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EN
One of the main problems of knee replacement is the limit of knee flexion. This study focuses on the knee implant and the patellar component currently in use in total knee arthroplasty, analyzing the influence of patellar thickness on the degree of knee flexion following surgery. Methods: A kinematics study was performed to evaluate whether an optimal patellar thickness can be identified, which enables the maximum flexion angle to be achieved. Using TC images, a healthy model was built. On this basis, a model of a knee joint which had undergone total knee arthroplasty using a Legion PS prosthesis was constructed. Initially, the standard thickness of patellar implant (9 mm) was used to build the model; then several different patellar implant thicknesses (in the range of 5–15 mm) were analyzed. Results: The results show a non-linear trend: a button thickness of less than 9 mm does not change the flexion angle, whereas a button thickness of over 9 mm results in a loss of flexion. The flexion loss is significant in the first two additions of thicknesses but negligible in the last ones. Conclusions: In the case studied, flexion reduction is not linearly proportional to the patellar thickness. The outcome of total knee arthroplasty is considered to be satisfactory with the standard patellar button. The results of this study could be used to compare the kinematics with other total prosthesis and patellar implants, and should enable the optimization of the patellar residue bone thickness to obtain deep flexion.
EN
Purpose: The patients expect optimal knee function after Total Knee Arthroplasty. It is necessary to apply appropriate surgical technique and supervised physical therapy. The optimal management of posterior cruciate ligament remains controversial. Both implant designs, i.e., cruciate retaining and posterior substituting, allow the orthopedic surgeon to achieve excellent clinical outcomes, as measured by commonly used questionnaires. Such methods of assessment may poorly reflect the functional status of patients. Therefore, three-dimensional gait analysis is recommended to evaluate the outcomes of surgical intervention. This study sought to determine differences in kinematic gait parameters and Knee Society Score between cruciate-retaining and posterior-substituting patients. Methods:23 individuals after cruciate-retaining total knee arthroplasty and 19 individuals after posterior-substituting total knee arthroplasty were subjected to gait analysis using three-dimensional motion capture system BTS Smart DX 7000. In addition, gait was assessed in 21 patients with knee osteoarthritis and in 30 healthy individuals. Results: The study did not reveal differences between cruciate-retaining and posterior-substituting groups, both in terms of Knee Society Score and kinematic gait parameters. There were also no differences in kinematic gait parameters between patients from the knee osteoarthritis group and total knee arthroplasty groups. The analyzed parameters in all of the groups differed significantly from those found in healthy individuals. Conclusions: Surgical technique and implant design do not affect values of kinematic gait parameters evaluated under natural walking speed. Several months after surgery the patients still demonstrated alterations in gait pattern, similar to those recorded in patients with knee osteoarthritis.
PL
Endoprotezoplastyka jest obecnie podstawową metodą leczenia osób z zaawansowanymi zmianami zwyrodnieniowymi stawu kolanowego. Głównym celem zabiegu jest redukcja dolegliwości bólowych, poprawa zakresu ruchomości oraz przywrócenie stabilności stawu, co ma doprowadzić do polepszenia jakości życia chorych. Celem pracy była ocena efektów usprawniania pacjentów po wszczepieniu jedno- lub wieloosiowej endoprotezy stawu kolanowego. Badaniem objęto grupę 60 osób (45 kobiet i 15 mężczyzn) z zaawansowaną gonartrozą. Średnia wieku wynosiła 66,4 lata. 30 pacjentom wszczepiono jednoosiową endoprotezę SCORPIO CR a pozostałym 30 pacjentom endoprotezę wieloosiową PFC SIGMA. We wszystkich przypadkach zachowano więzadło krzyżowe tylne PCL (ang. Posterior Cruciate Ligament). Program leczenia usprawniającego we wczesnym okresie pooperacyjnym był taki sam u wszystkich chorych. Po około 3 miesiącach od zabiegu pacjenci byli usprawniani na Oddziale Rehabilitacji Narządu Ruchu przez okres 3 tygodni, korzystając z odpowiednio dobranego programu kinezy- i hydroterapii. Oceny zakresu ruchomości stawu kolanowego dokonano przed zabiegiem operacyjnym oraz po zakończeniu rehabilitacji. Wyniki wskazują na poprawę zakresu zgięcia oraz wyprostu operowanego stawu, zarówno u pacjentów z jedno-, jak i wieloosiowym implantem.
EN
Total arthroplasty is currently the main treatment of patients with advanced knee degeneration. The basic goal of the surgery is to reduce pain, improve range of motion (ROM), restore join stability, what can lead to the improved quality of life.The aim of this study was to examine the effects of rehabilitation of patients after single- or multi-axis total knee arthroplasty (TKA). The research was performed on a group of 60 people (45 women and 15 men) with advanced gonarthrosis (mean age 66,4 years). In 30 patients single-axis SCORPIO CR prostheses and in 30 multi-axis PFC Sigma prostheses, were implanted. In all cases the posterior cruciate ligament (PCL) has been retained. Physical therapy in the immediate postoperative period was the same in all groups. The patients were exposed to kinesi- and hydrotherapy 3 months after surgery. The functional status of the knee before surgery and after rehabilitation, were evalutaed. It was stated that the knee flexion and extension were improved. There was no significant difference between these 2 groups.
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