Do the increment of femoral condyle curvature and the change of tibia shape improve clinical outcome in total knee arthr
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KNEE
Do the increment of femoral condyle curvature and the change of tibia shape improve clinical outcome in total knee arthroplasty? A propensity score matching analysis Jong‑Keun Kim1 · Jae‑Young Park2 · Han‑Jin Lee1 · Du Hyun Ro2 · Hyuk‑Soo Han2 · Myung Chul Lee2,3 Received: 5 April 2019 / Accepted: 16 September 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose Recently, the Persona total knee arthroplasty (TKA) system with more anatomical features and a similarly high flexion to the previous version, LPS-Flex, was introduced and is widely used. This study aimed to compare the early outcomes obtained using Persona versus an LPS-Flex fixed PS implant. Methods A total of 784 knees that underwent primary TKAs (162: Persona group and 622: LPS-Flex group) were included. After 1:2 propensity score matching, there were 143 and 286 knees in Persona and LPS-Flex groups, respectively. Range of motion at the 2-year follow-up was the primary variable. Secondary variables were functional score, ability to perform activities requiring deep knee flexion, patient satisfaction, and radiographic measurements, including radiolucent line (RLL). Results The average postoperative maximal flexion measured by goniometer at 2 years after TKA was 126.1° ± 10.8° (range 95°–140°) for the Persona group and 132.7° ± 11.7° (range 103°–145°) for the LPS-Flex group (P 20°, 89 with patella unresurfaced status, and 5 with previous high tibial osteotomy. Finally, a total of 784 knees were included in the present study. Of these, 162 were classified in the Persona group, and 622 knees were classified in the LPS-Flex group. To address potential source of bias and confounding in the observational study comparing different TKA system at different times, rigorous adjustment was conducted using propensity score matching. A 1:2 propensity score matching (caliper 0.2) to control for any selection bias using different TKA systems was performed by matching criteria such as age, sex, side, body max index (BMI), ROM, and mechanical axis (MA). After matching, 143 knees in the Persona group and 286 knees in the LPS-Flex group remained (Fig. 3). There were no significant differences in demographic characteristics between the two groups (Table 1).
Surgical technique All TKAs were performed by an experienced surgeon (MCL), and the same surgical technique was used in the two groups. Particularly, when using the LPS-Flex system, the natural tibial slope of the system (7°) was not applied. Instead, adjusted tibial slope (3°) was applied, which was the same as that in the Persona system. A medial parapatellar arthrotomy was used, and both cruciate ligaments were resected. Most patellae were resurfaced, on principle, and cement fixation was used for all components in every case.
Postoperative management and rehabilitation All patients received the same multimodal perioperative pain management including periarticular cocktail injection, intravenous patient-controlled analgesia, oral analgesics, and rescue in
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