Radiographs are not sufficient for evaluation of component fit in subtle knee pain after total knee arthroplasty
Date
2020Author
Simsek, Mehmet Emin and Gursoy, Safa and Akkaya, Mustafa and Kapicioglu,
M. I. Safa and Bozkurt, Murat
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Purpose To determine the component fit by radiography or computed
tomography after total knee arthroplasty and the relation of imaging
with clinical examination of residual knee pain. Methods The study was
conducted in 172 patients with residual knee pain after total knee
arthroplasty. The patients were examined to determine whether they
experienced pain upon palpation at nine regions surrounding the tibial
and femoral components, and the results were noted. The Knee Society
Clinical Rating System and The Western Ontario and McMaster Universities
Arthritis Index pain scale score forms were completed for all patients.
Radiologic evaluation was performed using computed tomography and
anteroposterior, lateral, and oblique radiographs to determine component
overhang/underhang status at these nine regions. Overhang, underhang,
and cortical fit groups were created based on the position of the
component at the bone margin. A statistical relationship was sought
between the clinical scores and the values measured to determine which
imaging method showed the best correlation with clinical scores.
Consistency of CT and Rx measurements was compared using the
McNemar-Bowker test. Comparisons between groups were made using
Student's t test for normally distributed data, and the Mann-Whitney U
test. Results Computed tomography and radiographic measurements were
similar in the medial, anterior, and lateral tibial regions. However, no
similarities were observed in the anteromedial, anterolateral,
posteromedial, and posterolateral tibial regions, and in the
distal-medial and distal-lateral aspects of the femur. Statistical
relationships among decreased clinical scores, pain with palpation, and
the presence of overhang/underhang were only observed in the medial
tibial region for imaging using radiography. A statistically significant
relationship was observed in the medial, posteromedial, and
posterolateral tibial regions, and in the distal-medial region of the
femur for imaging based on computed tomography. Conclusions Radiography
could only aid in assessing the component fit in the anteromedial,
medial, and lateral regions of the tibia in patients with residual knee
pain following knee arthroplasty, but it was not sufficient in
comparison with computed tomography in six other regions.
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