FUNCTIONAL AND RADIOGRAPHIC SHORT-TERM OUTCOME EVALUATION OF THE TOTAL KNEE ARTHROPLASTYIN PANTI RAPIH HOSPITAL YOGYAKARTA - AZETA ARIF-

FUNCTIONAL AND RADIOGRAPHIC SHORT-TERM OUTCOME EVALUATION OF THE TOTAL KNEE ARTHROPLASTY IN PANTI RAPIH HOSPITAL YOGYAKARTA

FUNCTIONAL AND RADIOGRAPHIC SHORT-TERM OUTCOME EVALUATION OF THE TOTAL KNEE ARTHROPLASTYIN PANTI RAPIH HOSPITAL YOGYAKARTA

Arif A*,Rhatomy S*,Kisworo B***Fellow of Indonesian Hip and Knee Fellowship Program**Staff of Orthopaedic and Traumatology department, Panti Rapih General Hospital,Yogyakarta

BackgroundTKA : standard treatment for end stage knee arthritis : degenerative, post-traumatic or metabolic causes. 1Generally relieves pain, improves physical function, and has a high level of patient satisfaction, especially in the elderly.1 1.Hawker G, Wright J, Coyte P, et al. Health-related quality of life after knee replacement. J Bone Joint Surg Am. 1998; 80(2):163-173. 1There have been many reports of the long-term outcome of cemented TKA2,3,4

We did not have report about the functional and radiographic outcome of TKA in Indonesian people.

2.Forster MC. Survival analysis of primary cemented total knee arthroplasty: which designs last? J Arthroplasty 2003;18:265-70.3. Ranawat CS, Flynn WF Jr, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplast: a 15-year survivorship study. Clin Orthop1993;286:94-102. 4.Falatyn S, Lachiewicz PF, Wilson FC. Survivorship analysis of cemented total condylar knee arthroplasty. Clin Orthop 1995;317:178-84.

Patient and Methods Jan 2003-Dec 2012330 TKAs on 294 patients PCL retaining TKA and PCL- sacrificing (J&J, Zimmer, Stryker) Retrospective cohort studyPatient come in to the clinic for evaluation 24 patient (37 knees)Pre op diagnosis : severe OA, RA.Demographics of the study population

Surgical Technique and Postoperative Care Standard length medial parapatellar approachWheater or not a lateral/medial release Did not performed patellar resurfacing for all casesFemoral and tibial components : cement, doughy.Torniquet release after cementation : hemostasisClosure : interupted nonabsorbable sutures to closure retinaculum.

DVT prophylaxis LMW heparinWeight bear as tolerated 1 day after surgeryDischarged 3 days after surgeryOutpatient physiotherapy 4-6 weeks after hospital dischargeRoutinely follow up at 10 days, 3 months, and 1 year and periodically year after Clinical Assesment Post Operative evaluation :Knee Society Function Score Knee Society Rating score ROM by goniometerEarly postoperative and final follow-up evaluations were assessed during the clinical follow-up.

Clinical assessment

KSS Rating System5 KSS Function Score6 5. Reference for Rating: Asif S , Choon DS . Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system. J Orthop Surg (Hong Kong). 2005 Dec;13(3):280-4.6. Reference for score: Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989 Nov;(248):13-4. link to pubmed. Link SF36, SF12

Clinical assessmentROM by goniometer

Early postoperative and final follow-up evaluations were assessed during the clinical follow-up.

Anteroposterior view : measure femoral angle (), tibial angle () and total valgus angle ( + )Lateral view : Femoral implant flexion (), tibial angle/posterior slope ()Skyline view : Patellar tilt, patellar shiftLucency : femoral implant and tibial implant anterior and lateral.

Radiographic Analysis

7. Lippincott Williams & Wilkins. This article originally appeared in Clin Orthop. 1989 Nov;(248):9-12. PMID: 2805502)

AP View

7. Lippincott Williams & Wilkins. This article originally appeared in Clin Orthop. 1989 Nov;(248):9-12. PMID: 2805502)

The mechanical axis cannot be accurately measured using short AP radiographs of the knee.7 In such cases, the compo- nent positions can be assessed with reference to the anatomical axes of the femur and tibia instead7 the femoral angle (the medial angle between the femoral anatomical axis and a tangent to the distal ends of the femoral condyles) should be about 95 degree.7,8 The tibial angle (the medial angle between the tibial anatomical axis and a line along the tibial base plate) should be about 90.7,8 The overall femorotibial angle is the sum of the femoral and tibial angles, and should be about 185. 7,8In other words, the replaced knee should be in about 5 valgus. It should be emphasised that this is only a surrogate measure for the mechanical axis.7

If there is significant bowing of the femur or tibia in the coronal plane, such angles may not reflect the actual lower limb mechanical axis.

7. Lippincott Williams & Wilkins. This article originally appeared in Clin Orthop. 1989 Nov;(248):9-12. PMID: 2805502)

Radiolucency

7. Chiu,K.Y.,Cheng,H.C.,Yau.W.P., et al, Reading radiograph after total knee arthroplasty.Hongkong J Orthop Surg.2010;14(1):225-39

RadiolucencyThe width of the radiolucent line for each of the zones is measured in mm and these widths are added together to give a total score. 7For a tibial component with a central stem (7 zones:7 a score of 4 is probably insignificant;closely followed for progression : score is 5-9a score of 10 signifies possible or impending failure regardless of symptoms. A stable radiolucent line at the cementbone interface of 5 degree or > 5 mm.12

12.Paratte.S.,Pagnano.M.W.,Trousdale.R.T., et al.Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern,cemented total knee arthroplasty.JBJS.2010;92:2143-9

Radiolucency Lateral view femoral componentOur Study:Patil et al : PFC-TKA 14 years follow-up

12.Patil,S.S.,Branovacki.G.,Martin,M.R.,et al.14-Year Median Follow-Up Using the Press-Fit Condylar Sigma Design for Total Knee Arthroplasty.Arthroplasty.2013;1-5Radioluscence Tibial implant AP View Our Study

Patil et al : PFC TKA14 years follow up

12.Patil,S.S.,Branovacki.G.,Martin,M.R.,et al.14-Year Median Follow-Up Using the Press-Fit Condylar Sigma Design for Total Knee Arthroplasty.Arthroplasty.2013;1-5Weaknesses of the study Weaknesses of the study are its retrospective nature, short-term follow up and small population.The latest developments in TKA are high-flex knees and sex-specific knees specifically developed to achieve more range of motion, potentially allowing a higher level of activity for patients. An increased range of motion in high-activity young patients may result in early loosening. Future research will show us the long-term results of the new TKA designs ConclusionOur experience with TKA in our hospital has been encouraging. The risks of implant loosening and wear in our study are low.This type of TKA seems to be an effective and safe treatment for patients. Functional and radiographic outcome were comparable to other published studiesMost patients do well after a short-term follow-up period.

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