FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2912772803> ?p ?o ?g. }

• W2912772803 endingPage "572" @default.
• W2912772803 startingPage "571" @default.
• W2912772803 abstract "Where Are We Now? Researchers have introduced several potential technological advances involving total knee replacements during the last decade, including the use of navigation, patient-specific instrumentation, robotically assisted total knee replacements, and custom total knee replacements. To date, no one method has shown consistently superior functional outcomes or improved survivorship compared to conventional total knee replacement inserted with mechanical instrumentation. While newer technologies offer improved alignment, this has not translated into improved patient outcomes [2, 4]. The knee joint consists of complex, asymmetrical medial and lateral femoral condylar morphology, resulting in varied bony geometry among patients. However, most components implanted are symmetrical with identical medial and lateral femoral geometries, creating alterations from the patient’s native anatomy. Additionally, inserting implants using traditional mechanical-alignment principles further alters the patient’s anatomy and, relative to the native knee, usually results in overresection on the medial side, underresection on the lateral side, and excessive external rotation of the femoral implant to accommodate a neutrally aligned tibia. Despite this alteration of native anatomy, the large majority of total knee replacements function well—a testament to knee replacement design over the last three decades. In the current study, Meier and colleagues [5] present a descriptive paper on various CT scan measurements of the distal femur noting the variability among patients and compare these measurements to known values of standard total knee replacements. They estimate the occurrence of a standard implant not fitting the native bone properly, thus resulting in improper sizing of the implant relative to the bone. In doing so, the authors make a case for a custom total knee replacement, which they argue would result in an improved fit to the bone that is more closely representative of the patients’ anatomy. Their point regarding implant fit and variable geometry may be valid. Indeed, roughly one-in-five patients are, to some degree, dissatisfied with their knee replacement typically for persistent pain or lack of expected function [1, 6]. While the reasons for dissatisfaction after knee replacement are multifactorial, the alteration and inability to restore the patients’ native anatomy may be one reason for the dissatisfaction some patients experience following knee replacement. Where Do We Need To Go? Tibial geometry and variability would undoubtedly be in Meier and colleagues’ CT database, and thus, a comparison of standard and custom implants would be relatively straightforward. However, the authors have not addressed the variability of the femoral trochlea and the patella. Future studies could determine whether abnormal patella-femoral kinematics is a source of dissatisfaction after knee replacement. The real challenge for custom designs will be distinguishing normal anatomy from abnormal anatomy. Reproducing the patient’s native anatomy may be appropriate in a situation with no or minimal deformity. But how much deformity, trochlear dysplasia, or lateral condylar hypoplasia can one accept as normal before risking the recreation of the pathological anatomy that may have led to the arthritic knee in the first place? Furthermore, would this recreation of abnormal anatomy risk result in poor function of the implant? Does an implant that fits well at the distal femur result in improved function? Although the advancements in custom-implant manufacturing are now at the point where custom designs could be mainstream and not just reserved for more-complex reconstructive cases, there only has been limited adoption in total knee replacements, likely due to cost and lack of evidence to suggest improved outcomes. Using custom implant manufacturing, it should be possible to resurface the knee and maintain more-normal kinematics. True resurfacing designs for total knee replacements are not out of reach. However, before we can embrace custom anatomical knees, we need a more-thorough understanding of the variability of anatomic norms, including race- and sex-related differences. With a better understanding of anatomic variability, we can begin to determine normal from abnormal anatomy. We also need to understand how much trochlear or condylar dysplasia, tibial varus, or slope we can accept before we resort to a standard knee design, and thus avoid recreating a pathological knee. Additionally, and equally important, moving forward, we will need better outcome metrics that don’t suffer from ceiling effects and can differentiate subtle differences at the upper end of knee function activities. How Do We Get There? Even though current advances in technologies have yet to demonstrate consistent improvements in functional outcomes, we cannot be satisfied with the status quo of knee replacement and need to continue to explore methods of improving implant designs and surgical techniques that I hope will ultimately translate into improved patient outcomes. However, before widespread clinical adoption of any new and more-expensive technology, including custom knee replacements, we will need well-designed clinical research comparing custom anatomical knee replacement to conventional knee replacements. It is less likely that we will see substantial improvement in the large majority of patients as generally most are satisfied with the function of their knee replacement. Future studies should focus on the subset of patients in whom more advanced technology may be beneficial. Data from the Australian Orthopaedic Association National Joint Replacement Registry has shown improved survivorship using navigation in patients less than 65 years of age [3]. Clinical research using new implant designs or technology should focus on this subset of younger or more active patients who may see a benefit from this technology, and not include all-comers in the study design. Similarly, outcome metrics that discriminate at the high end of function need to be developed as it is too simplistic to think that we can use the same metrics for low-demand elderly patients as for high-demand younger patients and expect to see subtle but important differences in functional outcomes. Consistently achieving a pain-free knee that also functions well during high-performance activities is the holy grail of knee replacement surgery. Knee designs that replicate normal anatomy and are clinically proven may move us towards this goal." @default.
• W2912772803 created "2019-02-21" @default.
• W2912772803 creator A5074169643 @default.
• W2912772803 date "2019-02-12" @default.
• W2912772803 modified "2023-09-27" @default.
• W2912772803 title "CORR Insights®: What Is the Possible Impact of High Variability of Distal Femoral Geometry on TKA? A CT Data Analysis of 24,042 Knees" @default.
• W2912772803 cites W1978351945 @default.
• W2912772803 cites W2009489629 @default.
• W2912772803 cites W2084559676 @default.
• W2912772803 cites W2778635291 @default.
• W2912772803 cites W2790484028 @default.
• W2912772803 cites W2914559937 @default.
• W2912772803 doi "https://doi.org/10.1097/corr.0000000000000669" @default.
• W2912772803 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/6382185" @default.
• W2912772803 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/30762690" @default.
• W2912772803 hasPublicationYear "2019" @default.
• W2912772803 type Work @default.
• W2912772803 sameAs 2912772803 @default.
• W2912772803 citedByCount "0" @default.
• W2912772803 crossrefType "journal-article" @default.
• W2912772803 hasAuthorship W2912772803A5074169643 @default.
• W2912772803 hasBestOaLocation W29127728031 @default.
• W2912772803 hasConcept C105702510 @default.
• W2912772803 hasConcept C13483470 @default.
• W2912772803 hasConcept C141071460 @default.
• W2912772803 hasConcept C2777236700 @default.
• W2912772803 hasConcept C2778104916 @default.
• W2912772803 hasConcept C2780554211 @default.
• W2912772803 hasConcept C2781411149 @default.
• W2912772803 hasConcept C2908736133 @default.
• W2912772803 hasConcept C29694066 @default.
• W2912772803 hasConcept C2986595273 @default.
• W2912772803 hasConcept C68312169 @default.
• W2912772803 hasConcept C71924100 @default.
• W2912772803 hasConcept C96646087 @default.
• W2912772803 hasConceptScore W2912772803C105702510 @default.
• W2912772803 hasConceptScore W2912772803C13483470 @default.
• W2912772803 hasConceptScore W2912772803C141071460 @default.
• W2912772803 hasConceptScore W2912772803C2777236700 @default.
• W2912772803 hasConceptScore W2912772803C2778104916 @default.
• W2912772803 hasConceptScore W2912772803C2780554211 @default.
• W2912772803 hasConceptScore W2912772803C2781411149 @default.
• W2912772803 hasConceptScore W2912772803C2908736133 @default.
• W2912772803 hasConceptScore W2912772803C29694066 @default.
• W2912772803 hasConceptScore W2912772803C2986595273 @default.
• W2912772803 hasConceptScore W2912772803C68312169 @default.
• W2912772803 hasConceptScore W2912772803C71924100 @default.
• W2912772803 hasConceptScore W2912772803C96646087 @default.
• W2912772803 hasIssue "3" @default.
• W2912772803 hasLocation W29127728031 @default.
• W2912772803 hasLocation W29127728032 @default.
• W2912772803 hasLocation W29127728033 @default.
• W2912772803 hasLocation W29127728034 @default.
• W2912772803 hasLocation W29127728035 @default.
• W2912772803 hasOpenAccess W2912772803 @default.
• W2912772803 hasPrimaryLocation W29127728031 @default.
• W2912772803 hasRelatedWork W2058582492 @default.
• W2912772803 hasRelatedWork W2199670388 @default.
• W2912772803 hasRelatedWork W2351708545 @default.
• W2912772803 hasRelatedWork W2409535795 @default.
• W2912772803 hasRelatedWork W2409712917 @default.
• W2912772803 hasRelatedWork W2574392526 @default.
• W2912772803 hasRelatedWork W2891417157 @default.
• W2912772803 hasRelatedWork W2901625263 @default.
• W2912772803 hasRelatedWork W3023653488 @default.
• W2912772803 hasRelatedWork W3093066356 @default.
• W2912772803 hasVolume "477" @default.
• W2912772803 isParatext "false" @default.
• W2912772803 isRetracted "false" @default.
• W2912772803 magId "2912772803" @default.
• W2912772803 workType "article" @default.