Computer navigation helps achieving appropriate gap balancing and restoration of alignment in total knee arthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach / Nikolai Kornilov in Acta Orthopaedica Belgica, Vol.81/4 (Décembre 2015)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.81/4 (Décembre 2015) . - p.673-681 Titre : Computer navigation helps achieving appropriate gap balancing and restoration of alignment in total knee arthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach Type de document : texte imprimé Auteurs : Nikolai Kornilov ; Taras Kulyaba ; Alexey Petukhov Année de publication : 2015 Article en page(s) : p.673-681 Langues : Anglais (eng) Résumé : The aim of this study was to describe the deformity of both bone and soft tissues in valgus knees and attempt, with the help of computer-assisted total knee arthroplasty (CAS-TKA), to answer the question whether a medial or lateral approach should be used in a fixed deformity. This was a prospective study of 52 consecutive patients with valgus knee osteoarthritis (OA) on who CAS-TKA was performed between 2008 and 2012. Only patients (N = 42) with valgus deformity Krackow type II and III were included for detailed analysis : 17 were operated utilizing a medial and 25 using a lateral approach. Computer navigation was used to perform quantitative control of alignment and gap changes in the medial and lateral knee compartment after each step of the release. Radiological alignment as well as functional results with Knee Society and WOMAC scores were evaluated after a mean (SD) of 23 (5) months in all patients. Twenty-eight different combinations of pathological changes of bone and soft-tissues were described in the 52 patients making the identification of a typical pathological pattern for valgus deformity impossible. In 60% of patients, irrespective from the approach, the valgus deformity was reduced after release of the ilio-tibial tract. No significant difference between both groups was observed in the extent of releases, gap balancing, surgical time, implants constraint, leg alignment and mid-term functional outcomes. None of the included patients were revised for any reason. In conclusion, regardless of the approach, CAS TKA facilitates the achievement of precise soft tissue balancing and alignment in patients with valgus type II and III deformity leading to good mid-term functional and radiological outcomes. Level of evidence : Level IV study. Permalink : ./index.php?lvl=notice_display&id=42351 [article] Computer navigation helps achieving appropriate gap balancing and restoration of alignment in total knee arthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach [texte imprimé] / Nikolai Kornilov ; Taras Kulyaba ; Alexey Petukhov . - 2015 . - p.673-681. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.81/4 (Décembre 2015) . - p.673-681 Résumé : The aim of this study was to describe the deformity of both bone and soft tissues in valgus knees and attempt, with the help of computer-assisted total knee arthroplasty (CAS-TKA), to answer the question whether a medial or lateral approach should be used in a fixed deformity. This was a prospective study of 52 consecutive patients with valgus knee osteoarthritis (OA) on who CAS-TKA was performed between 2008 and 2012. Only patients (N = 42) with valgus deformity Krackow type II and III were included for detailed analysis : 17 were operated utilizing a medial and 25 using a lateral approach. Computer navigation was used to perform quantitative control of alignment and gap changes in the medial and lateral knee compartment after each step of the release. Radiological alignment as well as functional results with Knee Society and WOMAC scores were evaluated after a mean (SD) of 23 (5) months in all patients. Twenty-eight different combinations of pathological changes of bone and soft-tissues were described in the 52 patients making the identification of a typical pathological pattern for valgus deformity impossible. In 60% of patients, irrespective from the approach, the valgus deformity was reduced after release of the ilio-tibial tract. No significant difference between both groups was observed in the extent of releases, gap balancing, surgical time, implants constraint, leg alignment and mid-term functional outcomes. None of the included patients were revised for any reason. In conclusion, regardless of the approach, CAS TKA facilitates the achievement of precise soft tissue balancing and alignment in patients with valgus type II and III deformity leading to good mid-term functional and radiological outcomes. Level of evidence : Level IV study. Permalink : ./index.php?lvl=notice_display&id=42351

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Dislocation of modern design rotating hinge total knee arthroplasty : case series and narrative review / Nikolai Kornilov in Acta Orthopaedica Belgica, Vol. 86/2 (Juin 2020)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol. 86/2 (Juin 2020) . - p. 303-312 Titre : Dislocation of modern design rotating hinge total knee arthroplasty : case series and narrative review Type de document : texte imprimé Auteurs : Nikolai Kornilov, Auteur Année de publication : 2020 Article en page(s) : p. 303-312 Langues : Anglais (eng) Résumé : Knee dislocation is an infrequent complication after rotating hinge total knee arthroplasty (RHTKA). The aim of the present study was to describe our experience with dislocating RHTKA in a consecutive prospective large series, its occurrence rate, causative mechanisms and to perform a review of available literature. In total, six dislocations were observed in 303 RHTKA procedures (NexGen RHK, ZimmerBiomet, Warsaw, Indiana, US) at a mean of 10 (range, 2 – 24) months after surgery. This results in a 2% dislocation rate, which is lower than the 3.1% cumulative rate reported earlier in literature. Men and women were distributed equally, with a mean age of 56 years old. The indication for RHTKA among the six dislocations was revision in 4 cases and primary arthroplasty for the other 2 cases. Analysis revealed that the main mechanism of hinge dislocation was forced knee flexion with concomitant extensor mechanism insufficiency (4/6 cases). The second cause was unscrewing of the locking pin (2/6 cases). This is probably caused by the screw home mechanism that results in a counterclockwise torque -and therefore a loosening- effect on locking bolts, specifically in right-sided RHTKA. Obesity probably predisposes to hinge dislocation since 83% of patients in this series were obese (BMI, range 34 to 52). The findings of this study suggest that dislocation of RHTKA is a rare complication that could happen to obsese patients without an adequate extensor mechanism. Level of evidence : IV Permalink : ./index.php?lvl=notice_display&id=91993 [article] Dislocation of modern design rotating hinge total knee arthroplasty : case series and narrative review [texte imprimé] / Nikolai Kornilov, Auteur . - 2020 . - p. 303-312. Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol. 86/2 (Juin 2020) . - p. 303-312 Résumé : Knee dislocation is an infrequent complication after rotating hinge total knee arthroplasty (RHTKA). The aim of the present study was to describe our experience with dislocating RHTKA in a consecutive prospective large series, its occurrence rate, causative mechanisms and to perform a review of available literature. In total, six dislocations were observed in 303 RHTKA procedures (NexGen RHK, ZimmerBiomet, Warsaw, Indiana, US) at a mean of 10 (range, 2 – 24) months after surgery. This results in a 2% dislocation rate, which is lower than the 3.1% cumulative rate reported earlier in literature. Men and women were distributed equally, with a mean age of 56 years old. The indication for RHTKA among the six dislocations was revision in 4 cases and primary arthroplasty for the other 2 cases. Analysis revealed that the main mechanism of hinge dislocation was forced knee flexion with concomitant extensor mechanism insufficiency (4/6 cases). The second cause was unscrewing of the locking pin (2/6 cases). This is probably caused by the screw home mechanism that results in a counterclockwise torque -and therefore a loosening- effect on locking bolts, specifically in right-sided RHTKA. Obesity probably predisposes to hinge dislocation since 83% of patients in this series were obese (BMI, range 34 to 52). The findings of this study suggest that dislocation of RHTKA is a rare complication that could happen to obsese patients without an adequate extensor mechanism. Level of evidence : IV Permalink : ./index.php?lvl=notice_display&id=91993

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