinical Rating Scores, and the Physical Component Summary of the Short Form 36 Health Survey (SF-36). There was a statistically significant difference between the two patient groups in postoperative knee flexion in favor of the MR design ( p = 0.011). Conclusion While an SR femoral implant design has several theoretical biomechanical advantages, postoperative standardized KSCs and quality of life scores in this single-surgeon series do not show a clear advantage of one design over the other. Level of evidence III.

https://journals.sagepub.com/doi/pdf/10.1177/2309499018792417

Quality of life and functional outcome after single-radius and multi-radius total knee arthroplasty.

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Quality of life and functional outcome after single-radius and multi-radius total knee arthroplasty.