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Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs

BACKGROUND: Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to determine the reliability of stress radiographs for flexion laxity using manual stress as well a...

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Autores principales: Ryan, Sean P., Cochrane, Niall H., Jiranek, William A., Seyler, Thorsten M., Wellman, Samuel S., Bolognesi, Michael P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10233901/
https://www.ncbi.nlm.nih.gov/pubmed/37264460
http://dx.doi.org/10.1186/s13018-023-03862-x
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author Ryan, Sean P.
Cochrane, Niall H.
Jiranek, William A.
Seyler, Thorsten M.
Wellman, Samuel S.
Bolognesi, Michael P.
author_facet Ryan, Sean P.
Cochrane, Niall H.
Jiranek, William A.
Seyler, Thorsten M.
Wellman, Samuel S.
Bolognesi, Michael P.
author_sort Ryan, Sean P.
collection PubMed
description BACKGROUND: Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to determine the reliability of stress radiographs for flexion laxity using manual stress as well as a commercially available flexion stress device, with the hypothesis that a commercially available force device would provide increased translation compared to manual stress, and radiographic measurements would be reproducible. METHODS: Ten patients who previously underwent TKA with non-hinged components were prospectively and consecutively enrolled at a single center to undergo stress radiographs. Three lateral radiographs with the knee at 90° of flexion were obtained for each patient: rest, commercial stress device at 150N, and manual stress. Calibrated radiographs were evaluated by two raters, and inter-rater and intra-rater reliability were determined using intraclass correlation coefficients (ICC). RESULTS: Ten patients (seven female) with mean age 72 (range 55–82) years and average duration from surgery 36 (range 12–96) months were evaluated. The commercial stress device provided significantly less anterior translation than manual stress (− 0.3 mm vs. 3.9 mm; p < 0.01). Two patients reported pain with use of the stress device. Inter-observer reliability of measurements was good for commercial stress (ICC = 0.86) and excellent for manual stress (ICC = 0.94). Eighty-five percent of measurements were within 1 mm between observers. Intra-observer reliability of measurements was good to excellent for both the stress device and manual stress. CONCLUSIONS: Lateral stress radiographs may assist in the objective evaluation of flexion instability. A commercially available product provided less translation than manual stress; however, measurements were reliable and reproducible between observers. Further research is required to correlate translation with stress radiographs to patient outcomes following revision arthroplasty.
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spelling pubmed-102339012023-06-02 Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs Ryan, Sean P. Cochrane, Niall H. Jiranek, William A. Seyler, Thorsten M. Wellman, Samuel S. Bolognesi, Michael P. J Orthop Surg Res Research Article BACKGROUND: Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to determine the reliability of stress radiographs for flexion laxity using manual stress as well as a commercially available flexion stress device, with the hypothesis that a commercially available force device would provide increased translation compared to manual stress, and radiographic measurements would be reproducible. METHODS: Ten patients who previously underwent TKA with non-hinged components were prospectively and consecutively enrolled at a single center to undergo stress radiographs. Three lateral radiographs with the knee at 90° of flexion were obtained for each patient: rest, commercial stress device at 150N, and manual stress. Calibrated radiographs were evaluated by two raters, and inter-rater and intra-rater reliability were determined using intraclass correlation coefficients (ICC). RESULTS: Ten patients (seven female) with mean age 72 (range 55–82) years and average duration from surgery 36 (range 12–96) months were evaluated. The commercial stress device provided significantly less anterior translation than manual stress (− 0.3 mm vs. 3.9 mm; p < 0.01). Two patients reported pain with use of the stress device. Inter-observer reliability of measurements was good for commercial stress (ICC = 0.86) and excellent for manual stress (ICC = 0.94). Eighty-five percent of measurements were within 1 mm between observers. Intra-observer reliability of measurements was good to excellent for both the stress device and manual stress. CONCLUSIONS: Lateral stress radiographs may assist in the objective evaluation of flexion instability. A commercially available product provided less translation than manual stress; however, measurements were reliable and reproducible between observers. Further research is required to correlate translation with stress radiographs to patient outcomes following revision arthroplasty. BioMed Central 2023-06-01 /pmc/articles/PMC10233901/ /pubmed/37264460 http://dx.doi.org/10.1186/s13018-023-03862-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Ryan, Sean P.
Cochrane, Niall H.
Jiranek, William A.
Seyler, Thorsten M.
Wellman, Samuel S.
Bolognesi, Michael P.
Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
title Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
title_full Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
title_fullStr Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
title_full_unstemmed Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
title_short Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
title_sort evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10233901/
https://www.ncbi.nlm.nih.gov/pubmed/37264460
http://dx.doi.org/10.1186/s13018-023-03862-x
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