Publications by authors named "Hilde Vandenneucker"

45 Publications

Patient-reported outcomes after primary rotating hinge total knee arthroplasty: a multi-centre clinical cohort study.

Int Orthop 2021 Jul 29. Epub 2021 Jul 29.

Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium.

Purpose: Rotating hinge prostheses for total knee arthroplasty (TKA) are mostly used in revision setting; however, evidence on the use of these constrained devices in primary setting is scarce and inconsistent. Therefore, we aimed to evaluate the functional outcomes after third-generation rotating hinge implants in primary TKA with a minimal follow-up of two years in a large dual-centre observational retrospective clinical trial.

Methods: The hospital databases of two centres were searched for primary rotating hinge arthroplasty from January 2007 to January 2015. A minimum follow-up of at least two years was assured. Patients meeting the inclusion criteria were asked to fill out two self-reported functional scores, the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS), to measure the functional status of the knee.

Results: In total, 267 primary rotating hinge knee arthroplasties in 242 patients were performed in two centres. The three major indications were axial malalignment (valgus/varus > 15°), 87/267 (33%), persistent ligamentous instability (28%) and neuromuscular disorders (12%). 184 patients with 202 primary rotating hinge knee arthroplasties could be included that provided data of the self-reported outcome measures (OKS and FJS). A mean OKS score of 37.71 (± 9.23) and a mean FJS score of 63.65 (± 31.01) could be obtained.

Conclusion: This large clinical study suggests that constrained devices provide the best results when treating bone-on-bone tricompartimental osteoarthritis of the knee with severe axial deviation (valgus/varus > 15°) and/or persistent ligamentous instability.
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http://dx.doi.org/10.1007/s00264-021-05162-7DOI Listing
July 2021

Bicruciate retaining total knee arthroplasty : results throughout history.

Acta Orthop Belg 2021 Mar;87(1):73-83

Approximately 20% amongst patients are dissatisfied after total knee arthroplasty (TKA). Bicruciate retaining (BCR) TKA offers superior knee kinematics and proprioception, but many surgeons abandoned its use because of complications and technical difficulties. Recently, two new BCR implant designs were introduced : Vanguard XP (Zimmer Biomet) and Journey XR (Smith&Nephew). We searched Pubmed, Limo, Embase and Cochrane, screened reference lists of eligible studies and included studies that met the inclusion criteria. We included 35 articles reporting on ten different BCR implants, including three articles presenting results of the Vanguard XP prosthesis. Unfortunately, no articles reporting on the results of the Journey XR prosthesis had been published. The BCR implants of the early 1970s showed good functional results, but a high rate of complications, mainly loosening and infections. The Townley Anatomic TKA was the first BCR implant with good clinical results, a low incidence of loosening and a high survivorship. One article of the three reporting on the Vanguard XP yielded high patient satisfaction (94%) with two revisions (1.4%). The two other articles reported three revisions (5%) after one year of follow-up and 19 revisions (13.4%) after three years of follow-up. Throughout history, the functional results of BCR TKA improved, with lessening of the complications. The short-term results of the Vanguard XP implant showed good functional results, but two out of three articles reported a high rate of loosening. Based on the results reported in this review, the use of BCR TKA is still debatable. Further high-level evidence research is necessary to assess the clinical benefit of BCR TKA.
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March 2021

Validated Ultrasound Speckle Tracking Method for Measuring Strains of Knee Collateral Ligaments In-Situ during Varus/Valgus Loading.

Sensors (Basel) 2021 Mar 8;21(5). Epub 2021 Mar 8.

Development and Regeneration Department, Institute for Orthopaedic Research and Training (IORT), KU Leuven, 3000 Leuven, Belgium.

Current ultrasound techniques face several challenges to measure strains when translated from large tendon to in-situ knee collateral ligament applications, despite the potential to reduce knee arthroplasty failures attributed to ligament imbalance. Therefore, we developed, optimized and validated an ultrasound speckle tracking method to assess the in-situ strains of the medial and lateral collateral ligaments. Nine cadaveric legs with total knee implants were submitted to varus/valgus loading and divided into two groups: "optimization" and "validation". Reference strains were measured using digital image correlation technique, while ultrasound data were processed with a custom-built speckle tracking approach. Using specimens from the "optimization" group, several tracking parameters were tuned towards an optimized tracking performance. The parameters were ranked according to three comparative measures between the ultrasound-based and reference strains: R, mean absolute error and strains differences at 40 N. Specimens from the "validation" group, processed with the optimal parameters, showed good correlations, along with small mean absolute differences, with correlation values above 0.99 and 0.89 and differences below 0.57% and 0.27% for the lateral and medial collateral ligaments, respectively. This study showed that ultrasound speckle tracking could assess knee collateral ligaments strains in situ and has the potential to be translated to clinics for knee arthroplasty-related procedures.
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http://dx.doi.org/10.3390/s21051895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962828PMC
March 2021

What are the determinants for return to work after primary total knee arthroplasty?

Acta Orthop Belg 2020 Sep;86(3):453-462

Total knee arthroplasty is increasingly performed on patients of working age, although little is known about return to work. This study aims to analyse the return to work percentage in a Belgian population and to identify underlying determinants. Data was gathered by analysing patients' files and sending a questionnaire to patients aged ≤ 62 years who underwent a total knee arthroplasty between January 2013 and December 2017 in the University Hospitals of Leuven. A total of 99 patients were included in the study and 66 patients returned to work. Significant factors included preoperative sick leave, availability of job adaptations, employment type and postoperative Knee Society Score. The return to work percentage of 67% in this Belgian population is slightly lower in comparison with similar studies in other countries. This difference could be driven by Belgium's specific insurance system or due to a lack of clear prescription guidelines for medical doctors.
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September 2020

Return to Work after Primary Total Knee Arthroplasty under the Age of 65 Years: A Systematic Review.

J Knee Surg 2021 Jan 20. Epub 2021 Jan 20.

Division of Orthopaedics, Department of Development and Regeneration-Organ Systems Cluster, KU Leuven, University Hospitals Leuven, Belgium, B-3000 Leuven, Belgium.

A growing number of patients undergoing total knee arthroplasty (TKA) is at working age and need to return to work (RTW) after surgery. The aim of this systematic review is to give an overview of the literature regarding RTW after TKA and beneficial and limiting factors influencing this process. A systematic search in four electronic databases was conducted in November 2019 to identify studies describing RTW after primary TKA in patients aged 65 years or younger. Study characteristics and data on work status before and after surgery were extracted. All studies were assessed for risk of bias. Fourteen studies published between 2009 and 2019 were included in this review, accounting for a total of 3,073 patients. The percentage of patients working after TKA ranged from 36 to 89%, and the fraction of patients working before and returning to work after surgery ranged from 40 to 98%. Mean time of RTW ranged from 7.7 to 16.6 weeks. Most important factors associated with a slower or no RTW were a more physical nature of employment and preoperative absence from work. The majority of patients undergoing TKA returned to work postoperatively. However, comparison between studies is seriously hampered by the wide variation regarding the definition and timeframe used to measure the work status. Therefore, standardized outcome measures for studies investigating RTW after TKA are warranted. We identify this review as level-I evidence (systematic review of level-I and level-II studies).
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http://dx.doi.org/10.1055/s-0040-1722626DOI Listing
January 2021

Mucoid degeneration of the anterior cruciate ligament. Complete resection as equivalent treatment to partial resection.

Acta Orthop Belg 2020 Jun;86(2):272-279

Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006-2016. Symptoms included limited range of motion (ROM) and posterior knee pain. Preoperative and postoperative results of eleven patient were compared. Postoperative recovery was four weeks on average. All patients (100%, n=11) reported an improvement in pain. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. All patients (100%, n=11) reported a good to very good surgery satisfaction. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL.
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June 2020

Athletes with an ACL reconstruction show a different neuromuscular response to environmental challenges compared to uninjured athletes.

Gait Posture 2021 01 4;83:44-51. Epub 2020 Oct 4.

Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Tervuursevest 101 Box 1501, 3001 Leuven, Belgium. Electronic address:

Background: Evidence suggests that neuromuscular alterations in patients with an anterior cruciate ligament reconstruction (ACLR) are rooted in neurocognitive and proprioceptive deficits. The aim of this study was to assess neuromuscular control of athletes with ACLR under increased cognitive and environmental challenges.

Research Question: Do athletes with ACLR show a different neuromuscular response to cognitive and environmental challenges relative to controls?

Methods: Cross-sectional study. Twenty athletes who had an ACLR (age: 23.7 ± 4.3 years, 14 males, time post-surgery: 258.6 ± 54 days) and twenty uninjured controls (age: 21.4 ± 1.5 years, 14 males) performed a stepping down-task in four environmental conditions: no additional challenges, while performing a cognitive dual-task, while undergoing an unpredictable support surface perturbation, and with the cognitive dual-task and unpredictable perturbation combined. Muscle activations of the vastus medialis (VM), vastus lateralis, hamstrings medialis (HM), hamstrings lateralis (HL), gastrocnemius medialis, gastrocnemius lateralis (GL) and gluteus medius were recorded with surface EMG. A three-way ANOVA with main effects for group, dual-task and perturbation was used to compare muscle activations.

Results: Athletes with ACLR show larger HM (ES = 0.45) and HL activation (ES = 1.32) and lower VM activation (ES = 0.72), compared to controls. Athletes with ACLR show a significantly smaller increase in VM (ES = 0.69), VL (ES = 0.53) and GL activation (ES = 0.52) between perturbed and unperturbed tasks compared to controls. Furthermore, under cognitive loading a significantly larger decrease in HM activation (ES = 0.40) and (medial) co-contraction (ES = 0.75) was found in athletes with ACLR compared to controls.

Significance: Athletes with ACLR show an altered neuromuscular response which might represent an arthrogenic muscle response. They show less additional adaptation to perturbed tasks compared to controls, potentially as result of altered proprioceptive input. Furthermore a larger influence of increased cognitive loading on the neuromuscular control was found in athletes with ACLR, indicating that also neurocognitive limitations may contribute to altered neuromuscular control.
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http://dx.doi.org/10.1016/j.gaitpost.2020.09.032DOI Listing
January 2021

Good long-term survival and patient-reported outcomes after high tibial osteotomy for medial compartment osteoarthritis.

Knee Surg Sports Traumatol Arthrosc 2020 Sep 9. Epub 2020 Sep 9.

Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.

The lateral closing and medial opening wedge high tibial osteotomy can correct a varus malalignment of the knee caused by medial compartment osteoarthritis. These procedures have produced great short-term and mid-term results. As no systematic review has examined their long-term results yet, the goal of this article was to compare the results of all articles about lateral closing and medial opening wedge high tibial osteotomies, published after the year 2000, with a mean follow-up of more than 10 years. A systematic search of the Medline, Web of Science and Cochrane databases resulted in the inclusion of 30 articles. All these studies combined examined the results of 7087 high tibial osteotomies in a total of 6636 patients after a mean follow-up of more than 10 years. Primary outcome measures were the survival rate of the osteotomy, functional scores, patient satisfaction and pain scores. Secondary outcome measures were alignment correction and the identification of factors influencing the survival of the osteotomy. The 5-year, 10-year, 15-year and 20-year survival rates, respectively, ranged from 86 to 100%, 64-97.6%, 44-93.2% and 46-85.1%. The subjective scoring systems showed an improvement postoperatively that was maintained until final follow-up. The anatomical and mechanical tibiofemoral axis were, respectively, corrected to a mean of 7.3°-13.8° of valgus and 0.6°-4° of valgus. The results of the articles evaluating the influence of potential risk factors were contradictory. Despite the low quality of the available evidence, the lateral closing and medial opening wedge high tibial osteotomy seem to remain valid long-term treatment options for patients with painful varus malalignment caused by isolated medial compartment osteoarthritis of the knee. The available results indicate that the need for arthroplasty could be delayed for more than 15 years in the majority of patients. However, higher-quality studies are needed to confirm these findings. As a systematic review is assigned a level of evidence equivalent to the lowest level of evidence used from the analyzed manuscripts, the level of evidence of this systematic review is IV.
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http://dx.doi.org/10.1007/s00167-020-06262-4DOI Listing
September 2020

Can a ratio between medial and lateral meniscal volumes be calculated to determine critical meniscal volume in view of post-meniscectomy symptoms?

Acta Orthop Belg 2020 Mar;86(1):77-81

Partial meniscectomy is a frequently performed treatment strategy for non-suturable meniscal tears. However, the meniscal volume which can be resected without compromising the load-bearing, shock-absorbing function of the meniscus remains a topic of ongoing research. The aim of this study was to calculate the medio-lateral meniscal volume ratio to estimate this volume. In 90 patients (98 pairs of menisci) without meniscal injury, medial and lateral menisci were segmented on MRI imaging and 3D surface models were created to calculate volume. The mean medial meniscal volume was 1928,9mm3 and the mean lateral meniscal volume was 1681,7mm3. A fixed ratio of the medial over the lateral meniscal volume was calculated to be 1,16. The standard deviation of the prediction errors based on this ratio equals 217mm3. This ratio seems a useful parameter in follow-up research to determine whether there is a critical volume which can be resected without post-operative pain and osteoarthritis.
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March 2020

The influence of weather conditions on osteoarthritis and joint pain after prosthetic surgery.

Acta Orthop Belg 2020 Mar;86(1):1-9

The purpose of this narrative review was to highlight the research on the influence of weather conditions on patients with osteoarthritis, the pathophysiological mechanisms and the therapeutic consequences. A search was conducted using the Pubmed, Medline and Web of Science databases. Barometric pressure, temperature and humidity are the weather conditions that are found to be correlated most to the worsening of pain complaints. But, due to the difficulty of measuring the impact of these variables and the great diversity in study protocols, an analysis of studies regarding this topic shows conflicting results. Central sensitization mechanisms and the function of a Transient Receptor Potential channel might explain the pain hypersensitivity to cold weather. Joint pain, caused by central sensitization mechanisms, cannot always be treated with joint arthroplasty. When pain remains present after joint arthroplasty, centrally mediated pain constitutes an important role.
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March 2020

SCreg: a registration-based platform to compare unicondylar knee arthroplasty SPECT/CT scans.

BMC Musculoskelet Disord 2020 Mar 12;21(1):162. Epub 2020 Mar 12.

Development and Regeneration Department, Institute for Orthopaedic Research and Training, KU Leuven, 49 Herestraat - Box 805, 3000, Leuven, Belgium.

Background: A combination of conventional computed tomography and single photon emitted computed tomography (SPECT/CT) provides simultaneous data on the intensity and location of osteoblastic activity. Currently, since SPECT/CT scans are not spatially aligned, scans following knee arthroplasty are compared by extracting average and maximal values of osteoblastic activity intensity from large subregions of the structure of interest, which leads to a loss of resolution, and hence, information. Therefore, this paper describes the SPECT/CT registration platform (SCreg) based on the principle of image registration to spatially align SPECT/CT scans following unicondylar knee arthroplasty (UKA) and allow full resolution intra-subject and inter-subject comparisons.

Methods: SPECT-CT scans of 20 patients were acquired before and 1 year after UKA. Firstly, scans were pre-processed to account for differences in voxel sizes and divided in volumes of interest. This was followed by optimization of registration parameters according to their volumetric agreement, and alignment using a combination of rigid, affine and non-rigid registration. Finally, radiotracer uptakes were normalized, and differences between pre-operative and post-operative activity were computed for each voxel. Wilcoxon signed rank sum test was performed to compare Dice similarity coefficients pre- and post-registration.

Results: Qualitative and quantitative validation of the platform assessing the correct alignment of SPECT/CT scans resulted in Dice similarity coefficient values over 80% and distances between predefined anatomical landmarks below the fixed threshold of (2;2;0) voxels. Locations of increased and decreased osteoblastic activity obtained during comparisons of osteoblastic activity before and after UKA were mainly consistent with literature.

Conclusions: Thus, a full resolution comparison performed on the platform could assist surgeons and engineers in optimizing surgical parameters in view of bone remodeling, thereby improving UKA survivorship.
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http://dx.doi.org/10.1186/s12891-020-3185-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066757PMC
March 2020

Single-Joint and Whole-Body Movement Changes in Anterior Cruciate Ligament Athletes Returning to Sport.

Med Sci Sports Exerc 2020 08;52(8):1658-1667

Musculoskeletal Rehabilitation Research Group, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM.

Introduction: Athletes returning to sport after anterior cruciate ligament reconstruction (ACLR) demonstrate prolonged changes in landing kinematics, kinetics, and muscle activation, predisposing them for reinjury, knee osteoarthritis, and/or knee instability. So far, researchers have been focusing on how kinematics and kinetics change in every joint separately. However, as the human body operates within a kinetic chain, we will assess whether single-joint changes are associated with whole-body changes.

Methods: Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks, whereas lower limb kinematics, kinetics, and muscle activations of vastus medialis, vastus lateralis, biceps femoris, semitendinosus, semimembranosus, gastrocnemius, and gluteus medius were recorded. Single-joint landing kinematics, kinetics, and muscle activations of the ACL-injured leg were compared with the uninjured leg and compared with the control group. Whole-body changes were assessed by decomposing movements into fundamental components using marker-based principal component analysis (PCA).

Results: We found several single-joint changes in landing kinematics, kinetics, and muscle activations in the athletes with ACLR that were seen across all tasks and therefore of major interest as they are likely to occur during sports as well. Hamstrings activation increased and external knee flexion moments decreased in the ACL-injured leg compared with their uninjured leg. Furthermore, hip adduction moments and knee abduction angles decreased compared with the control group. The PCA could detect changes in whole-body movement, which were task-specific.

Conclusions: Athletes with ACLR still show protective task-independent single-joint kinematic, kinetic, and muscle activation changes during single-leg landings at the time of return to sport. These single-joint changes were not consistently accompanied by changes in whole-body movements (revealed by marker-based PCA). Whole-body expressions of the single-joint compensations are likely to be affected by the demands of the task.
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http://dx.doi.org/10.1249/MSS.0000000000002308DOI Listing
August 2020

Are Anterior Cruciate Ligament-reconstructed Athletes More Vulnerable to Fatigue than Uninjured Athletes?

Med Sci Sports Exerc 2020 02;52(2):345-353

Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, BELGIUM.

Introduction: Fatigue has a negative impact on lower extremity neuromuscular and biomechanical control. Because anterior cruciate ligament reconstruction (ACLR) athletes show already neuromuscular/biomechanical deficits in an unfatigued state, the negative impact of fatigue may magnify these deficits or help expose other deficits. So far, this has only scarcely been assessed warranting further research.

Methods: Twenty-one athletes who had an ACLR and 21 uninjured controls performed five unilateral landing tasks before and after a match simulation protocol, whereas muscle activation (vastus medialis, vastus lateralis, hamstrings medialis, hamstrings lateralis, gastrocnemius medialis, gastrocnemius lateralis, gluteus medius) and landing kinematics and kinetics of the hip, knee, and ankle joint were recorded. A two-way ANOVA with a mixed-model design (main effects for group and fatigue) was used to compare landing kinematics, kinetics, and muscle activation between groups, and prefatigue and postfatigue. To avoid unjustified reduction of the data to discrete values, we used one-dimensional Statistical Parametric Mapping.

Results: Only two interaction effects were found: an increased postfatigue knee abduction moment and an increased postfatigue thorax flexion angle was found in the ACL injured legs but not in the uninjured legs of the ACL group or in the control group, during the lateral hop and the vertical hop with 90° medial rotation, respectively.

Conclusions: This study showed that overall ACLR athletes and uninjured athletes have similar biomechanical and neuromuscular responses to fatigue. For two biomechanical parameters, however, we did find an interaction effect, suggesting that landing deficits in ACLR athletes may become clearer in certain tasks when fatigued.
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http://dx.doi.org/10.1249/MSS.0000000000002143DOI Listing
February 2020

Patellar tendon buckling in post-operative total knee arthroplasty patients is more prominent than in healthy controls.

Med Eng Phys 2019 07 18;69:28-32. Epub 2019 Jun 18.

University Hospitals Leuven, Campus Pellenberg, Pellenberg, Belgium.

Recent evidence suggests the patellar tendon undergoes buckling during normal knee flexion, which likely contributes to the functioning of the extensor mechanism. Thus, evaluating buckling in patients following total knee arthroplasty (TKA), where extensor mechanism dysfunction remains a common complication, may be relevant. The study goals were to identify whether post-TKA patients exhibit differences in patellar tendon buckling from healthy, similarly-aged adults and whether such buckling correlates with knee and patellar tendon health. Patellar tendon buckling was assessed during passive knee flexion using ultrasound in post-TKA patients (n = 20; 12M, 68 ± 8 years) and compared with previously reported data from healthy adults (n = 12; 12M; 70 ± 8 years). Patients exhibited significantly larger (p < 0.01) buckling magnitude and angles than healthy adults, and reduced distal buckling was linked with better Knee Society Scores (p = 0.04, R = 0.24). The greater patellar tendon buckling observed in post-TKA patients could arise due to factors related to the surgery itself (e.g. infrapatellar fat pad resection) or it may be that post-TKA patients had greater patellar tendon buckling before their procedure. Alterations in patellar tendon buckling may predispose individuals to post-surgical complications including instability, anterior knee pain, and extensor mechanism dysfunction, with further work necessary to elucidate potential links.
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http://dx.doi.org/10.1016/j.medengphy.2019.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612598PMC
July 2019

Midterm Performance of a Guided-Motion Bicruciate-Stabilized Total Knee System: Results From the International Study of Over 2000 Consecutive Primary Total Knee Arthroplasties.

J Arthroplasty 2019 07 14;34(7S):S201-S208. Epub 2019 Feb 14.

Marra Knee and Shoulder Center Inc, Wheeling, WV.

Background: The JOURNEY II Bi-Cruciate Stabilizing Total Knee System (BLINDED) is a second-generation guided-motion knee implant that has been used in over 100,000 primary total knee arthroplasties (TKAs) worldwide. However, performance information is limited.

Methods: Data for 2059 primary TKAs were abstracted at 7 US and 3 European sites. Estimates of cumulative incidence of revision were compared with registry data for cemented posterior-stabilized implants.

Results: Average age was 64.3 years (range, 18-91); 58.5% were females; and 12.3% TKAs were in subjects younger than 55 years. Patellae were resurfaced in 95.9%. Median time since primary TKA was 4.2 years; longest was 6.1 years; and 78.9% were 3 years or more since primary TKA. Of 67 revisions (3.2%), 20 (30%) involved femoral or tibial component removal compared to 42% in the Australian Joint Registry (Australian Orthopedic Association National Joint Replacement Registry). All-component revisions accounted for 15 of 67, femoral component only for 2 of 67, tibial component only for 3 of 67, patellar component with/without tibial insert exchange for 17 of 67, and isolated tibial insert exchange for 30 of 67. In addition, there were 18 reoperations without component exchange. Component revision indications were infection (33%), mechanical loosening (21%), fracture of bone around the joint (16%), and instability (15%). Kaplan-Meier revision estimate was 3.1 and 3.6 per 100 TKAs at 3 and 5 years, respectively, compared to Australian Orthopedic Association National Joint Replacement Registry estimates of 3.1 and 4.1 per 100 TKAs.

Conclusion: The revision rate for the second-generation implant was similar to cemented posterior-stabilized registry controls.
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http://dx.doi.org/10.1016/j.arth.2019.02.011DOI Listing
July 2019

Indications for primary rotating-hinge total knee arthroplasty. Is there consensus?

Acta Orthop Belg 2018 Sep;84(3):245-250

The use of rotating-hinge systems in total knee arthroplasty is most often seen in revision setting where excessive bone loss, ligamentous instability and/ or extensor mechanism dysfunction may necessitate an increased level of component constraint. However, this implant type is also being increasingly used in the primary setting. The aim of this study is to review literature concerning the use of third generation rotating-hinge devices focusing on the indications for primary cases. Literature was searched for following search terms: total knee arthroplasty, primary indication, constraint, rotating hinge knee, knee prosthesis, hinged knee, total knee replacement. Additional papers were identified by screening references and similar articles. All papers dealing with first or second generation rotating-hinge implants and revision cases were discarded. After conducting a large literature search, we concluded that third generation rotating-hinge implants should be considered in limited indications in which ligamentous tibiofemoral instability is the core indication.
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September 2018

Educational outreach visits to improve knee osteoarthritis management in primary care.

BMC Med Educ 2019 Mar 1;19(1):66. Epub 2019 Mar 1.

Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, J building, 3000, Leuven, Belgium.

Background: Knee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy.

Methods: An educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP.

Results: The intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group.

Conclusions: This intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners' prescription behavior, more extensive or combined interventional approaches seem warranted.
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http://dx.doi.org/10.1186/s12909-019-1504-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397491PMC
March 2019

Non-uniformity in the healthy patellar tendon is greater in males and similar in different age groups.

J Biomech 2018 10 23;80:16-22. Epub 2018 Aug 23.

KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium; University Hospitals Leuven, Campus Pellenberg, Pellenberg, Belgium.

There is increasing evidence that tendons are heterogeneous and take advantage of structural mechanisms to enhance performance and reduce injury. Fascicle-sliding, for example, is used by energy-storing tendons to enable them to undergo large extensions while protecting the fascicles from damage. Reductions in fascicle-sliding capacity may thus predispose certain populations to tendinopathy. Evidence from the Achilles tendon of significant superficial-to-deep non-uniformity that is reduced with age supports this theory. Similar patellar tendon non-uniformity has been observed, but the effects of age and sex have yet to be assessed. Healthy adults (n = 50, 25M/25F) from a broad range of ages (23-80) were recruited and non-uniformity was quantified using ultrasound speckle-tracking during passive knee extension. Significant superficial-to-deep non-uniformity and proximal/distal variations were observed. No effect of age was found, but males exhibited significantly greater non-uniformity than females (p < 0.05). The results contrast with previous findings in the Achilles tendon; in this study, tendons and tendon regions at high risk for tendinopathy (i.e. males and proximal regions, respectively) exhibited greater non-uniformity, whereas high-risk Achilles tendons (i.e. older adults) previously showed reduced non-uniformity. This suggests that non-uniformity may be dominated by factors other than fascicle-sliding. Anatomically, the varied proximal attachment of the patellar tendon may influence non-uniformity, with quadriceps passive resistance limiting superficial tendon movement, thus linking flexibility, non-uniformity and injury risk. This study also provides evidence of a differential effect of aging on the patellar tendon compared with evidence from prior studies on other tendons necessitating further study to elucidate links between non-uniformity and injury.
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http://dx.doi.org/10.1016/j.jbiomech.2018.08.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231227PMC
October 2018

Patellar tendon buckling is altered with age.

Med Eng Phys 2018 09 27;59:15-20. Epub 2018 Jul 27.

Institute for Orthopaedic Research and Training (IORT), KU Leuven, UZ Pellenberg, Weligerveld 1/Blok 1, Pellenberg, 3212 Leuven, Belgium; University Hospitals Leuven, Campus Pellenberg, Pellenberg, Belgium.

Recent evidence has revealed that the patellar tendon exhibits buckling during passive knee extension, wherein the tendon folds back onto itself. The clinical relevance of such buckling is unclear, but it has been suggested that it serves to protect the patellar tendon from rupture when subjected to a sudden extreme contraction. Although prior evidence suggests buckling occurs universally, it is poorly understood, and may be influenced by age and sex. Healthy adults (n = 41, aged 21-80 years) were recruited to assess age- and sex-based differences in patellar tendon buckling during passive knee extension. 93% of subjects exhibited buckling in extension, with buckling more prominent in the distal tendon. No age- or sex-based differences in buckling magnitude were observed, but a significant age-based difference in buckling angle was found, with the tendon unbuckling later in flexion in younger adults compared with middle-aged (p = 0.025) and older (p = 0.014) adults. Intrinsic factors were also linked with buckling; for example, smaller maximum knee extension (i.e. less flexibility) correlated with smaller buckling magnitude (p = 0.037, R = 0.116), suggesting a link between patellar tendon buckling and joint-level mechanics. These results suggest that buckling is an inherent component of normal knee function that older adults may be failing to take advantage of, predisposing them to injury. Further study will be critical to elucidate the clinical implications of patellar tendon buckling.
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http://dx.doi.org/10.1016/j.medengphy.2018.04.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219636PMC
September 2018

Raising the Joint Line in TKA is Associated With Mid-flexion Laxity: A Study in Cadaver Knees.

Clin Orthop Relat Res 2018 03;476(3):601-611

T. Luyckx, H. Vandenneucker, L. Scheys Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium E. Vereecke Department of Development and Regeneration, University of Leuven campus KULAK, Kortrijk, Belgium A. Victor Department of Engineering, University of Leuven, Leuven, Belgium J. Victor Department of Physical Medicine and Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium.

Background: In a typical osteoarthritic knee with varus deformity, distal femoral resection based off the worn medial femoral condyle may result in an elevated joint line. In a setting of fixed flexion contracture, the surgeon may choose to resect additional distal femur to obtain extension, thus purposefully raising the joint line. However, the biomechanical effect of raising the joint line is not well recognized.

Questions/purposes: (1) What is the effect of the level of the medial joint line (restored versus raised) on coronal plane stability of a TKA? (2) Does coronal alignment technique (mechanical axis versus kinematic technique) affect coronal plane stability of the knee? (3) Can the effect of medial joint-line elevation on coronal plane laxity be predicted by an analytical model?

Methods: A TKA prosthesis was implanted in 10 fresh frozen nonarthritic cadaveric knees with restoration of the medial joint line at its original level (TKA0). Coronal plane stability was measured at 0°, 30°, 60°, 90°, and 120° flexion using a navigation system while applying an instrumented 9.8-Nm varus and valgus force moment. The joint line then was raised in two steps by recutting the distal and posterior femur by an extra 2 mm (TKA2) and 4 mm (TKA4), downsizing the femoral component and, respectively, adding a 2- and a 4-mm thicker insert. This was done with meticulous protection of the ligaments to avoid damage. Second, a simplified two-dimensional analytical model of the superficial medial collateral ligament (MCL) length based on a single flexion-extension axis was developed. The effect of raising the joint line on the length of the superficial MCL was simulated.

Results: Despite that at 0° (2.2° ± 1.5° versus 2.3° ± 1.1° versus 2.5° ± 1.1°; p = 0.85) and 90° (7.5° ± 1.9° versus 9.0° ± 3.1° versus 9.0° ± 3.5°; p = 0.66), there was no difference in coronal plane laxity between the TKA0, TKA2, and TKA4 positions, increased laxity at 30° (4.8° ± 1.9° versus 7.9° ± 2.3° versus 10.2° ± 2.0°; p < 0.001) and 60° (5.7° ± 2.7° versus 8.8° ± 2.9° versus 11.3° ± 2.9°; p < 0.001) was observed when the medial joint line was raised 2 and 4 mm. At 30°, this corresponds to an average increase of 64% (3.1°; p < 0.01) in mid-flexion laxity with a 2-mm raised joint line and a 111% (5.4°; p < 0.01) increase with a 4-mm raised joint line compared with the 9-mm baseline resection. No differences in coronal alignment were found between the knees implanted with kinematic alignment versus mechanical alignment at any flexion angle. The analytical model was consistent with the cadaveric findings and showed lengthening of the superficial MCL in mid-flexion.

Conclusions: Despite a well-balanced knee in full extension and at 90° flexion, increased mid-flexion laxity in the coronal plane was evident in the specimens where the joint line was raised.

Clinical Relevance: When recutting the distal and posterior femur and downsizing the femoral component, surgeons should be aware that this action might increase the laxity in mid-flexion, even if the knee is stable at 0° and 90°.
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http://dx.doi.org/10.1007/s11999.0000000000000067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260050PMC
March 2018

Isolated patellofemoral arthroplasty reproduces natural patellofemoral joint kinematics when the patella is resurfaced.

Knee Surg Sports Traumatol Arthrosc 2016 Nov 9;24(11):3668-3677. Epub 2014 Nov 9.

Department of Development and Regeneration - Orthopaedic Surgery, University Hospitals Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium.

Purpose: The objectives of this in vitro project were to compare the dynamic three-dimensional patellofemoral kinematics, contact forces, contact areas and contact pressures of a contemporary patellofemoral prosthetic implant with those of the native knee and to measure the influence of patellar resurfacing and patellar thickness. The hypothesis was that these designs are capable to reproduce the natural kinematics but result in higher contact pressures.

Methods: Six fresh-frozen specimens were tested on a custom-made mechanical knee rig before and after prosthetic trochlear resurfacing, without and with patellar resurfacing in three different patellar thicknesses. Full three-dimensional kinematics were analysed during three different motor tasks, using infrared motion capture cameras and retroflective markers. Patellar contact characteristics were registered using a pressure measuring device.

Results: The patellofemoral kinematic behaviour of the patellofemoral arthroplasty was similar to that of the normal knee when the patella was resurfaced, showing only significant (p < 0.0001) changes in patellar flexion. Without patellar resurfacing, significant more patellar flexion, lateral tilt and lateral rotation was noticed. Compared to the normal knee, contact pressures were significantly elevated after isolated trochlear resurfacing. However, the values were more than doubled after patellar resurfacing. Changes in patellar thickness only influenced the antero-posterior patellar position. There was no other influence on the kinematics, and only a limited influence on the contact pressures in the low flexion angles.

Conclusion: The investigated design reproduced the normal patellofemoral kinematics acceptable well when the patella was resurfaced. From a kinematic point of view, patellar resurfacing may be advisable. However, the substantially elevated patellar contact pressures remain a point of concern in the decision whether or not to resurface the patella. This study therefore not only adds a new point in the discussion whether or not to resurface the patella, but also supports the claimed advantage that a patellofemoral arthroplasty is capable to reproduce the natural knee kinematics.
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http://dx.doi.org/10.1007/s00167-014-3415-5DOI Listing
November 2016

High-demand motor tasks are more sensitive to detect persisting alterations in muscle activation following total knee replacement.

Gait Posture 2016 10 6;50:151-158. Epub 2016 Sep 6.

Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven, Belgium; Department of Regeneration and Development - Organ Systems Cluster, KU Leuven/Division of Orthopaedics, University Hospitals Leuven, Belgium.

Knee osteoarthritis is one of the most frequent indications for total knee replacement (TKR). Unfortunately, many patients still have difficulties during daily life activities after TKR. As the underlying causes of these difficulties are still not fully understood, especially with regard to the role of aberrant muscle activation profiles, the purpose of this study was to examine to what extent muscle activation patterns return to normal after TKR. Furthermore, we aimed to further discuss remaining differences by linking them to pre- and post-operative measurements of the knee and hip kinetics and kinematics during multiple functional motor tasks. Therefore, muscle activity, kinetics and kinematics of knee and hip were measured and analyzed in seven patients during a number of functional tasks by using electromyography and three-dimensional motion analysis. Measurements were performed one week before and one year after surgery. Results were compared to seven matched healthy controls. The analyzed functional tasks included walking at self-selected speed, walking followed by a crossover and a sidestep turn, step descent and ascent. This study suggested that, while muscle activation profiles in patients one year after TKR did return to normal during walking, this was not the case during more demanding motor tasks. These findings may have direct implications for the design of future rehabilitation programs in order to result in faster recovery and ultimately more functional patients after TKR.
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http://dx.doi.org/10.1016/j.gaitpost.2016.09.003DOI Listing
October 2016

Patellofemoral arthroplasty influences tibiofemoral kinematics: the effect of patellar thickness.

Knee Surg Sports Traumatol Arthrosc 2014 Oct 15;22(10):2560-8. Epub 2014 Jul 15.

Department of Orthopaedics, University Hospital Leuven, Weligerveld 1, 3212, Pellenberg-Lubbeek, Belgium,

Purpose: Although controversy still remains, isolated patellofemoral arthroplasty recently gained in popularity as a treatment option for patellofemoral osteoarthritis. It has compared to total knee arthroplasty the advantage of preserving the tibiofemoral articulation, which in theory would allow the preservation of natural tibiofemoral kinematics. Today, however, no data exist to support this assumption. This study was therefore performed in order to investigate the effect of isolated patellofemoral arthroplasty on the native three-dimensional tibiofemoral kinematic behaviour and whether a change in patellar thickness would have an influence.

Methods: Six fresh-frozen cadavers were fixed on a custom-made mechanical knee rig. Full 3D kinematics was analysed during passive flexion-extension cycles, open chain extension, with and without mechanical resistance, as well as deep knee squats, using infrared motion capture cameras and retroflective markers. Measurements were taken for the native knee and after prosthetic trochlear resurfacing with and without patellar resurfacing in three different patellar thicknesses.

Results: Compared to the natural knee, patellofemoral arthroplasty resulted in significant changes in tibiofemoral kinematics, which were most pronounced in the most loaded motor tasks. Increased internal tibial rotation was noted in the mid- and high flexion ranges, reaching at 120° of flexion a mean difference of 4.5°±4.3° (p<0.0001) during squat motion, over the whole flexion range during open chain motion and in deeper flexion beyond 50° (mean at 70°, 1.9°±3.7°) during resisted open chain. During squats, also, a more posterior translation of the lateral femoral condyle was observed. The effect was accentuated in case of patella overstuffing, whereas kinematics was closer to normal with patellar thinning.

Conclusion: Isolated patellofemoral arthroplasty alters natural tibiofemoral kinematics, and the effects become more pronounced in case of increased patellar thickness. Therefore, it might be recommended to aim for a slight over-resection of patellar bone if sufficient bone stock is available.
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http://dx.doi.org/10.1007/s00167-014-3160-9DOI Listing
October 2014

A surgical algorithm for the treatment of recurrent patellar dislocation. Results at 5 year follow-up.

Acta Orthop Belg 2013 Jun;79(3):318-25

Orthopaedic Department, Pellenberg University Hospital, Leuven, Belgium.

Several options exist for the treatment of recurrent patellar dislocation. In our institution a specific treatment algorithm for patellofemoral maltracking, depending on skeletal maturity and the recognition of local risk factors has been in use for several years. The aim of our study was to evaluate the overall results of using this algorithm and to compare the outcome of the different subgroups. A total of 110 patients were studied with an average follow-up of 53 years. The patients were classified into 6 groups depending on the surgical treatment they had received. Eighty-seven percent of patients remained free of dislocation at final follow-up, and 66% of patients no longer experienced any patellar instability or subluxation. There was no statistically significant difference between skeletally mature and immature patients in the incidence of redislocation or recurrent instability, nor in functional or clinical outcome scores. Skeletally immature patients who underwent isolated medial retinacular imbrication experienced the highest redislocation rate (29%), whereas skeletally mature patients who were treated with combined proximal and distal realignment procedures demonstrated the lowest redislocation rate (6%). Skeletally mature patients with combined proximal and distal procedures reached lower clinical and functional outcome scores. Based upon the results from this study we believe that our surgical algorithm can serve as a model for the treatment of recurrent patellofemoral dislocation.
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June 2013

Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial.

Clin Orthop Relat Res 2014 Jan;472(1):263-71

Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium,

Background: Recently, patient-specific guides (PSGs) have been introduced, claiming a significant improvement in accuracy and reproducibility of component positioning in TKA. Despite intensive marketing by the manufacturers, this claim has not yet been confirmed in a controlled prospective trial.

Questions/purposes: We (1) compared three-planar component alignment and overall coronal mechanical alignment between PSG and conventional instrumentation and (2) logged the need for applying changes in the suggested position of the PSG.

Methods: In this randomized controlled trial, we enrolled 128 patients. In the PSG cohort, surgical navigation was used as an intraoperative control. When the suggested cut deviated more than 3° from target, the use of PSG was abandoned and marked as an outlier. When cranial-caudal position or size was adapted, the PSG was marked as modified. All patients underwent long-leg standing radiography and CT scan. Deviation of more than 3° from the target in any plane was defined as an outlier.

Results: The PSG and conventional cohorts showed similar numbers of outliers in overall coronal alignment (25% versus 28%; p = 0.69), femoral coronal alignment (7% versus 14%) (p = 0.24), and femoral axial alignment (23% versus 17%; p = 0.50). There were more outliers in tibial coronal (15% versus 3%; p = 0.03) and sagittal 21% versus 3%; p = 0.002) alignment in the PSG group than in the conventional group. PSGs were abandoned in 14 patients (22%) and modified in 18 (28%).

Conclusions: PSGs do not improve accuracy in TKA and, in our experience, were somewhat impractical in that the procedure needed to be either modified or abandoned with some frequency.
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http://dx.doi.org/10.1007/s11999-013-2997-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889461PMC
January 2014

Reason for revision TKA predicts clinical outcome: prospective evaluation of 150 consecutive patients with 2-years followup.

Clin Orthop Relat Res 2013 Jul 30;471(7):2296-302. Epub 2013 Mar 30.

Sint Maartenskliniek, Nijmegen, The Netherlands.

Background: There is limited knowledge regarding the relationship between the reason for revising a TKA and the clinical outcome in terms of satisfaction, pain, and function with time.

Questions/purposes: In a cohort of patients receiving a fully revised TKA, we hypothesized (1) outcomes would differ according to reason for revision at 2 years, (2) outcomes would improve gradually during those 2 years, (3) rates of complications differ depending on the reason for revision, and (4) patients with complications have lower scores.

Methods: We studied a prospective cohort of 150 patients receiving a fully revised TKA using a single implant system in two high-volume centers at 24 months of followup. VAS satisfaction, VAS pain, The Knee Society Scoring System(©) (KSS) clinical and functional scores, and complication rate were correlated with their reasons for revision, including septic loosening, aseptic loosening, component malposition, instability, and stiffness.

Results: The aseptic loosening group showed better outcomes compared with the instability, malposition, and septic loosening groups, which showed intermediate results (p < 0.05). The stiffness group performed significantly worse on all outcome measures. The outcome for patients with a complication, after treatment of the complication, was less favorable.

Conclusions: The reason for revision TKA predicts clinical outcomes. Satisfaction, pain reduction, and functional improvement are better and complication rates are lower after revision TKA for aseptic loosening than for other causes of failure. For component malposition, instability, and septic loosening groups, there may be more pain and a higher complication rate. For stiffness, the outcomes are less favorable in all scores.

Level Of Evidence: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1007/s11999-013-2940-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676611PMC
July 2013

Range of motion after total knee arthroplasty: the effect of a preoperative home exercise program.

Knee Surg Sports Traumatol Arthrosc 2014 Mar 28;22(3):703-9. Epub 2012 Dec 28.

Orthopedic Clinic, University of Florence, Largo Palagi, 1, 50139, Florence, Italy,

Purpose: Preoperative range of motion (ROM) is the most important variable to determine final flexion after total knee arthroplasty (TKA). The purpose of this study was to determine whether a preoperative home exercise program could improve ROM in the arthritic knee and whether this influenced ROM and functional recovery following primary TKA.

Methods: During the period between 2005 and 2006, one hundred and twenty-two patients with gonarthrosis were included in a prospective study and randomly allocated to either the control or the treatment group. The sixty-one subjects in the treatment group underwent a 6-week home-based exercise program before TKA surgery. All one hundred and twenty-two patients were assessed before and after this exercise intervention. Postoperative assessments were at 6 weeks, 6 months and 1 year. Each evaluation included knee ROM and the Knee Society Clinical Rating System. Length of hospital stay and postoperative duration before achieving 90° of knee flexion were also recorded.

Results: Exercise program improves knee motion in the presence of gonarthrosis. After TKA, the patients in the exercise group achieved 90° of knee flexion faster and had a shorter hospital stay. There is no prolonged effect on knee motion or patient function between 6 weeks and 1 year postoperatively.

Conclusion: Preoperative exercise of the arthritic knee facilitates immediate postoperative recovery following primary TKA.

Levels Of Evidence: Therapeutic study, Level I.
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http://dx.doi.org/10.1007/s00167-012-2349-zDOI Listing
March 2014

The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus.

Clin Orthop Relat Res 2012 Jan;470(1):45-53

Department of Orthopaedic Surgery, University Hospital Pellenberg, Weligerveld 1, 3012 Pellenberg, Belgium.

Background: Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. Patients with so-called "constitutional varus" knees have had varus alignment since they reached skeletal maturity. Restoring neutral alignment in these cases may in fact be abnormal and undesirable and would likely require some degree of medial soft tissue release to achieve neutral alignment.

Questions/purposes: We investigated what percentage of the normal population has constitutional varus knees and what are the contributing factors.

Subjects And Methods: We recruited a cohort of 250 asymptomatic adult volunteers between 20 and 27 years old for this cross-sectional study. All volunteers had full-leg standing digital radiographs on which 19 alignment parameters were analyzed. The incidence of constitutional varus alignment was determined and contributing factors were analyzed using multivariate prediction models.

Results: Thirty-two percent of men and 17% of women had constitutional varus knees with a natural mechanical alignment of 3° varus or more. Constitutional varus was associated with increased sports activity during growth, increased femoral varus bowing, an increased varus femoral neck-shaft angle, and an increased femoral anatomic mechanical angle.

Conclusions: An important fraction of the normal population has a natural alignment at the end of growth of 3° varus or more. This might be a consequence of Hueter-Volkmann's law. Restoration of mechanical alignment to neutral in these cases may not be desirable and would be unnatural for them.
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http://dx.doi.org/10.1007/s11999-011-1936-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237976PMC
January 2012

Are clinical photographs appropriate to determine the maximal range of motion of the knee?

Acta Orthop Belg 2010 Dec;76(6):794-8

University Hospital Pellenberg, Leuven, Belgium.

Goniometry is a commonly used method for the clinical assessment of range of motion (ROM) of the knee. A digital photograph of the knee in maximal flexion and extension could provide a more objective way to assess the ROM. The aim of our study was to investigate the reliability of the use of digital photographs as a method for measuring the ROM of the knee. Four observers examined 49 patients. Digital photographs of the knee in maximal flexion and extension were compared with standard clinical goniometric measurements in the same position. We observed higher intra-observer reliability for the digital method in flexion (p < 0.0001) and extension (p = 0.005) compared to goniometry. The extension results were numerically lower when using goniometry compared to the digital method (p < 0.001). For both methods, the intra-observer reliability for extension was lower compared to flexion. The intraobserver standard error of measurement (SEM) of the digital method was smaller than the goniometric SEM; the digital method thus appeared more reliable. Measuring maximal flexion and extension on digital photographs is more reliable for both extension and flexion compared to standard goniometric measurements.
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December 2010

Range of motion and repeatability of knee kinematics for 11 clinically relevant motor tasks.

Gait Posture 2010 Oct;32(4):597-602

Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Katholieke Universiteit Leuven, Belgium.

Standard gait analysis reports knee joint rotations in the three anatomical planes without addressing their different levels of reliability. Most clinical studies also restrict analysis to knee flexion-extension, because knee abduction-adduction and axial rotation are small with respect to the corresponding amount of measurement artefact. This study analyses a set of 11 motor tasks, in order to identify those that are adequately repeatable and that can induce greater motion at the knee than walking. Ten volunteers (mean ± SD age: 29 ± 9 years) each underwent three motion analysis sessions on different days with a standard gait analysis system and protocol. In each session they performed normal walking, walking with sidestep and crossover turns, ascent onto and descent off a step, descent with sidestep and crossover turns, chair rise, mild and deep squats, and lunge. Range and repeatability of motions in the three anatomical planes were compared by ANOVA. The sidestep turns showed a range of axial rotation significantly larger than that in walking (about 8°), while maintaining similar levels of repeatability. Ascent, chair rise, squat, and lunge showed greater flexion ranges than walking; among these, ascent was the most repeatable. The results show that turning increases knee axial rotation in young subjects significantly. Further, squats and lunges, currently of large interest in orthopaedics and sports research, have smaller repeatability, likely accounted for to the smaller constraints than in the traditional motor tasks.
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http://dx.doi.org/10.1016/j.gaitpost.2010.08.010DOI Listing
October 2010
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