Dual-pivot bearings improve ambulation and promote increased activity levels in Total knee arthroplasty: A match-controlled retrospective study

Rory Sandberg, Evan R. Deckard, Mary Ziemba-Davis, Scott A. Banks, R. Meneghini

Research output: Contribution to journalArticle

Abstract

Background: Modern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA. Methods: One hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up. Results: Study cohorts were identical with 72% female, average age of 68 years, and BMI of 33 kg/m2. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs. Conclusion: Patients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.

Original languageEnglish (US)
JournalKnee
DOIs
StateAccepted/In press - Jan 1 2019

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Knee Replacement Arthroplasties
Walking
Retrospective Studies
Knee
Spine
Pain
Fibromyalgia
Narcotics
Thigh
Patient Satisfaction
Biomechanical Phenomena
Sports
Cohort Studies
Depression

Keywords

  • Conforming polyethylene
  • Dual-pivot
  • Kinematics
  • Patient satisfaction
  • Total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Dual-pivot bearings improve ambulation and promote increased activity levels in Total knee arthroplasty : A match-controlled retrospective study. / Sandberg, Rory; Deckard, Evan R.; Ziemba-Davis, Mary; Banks, Scott A.; Meneghini, R.

In: Knee, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Modern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA. Methods: One hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up. Results: Study cohorts were identical with 72{\%} female, average age of 68 years, and BMI of 33 kg/m2. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs. Conclusion: Patients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.",
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AU - Sandberg, Rory

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AU - Banks, Scott A.

AU - Meneghini, R.

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N2 - Background: Modern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA. Methods: One hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up. Results: Study cohorts were identical with 72% female, average age of 68 years, and BMI of 33 kg/m2. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs. Conclusion: Patients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.

AB - Background: Modern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA. Methods: One hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up. Results: Study cohorts were identical with 72% female, average age of 68 years, and BMI of 33 kg/m2. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs. Conclusion: Patients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.

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KW - Patient satisfaction

KW - Total knee arthroplasty

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