ABSTRACT
PURPOSE: Anterior knee pain (AKP) following total knee replacement (TKR) is both prevalent and clinically relevant. The purpose of this study was to systematically review the peer-reviewed literature, and to identify and assess the different modifiable and non-modifiable determinants that may be associated with the development of AKP in patients following primary TKR. METHODS: A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Google Scholar) was performed in January 2012. The quality of the studies was assessed using the GRADE approach. RESULTS: A total of 54 articles met the inclusion criteria. Variables that have been researched with regard to the prevalence of AKP include patient and knee-specific characteristics, prosthetic design, operative technique, treatment of the patella, and time of assessment. A weak correlation with AKP was found for specific retained presurgery gait patterns. A weak recommendation can be given for the use of femoral components with a posterior centre of rotation, resection of Hoffa's fat pad, patellar rim electrocautery, and preventing combined component internal rotation. The correlation between postsurgical AKP and the degree of patellar cartilage wear, tibial component bearing strategies, and patellar resurfacing is inconclusive. Due to substantial heterogeneity of the included studies, no meta-analysis was performed. CONCLUSIONS: No single variable is likely to explain the differences in the reported rates of AKP, although variables leading to abnormal patellofemoral joint loading appear to be of special significance. LEVEL OF EVIDENCE: III.
Subject(s)
Arthroplasty, Replacement, Knee , Pain, Postoperative/etiology , Patellofemoral Pain Syndrome/etiology , Arthroplasty, Replacement, Knee/instrumentation , Arthroplasty, Replacement, Knee/methods , Humans , Knee Prosthesis/adverse effects , Pain Measurement , Pain, Postoperative/diagnosis , Patella/surgery , Patellofemoral Pain Syndrome/diagnosisABSTRACT
BACKGROUND: The indication for total ankle replacement (TAR) as an alternative to ankle fusion continues to be a much-debated topic. The reported survival of TAR at midterm followup is approximately 90%. The aim of this study was to compare functional outcome and survival of TAR in low volume centers versus high volume centers. MATERIALS AND METHODS: A retrospective cohort study was carried out in four low volume centers. Sixty-four Salto TARs were performed between 2003 and 2007 in 60 patients. Fifty-five (59 TAR) patients were eligible for followup with 28 men. Standardized American Orthopaedic Foot and Ankle Society (AOFAS) scores, patient satisfaction, and range of motion (ROM) were measured. Standardized and dynamic radiographs were used for evaluation of radiolucencies, ROM and component alignment. RESULTS: Seven of the 59 ankle prostheses had to be revised: five for loosening and two for deep infection. Three of the five revised for loosening went on to fusion, and in two a revision of one of the components was performed. Both infected ankles were fused. Five patients declined to participate this study, among these two were TAR failures. Survival with revision as the endpoint was 86% at final followup. The average AOFAS score was 75 (SD ± 15). On dynamic radiographs the ROM was 22 degrees (SD ± 8) in the tibiotalar joint. CONCLUSION: This study demonstrated that functional results of total ankle replacement in low volume centers were comparable to most high volume centers but survival was lower especially when we consider our shorter followup than most comparable series.
