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Three different cruciate sacrificing TKA designs: no intraoperative kinematic differences and no clinical differences at 2 years follow up. Bruni D, Bignozzi.

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Presentation on theme: "Three different cruciate sacrificing TKA designs: no intraoperative kinematic differences and no clinical differences at 2 years follow up. Bruni D, Bignozzi."— Presentation transcript:

1 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. Rizzoli Orthopaedic Institute – Bologna, Italy

2 Sparmann et al 2003 Amiot et al 2004 Decking et al 2005 Saragaglia et al 2001 Jenny et al 2001 Kim et al 2005 Anderson et al 2005 Novak et al 2007 Sparmann et al 2003 Amiot et al 2004 Decking et al 2005 Saragaglia et al 2001 Jenny et al 2001 Kim et al 2005 Anderson et al 2005 Novak et al 2007 Chauhan et al 2004 Martin et al 2005 Decking et al 2005 Matziolis et al 2007 Kim et al 2007 Kalairajah et al 2007 Chauhan et al 2004 Martin et al 2005 Decking et al 2005 Matziolis et al 2007 Kim et al 2007 Kalairajah et al 2007 Perlick et al 2004 Haaker et al 2005 Chauahan et al 2004 Bathis et al 2004 Matziolis et al Perlick et al 2004 Haaker et al 2005 Chauahan et al 2004 Bathis et al 2004 Matziolis et al  Better limb alignment  Better implant positioning  Comparable surgical times  Less blood loss Why using Navigation system? Brin, Int Orthop 2010 Biasca, Orthop Clin North Am Dorr, Orthopedics Berend ME. Orthopedics Dattani R. Int Orthop Sikorski JM. Jbjs Br Mason JB, J Arthroplasty Claus A, Orthopade Briard JL, Orthopade Siston RA, J Biomech Laskin RS CORR. 2006

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

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] [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. [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): [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° 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  Significative reduction at 0° (p=0.006)  Not significant at 30°  No statistical differences between the three models «3° condyle» -MBULTRACONGRUENT-MB (AS)SPINE CAM-MB

8 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) «3° condyle» -MB ULTRACONGRUENT-MB (AS)SPINE CAM-MB Under stress AP 90 Laxity

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’’ B) “3° CONDYLE“- MB C) ULTRACONGRUENT-MB A) SPINE-CAM MB NOT statistically significant

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

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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