IKS Function Scores Research Articles

Long-term results (after a mean 11.3 years, and up to 22 years, of follow-up) of the Legacy Constrained Condylar Knee (LCCK™) in primary total knee arthroplasty

IntroductionThe use of a sliding prosthesis in total knee arthroplasty (TKA) with increased stress is an intermediate solution in primary surgery, between posteriorly stabilized prostheses and hinged prostheses, in cases of ligamentous laxity and/or loss of bone substance. Favorable results have been reported in the medium term but to our knowledge, this type of prosthesis has not been evaluated in Europe beyond 10 years of follow-up. We therefore conducted a retrospective study in order to carry out: 1) the study of the survival of the Legacy Constrained Condylar Knee (LCCK™) prosthesis in primary surgery, 2) the analysis of complications, functional scores and radiographic data, 3) the analysis of the link between the diaphyseal filling rate and prosthetic loosening. HypothesisThe LCCK™ sliding prosthesis with increased constraint has equivalent long-term survival and clinical results to standard posteriorly stabilized TKA and superior to hinged TKA. Material and methodA retrospective series of 141 LCCK™ implanted in 134 patients between 1997 and 2010 was analyzed. Survival was assessed with censoring through an evaluation of partial or total revision of the implants. The functional results were evaluated using the IKS and Oxford 12 scores. Data regarding the Canal Fill Ratio (CFR) and the presence of pathological periprosthetic lines were also collected. ResultsThe average follow-up was 11.3±5.3years with a maximum follow-up of 22.7years. Survival at 20years was 90.8% [95% CI: 83.7–95.7]. The rate of early complications was 13.5% (19/141), predominantly comprised of venous thrombosis (6/141), hematomas (3/141 including two requiring surgical drainage), stiffness (3/141) and early infections (3/141). The rate of late complications was 17% (24/141), led by stiffness (4.4%; 6/141), infections (2.9%; 4/141) and hardware failure (2. 2%; 3/141). Ten of the 141 patients (7.1%) had LCCK failure, including 3 (2.1%) for stiffness, 3 (2.1%) for hardware failure, 2 (1.4%) for infection, 1 (0.7%) for laxity and 1 (0.7%) for a periprosthetic fracture. No aseptic loosening was found. The total IKS score went from 65 [0–116] to 143 [79–200] at follow-up, the IKS knee score went from 30 [0–66] to 85 [44–100], and the IKS function score went from 35 [0–70] to 57 [0–100]. The Oxford score went from 14 [2–25] to 34 [15–48] at follow-up. Only two patients (1.4%) presented with a partial periprosthetic line. The tibial CFR was 0.81 and the femoral CFR was 0.76. The influence of the CFR could not be analyzed due to the absence of loosening. DiscussionThe LCCK™ prosthesis in primary surgery has good medium-term survival, a significant improvement in functional scores and a complication rate comparable to posteriorly stabilized prostheses. The complication rate is lower than that of hinged prostheses. Level of evidenceIV; single-center retrospective study.

Preliminary outcomes of the introduction of computer assistance in total knee arthroplasty at the Basse-Terre hospital center in Guadeloupe

Background: Computer-assisted total knee arthroplasty (TKA) is associated with significant precision during the surgical installation of prosthesis. We aimed to compare the radiological outcomes between the prostheses’ positioning assisted by a passive computer system and with the conventional technique.Methods: Participants included in this study were divided into two mixed groups based on the use of classical procedure and the computer navigated method during the positioning of implants during fractures. Clinical factors such as degrees of knee amplitude, knee IKS score and IKS function score and radiological features including the stage of osteoarthritis according to Ahlbäck classification, HKA and HKS angles, femoral and tibial mechanical axes, tibial slope prior and after the surgical procedure were measured in each group and then were compared.Results: Of a total of 92 patients, there were 63 women and 29 men; among which 42 patients for were treated with conventional TKA and 50 patients benefited from navigated TKA. 76 patients had stage IV osteoarthritis, 15 patients were at stage III of Albäck classification, and one patient at stage V. The postoperative HKA angle was found to be better in the navigated cohort with a statistically significant difference. The IKS knee and function scores are significantly better in the navigated cohort.Conclusions: Computer surgical navigation practiced during the total arthroplasty of the knee highlighted significant improvement in the positioning of the implants; and is associated with better functioning of the knees.

Knee extensor mechanism allograft reconstruction following chronic disruption

The management of chronic extensor mechanism disruption can be complex. One of the options is allograft reconstruction. The goal of this study was to present the surgical procedure and provide preliminary results with this technique. The allograft uses the whole extensor mechanism (anterior tibial tubercle, patellar ligament, patella, quadriceps tendon). The native patella can be completely removed if the quality of the bone is poor, otherwise a bone groovecan be created to receive the allograft. The allograft is tightly tensioned with the knee in full extension. This surgical technique was performed 5 times with a minimum follow-up of 1year. Active extension was recovered in all cases. The mean postoperative KOOS was 55.5 the IKS function score was 68.5 and the IKS knee score was 83.

Total knee arthroplasty for advanced osteoarthritis in the anterior cruciate ligament deficient knee

Little is known about intra-operative difficulties and outcomes of TKA in ACL deficient knees. Fifty-seven osteoarthritic knees (mean age 70 years) with a history of ACL injury underwent posterior-stabilised TKA. Intra-operative findings and results were compared with a matched control group. Difficult tibial exposure and bone loss were noted in the ACL-deficient group leading to one partial patellar tendon avulsion and one femoral condylar fracture. After three years, no infections or revisions occurred. No differences were noted in ROM, IKS knee score (95 ± 6 versus 93 ± 8, p = 0.1), IKS function score (83± 19 versus 84 ± 16, p = 0.7), or radiolucent line presence. Total knee arthroplasty in ACL deficient knees is effective. Difficulty obtaining tibial exposure and posteromedial tibial bone defects should be anticipated. Outcomes are comparable to standard primary TKA.

Arthroplastie totale de genou pour fracture récente grave de l’épiphyse tibiale proximale chez le sujet âgé

Purpose of the study Bone comminution, serious cartilage damage, and the poor mechanical quality of osteoporotic bone create a difficult challenge for osteosynthesis of joint fractures in the elderly subject. Poor results with certain hip, elbow and shoulder fractures have lead certain authors to propose emergency arthroplasty in selected cases. We report our experience with four knee arthroplasties implanted for recent severe fracture of the proximal tibial epiphysis in elderly subjects. Material and methods Four independent patients aged over 75 years presented a severe comminutive fracture of the proximal epiphysis of the tibia (Three Schatzker 5, one Schatzker 4). After obtaining the patients’ informed consent, early knee arthroplasty was performed. A long-stem cemented tibial piece was used on which the epiphysis was reconstructed. Implants providing support for ligament deficits were used in all cases. Immediate weight-bearing was authorized. Results Follow-up ranged from two to seven years. The IKS function score (15, 60, 100, 100) depended on the patient's general status. The IKS knee score was excellent for three knees (90, 95, 95), and fair in one (45). Re-operations were not needed in any of the patients. All x-rays showed bone healing with correctly aligned limbs (less than 2̊ deformation). There were no lucent lines at last follow-up. Discussion Early arthroplasty for complex fractures of the proximal epiphysis of the tibia is a realistic option. Using a cemented long-stem tibial piece ensures primary stability sufficient for early weight-bearing before bone healing. Use of a constrained prosthesis, or better a hinged prosthesis, can be questioned but avoids the difficulty of ligament balance on an osteoporotic knee with a destroyed joint surface. None of the patients required reoperation and the results in terms of pain were excellent. The overall outcome depends on the general status of the patient.