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A new tibial insert design with ball-in-socket medial conformity and posterior cruciate ligament retention has low tibial baseplate migration after unrestricted kinematically aligned total knee arthroplasty: a cohort study using radiostereometric analysis. | LitMetric

A new tibial insert design with ball-in-socket medial conformity and posterior cruciate ligament retention has low tibial baseplate migration after unrestricted kinematically aligned total knee arthroplasty: a cohort study using radiostereometric analysis.

Acta Orthop

Department of Biomedical Engineering, University of California, Davis, CA; Department of Mechanical Engineering, University of California, Davis, CA; Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA.

Published: December 2024

AI Article Synopsis

  • - In total knee arthroplasty (TKA), using a ball-in-socket medial conformity (BS MC) insert with posterior cruciate ligament (PCL) retention better mimics natural knee movement compared to an intermediate (I) MC insert, but there are concerns about baseplate stability.
  • - A study on 35 patients using the BS MC insert found that the mean maximum total point motion (MTPM) was 0.35 mm after a year, indicating good stability, and showed no strong correlation with varus alignment.
  • - The results indicated that the BS MC insert provided similar clinical outcomes, flexion, and stability compared to the I MC insert, suggesting it is an effective alternative in TKA

Article Abstract

Background And Purpose:  In total knee arthroplasty (TKA), an insert with ball-in-socket (BS) medial conformity (MC) and posterior cruciate ligament (PCL) retention restores kinematics closer to native than an insert with intermediate (I) MC. However, high medial conformity might compromise baseplate stability as indicated by maximum total point motion (MTPM). Using the BS MC insert with PCL retention, we aimed to determine whether (i) the baseplate is stable as indicated by mean MTPM < 0.5 mm, (ii) baseplate stability is not strongly correlated to varus baseplate alignment, and (iii) baseplate stability, clinical outcome scores, and flexion are comparable with that of an I MC insert cohort which has demonstrated high stability, clinical outcome scores, and flexion.

Methods:  Unrestricted kinematic alignment (unKA) TKA was performed on a cohort of 35 patients using a cemented baseplate. Biplanar radiographs acquired at timepoints up to 12 months were processed with model-based radiostereometric analysis (RSA) software to determine MTPM.

Results:  At 1 year, mean MTPM of 0.35 mm was significantly below 0.5 mm (P < 0.001). MTPM was not strongly correlated to varus baseplate alignment up to 9° (r = 0.12, 95% confidence interval -0.22 to 0.44). Equivalence analyses revealed that MTPM, Forgotten Joint Score, Oxford Knee Score, and maximum flexion for the sBS MC insert were comparable with the I MC insert.

Conclusion:  Using the new BS MC insert with PCL retention, the tibial baseplate was stable at the group level at 1 year. Baseplate stability was not strongly related to varus baseplate and limb alignment. Comparable patient-reported outcome scores and maximum flexion/extension at 1 year were shown between the 2 insert designs.

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Source
http://dx.doi.org/10.2340/17453674.2024.42489DOI Listing

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