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Rizzoli Orthopaedic Institute – Bologna, Italy

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Presentation on theme: "Rizzoli Orthopaedic Institute – Bologna, Italy"— Presentation transcript:

1 Rizzoli Orthopaedic Institute – Bologna, Italy
Three different cruciate sacrificing TKA designs: no intraoperative kinematic differences and no clinical differences at 2 years follow up. Bruni D, Bignozzi S, Zaffagnini S, Akkawi I, Marko T, Gagliardi M, Colle F, Marcacci M.

2 Why using Navigation system?
Better limb alignment Better implant positioning Sparmann et al Amiot et al Decking et al Saragaglia et al 2001 Jenny et al Kim et al Anderson et al Novak et al Brin, Int Orthop 2010 Biasca, Orthop Clin North Am. 2009 Dorr, Orthopedics. 2009 Berend ME. Orthopedics. 2009 Dattani R. Int Orthop. 2009 Sikorski JM. Jbjs Br. 2008 Mason JB, J Arthroplasty. 2007 Claus A, Orthopade. 2007 Briard JL, Orthopade. 2007 Siston RA, J Biomech. 2007 Laskin RS CORR. 2006 Perlick et al Haaker et al Chauahan et al 2004 Bathis et al Matziolis et al. 2007 Comparable surgical times Less blood loss Chauhan et al Martin et al Decking et al Matziolis et al Kim et al Kalairajah et al 2007

3 Clinical efficacy has not yet been demonstrated
1/4 patients in USA,UK & Canada are not satisfied Regardless of whether CAS or conventional Can we use navigation system to evaluate intraoperative clinical and functional differences in different implants?

4 Materials and Methods 90 patients with primary OA
Average age at surgery: 70 years (57-85) Randomized distribution into 3 groups of cruciate sacrificing TKA “3° Condyle“- MB (CS) ULTRACONGRUENT-MB (AS) SPINE CAM-MB (PS)

5 Intraoperative kinematics acquisition:
PROM: passive range of motion, (0°-120°) AP90: Drawer test at 90 ° of flexion, exerting maximum force VV Stress Test at 0° and 30° Test repeated 3 times

6 Materials and methods Clinical evaluation using standardized scores: WOMAC [1], KSS-f [2], SF-36 [3]  [1] Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther Aug;28(2):88-96.  [2] Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res Nov;(248):13-4. [3] Ware JE Jr, Sherbourne D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care  1992 Jun;30(6):

7 Under stress VV Laxity at 0° e 30°
«3° condyle» -MB ULTRACONGRUENT-MB (AS) SPINE CAM-MB Significative reduction at 0° (p=0.006) Not significant at 30° No statistical differences between the three models Laxity reduction VV 0°: -3,1° ’’3rd CONDYLE’’ -2,4° ULTRACONGRUENT-MB -2,3° SPINE CAM-MB Laxity reduction VV 30°: -0° ’ ’3rd CONDYLE’’ -1,1° ULTRACONGRUENT-MB -1,1° SPINE CAM-MB

8 Under stress AP 90 Laxity Under stress AP 90 laxity
«3° condyle» -MB ULTRACONGRUENT-MB (AS) SPINE CAM-MB Under stress AP 90 laxity 2mm of laxity reduction for ‘’3° CONDYLE’’ model (p=0.007) 4.9mm of laxity increase for ULTRACONGRUENT-MB model (p=0.008) 5mm of laxity increase for SPINE CAM-MB model (p=0.008)

9 Internal (-) and External (+) tibial rotation during flexion
Postoperative reduction of Internal rotation in all 3 models More stable pattern for SPINE CAM-MB e ’’3rd Condyle’’ A) SPINE-CAM MB NOT statistically significant B) “3° CONDYLE“- MB C) ULTRACONGRUENT-MB

10 NOT statistically significant
B) “3rd CONDYLE“- MB AP translation (mm) Of femoral epicondyles during flexion C) ULTRACONGRUENT-MB NOT statistically significant A) SPINE-CAM MB Slightly better pattern in SPINE CAM-MB

11 Clinical results

12 CONCLUSIONS Reduction of tibial internal rotation after surgery, increased posterior translation of the femoral epicondyles in all three models Better AP stability was noticed in ‘’3rd condyle’’ model No significant differences in clinical score at 2 years in all 3 models

13 Thank you for your attention

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