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INNEX-Knee The Lyon experience. J.L Lerat, B. Moyen, I. Bénareau E. Berthonnaud, J. Dimnet Service de Chirurgie Orthopédique & Laboratoire de Biomécanique du Mouvement Centre Hospitalier Lyon-Sud. INNEX-Knee The Lyon experience. J.L Lerat, B. Moyen, I. Bénareau

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INNEX-Knee

The Lyon experience

J.L Lerat, B. Moyen, I. Bénareau

E. Berthonnaud, J. Dimnet

Service de Chirurgie Orthopédique &

Laboratoire de Biomécanique du Mouvement

Centre Hospitalier Lyon-Sud


INNEX-Knee

The Lyon experience

J.L Lerat, B. Moyen, I. Bénareau

E. Berthonnaud, J. Dimnet

Service de Chirurgie Orthopédique &

Laboratoire de Biomécanique du Mouvement

Centre Hospitalier Lyon-Sud

Aim of the presentation

1 - Preliminary results (1 to 3 years)

2 - Anterior-posterior laxity

3 - Mobility of the plateau


INNEX-Knee

The Lyon experience

1st Pilot study (April 1998 - Nov. 1998)

  • Innex knee cemented femur and tibia :

    30 cases (20 CR - 10 PS)


INNEX-Knee

The Lyon experience

1st Pilot study (April 1998 - Nov. 1998)

  • Innex knee cemented femur and tibia :

    30 cases (20 CR - 10 PS)

    2nd Pilot study(Nov. 1999 - 0ct. 2000)

  • Innex knee non cemented femur :

    20 cases (10 CR - 10 UCOR)

    + further experience : 23 cases


INNEX-Knee

The LYON experience

73 cases

  • 44 F - 29 M

  • Age : 69 ± 10 years (26-88)

  • Etiology

    2 R. A, 1 SVNH

    2 hemophilic arthropathies

    1 Paget’s disease

    68 gonarthrosis

    - 14 previous osteotomies

    - 6 previous surgery (2 ACL,1 fract, 2 patella)

Some cases are particularly difficult for a pilot study


Innex knee

These difficulties explain :

Op. time : 90 mn ± 19 (55-145)

Tibial tuberosity ost : 10 cases

Immediate weight bearing

Discharge : 7 days

Flexion after 7 days : 80°

INNEX-Knee


Innex knee1

PCL preservation : 42

Postero-stabilisation : 12

UCOR : 19

PCL normal : 73 (100 %)

ACL normal : 45 (61.5 %)

ACL ruptured : 28 (38.5 %)

INNEX-Knee


Complications
Complications

  • 1 Reflex Sympathic Dystrophy

  • 11 Deep Veinous Thombosis

  • 1 fracture of tibial tubercule (fall in stairs after 1 month)

  • 1 skin necrosis (after 8 op with 7 skin incisions : arthrodesis)

  • 0 infection

  • 4 Manipulations under Gen. anest.


Functional results

Internat. Knee Society Score

(200 pts)

Pre op : 116 ± 27(50-173)

Post op : 184 ± 24(87-200)

Bad : 1

Correct : 7 %

Good : 20 %

Excellent : 73 %

Functional results

n = 30 cases (1 year)


Mobility

After 2 months

n = 66

Flexion = 106° ± 18

(45° - 140°)

Extension : 0° : 55 cas

- 5° : 6 cas

-10° : 5 cas

  • 45-80° : 5

  • 85°-95° : 8

  • 100°-105° : 12

  • 110°-115° : 14

  • 120°-125° : 16

  • 130°-135° : 9

  • 135°-140° : 2


Mobility

Follow-up : 1 year

n = 34

Flexion = 112°± 18°

(45° - 140°)

Extension : -1° ± 3°

0° : 29 cases

- 5° : 2 cases

-10° : 3 cases

  • 45°-80° : 2

  • 90°-95° : 2

  • 100°-105° : 4

  • 105°-110° : 6

  • 110°-120° : 4

  • 120°-125° : 7

  • 125°-130° : 3

  • 130°-140° : 6


Mobility

Follow-up : 1 year

n = 34

112°± 18°

  • 45°-80° : 2

  • 90°-95° : 2

  • 100°-105° : 4

  • 105°-110° : 6

  • 110°-120° : 4

  • 120°-125° : 7

  • 125°-130° : 3

  • 130°-140° : 6

> 120° : 47 %


Anatomical results
Anatomical results

HKA= mechanical axis

postop

preop

H

Varus

HKA = 179° ± 2°

(173° - 186°)

178 to 182° : 88 %

Varus knees (n = 60)

HKA = 172° ± 5°

(160° - 180°)

K

A


Anatomical results1
Anatomical results

postop

preop

H

varus

HKA = 179° ± 2°

(173° - 186°)

Valgus

HKA = 180° ± 3°

(178° - 184°)

Varus knees (n = 60)

HKA = 172° ± 5°

(160° - 180°)

Valgus knees (n = 13)

HKA = 184° ± 3°

(181° - 189°)

K

A


Precision of the cuts
Precision of the cuts

F (femur A-P) : 90° ± 1

T (tibia A-P) : 89° ± 2

Femur lateral : 88° ± 2

Tibia lateral : 87° ± 2

n=71


Distal f moral cut
Distal fémoral cut

F angle : 90° ± 1°

  • 87° : 1

  • 88° : 8

  • 89° : 10

  • 90° : 27

  • 91° : 10

  • 92° : 11

  • 93° : 4

    n = 71

F


Distal femoral cut
Distal femoral cut

F angle : 90° ± 1°

  • 87° : 1

  • 88° : 8

  • 89° : 10

  • 90° : 27

  • 91° : 10

  • 92° : 11

  • 93° : 4

    n = 71

93%

F


Hks angle 6 2
HKS angle : 6° ± 2

Important pre operative measurement to do a precise distal cut

H

  • 2° : 1 case

  • 3° : 2

  • 4° : 6

  • 5° : 29

  • 6° : 14

  • 7° : 9

  • 8° : 6

  • 9° : 2

  • 10° : 2

  • 11° : 2

    n = 73

S

K


Tibial cut
Tibial cut

T angle : 89° ± 2°

  • 85° : 1

  • 86° : 1

  • 87° : 9

  • 88° : 14

  • 89° : 8

  • 90° : 25

  • 91° : 7

  • 92° : 3

  • 93° : 3

    n = 71


Tibial cut1
Tibial cut

T angle : 89° ± 2°

  • 85° : 1

  • 86° : 1

  • 87° : 9

  • 88° : 14

  • 89° : 8

  • 90° : 25

  • 91° : 7

  • 92° : 3

  • 93° : 3

    n = 71

81%


Position of the components
Position of the components

  • Inclination of femoral component : F lateral

  • 88° ± 2°

  • 85° : 11

  • 86° : 7

  • 87° : 13

  • 88° : 8

  • 89° : 5

  • 90° : 24

  • 92° : 1

  • n = 71


The intramedullary axis is not always the recommended guide for anterior and posterior cuts

Sometimes, metaphyseal axis should be better


Position of the components1
Position of the components for anterior and posterior cuts

Inclination of tibial component : T lateral

Instrumentation takes into account the mean anatomical slope : 6° (or 84°)

82° : 2

83° : 3

84° : 9

85° : 5

86° : 9

87° : 18

88° : 9

89° : 1

90° : 11

91° : 3

87° ± 2


Position of the components2
Position of the components for anterior and posterior cuts

Inclination of tibial component : T lateral

82° : 2

83° : 3

84° : 9

85° : 5

86° : 9

87° : 18

88° : 9

89° : 1

90° : 11

91° : 3

The difference comes probably from the fact that the measurements are done on short X-ray films and not on the complete tibia

87° ± 2


In conclusion, the precision of the cut is satisfactory for anterior and posterior cuts

All the cases are included (learning curve)

Other TKAs INNEX-knee

N = 73

90°±1 88°±2

89°±2 87°±2

no difference between Innex and other types of TKR in our experience


Patella
Patella for anterior and posterior cuts

  • 64/73 without resurfacing

  • Thickness of bone = 22 ± 2 mm

  • 9 patella resurfaced

  • Blackburn index p. op = 0.76 ± 0.16

  • Patella centered : 68 cases

  • Subluxation (1 to 3 mm) : 5 cases

Only 1 case of secondary patellar resurfacing


Patella1
Patella for anterior and posterior cuts

  • 9 patellar resurfacing (12 %)

  • Thickness of bone = 22 ± 2 mm

  • Post-op thickness of bone = 14 ± 1 mm


Interest of the csti used successfully with the natural knee
Interest of the CSTI used successfully with the « Natural knee »

530 knees

follow-up max. : 4.5 Y

CSTI



In case of severe valgus after HTO the short stem of Innex permits to associate TKR and a new osteotomy in the same time


Innex cr osteotomy
Innex CR + osteotomy permits to associate TKR and a new osteotomy in the same time

Extension Post drawer Ant drawer


Second part permits to associate TKR and a new osteotomy in the same time

  • Study of anterior and posterior drawer

  • Study of the mobility of MB

    • Anterior-posterior translation during flexion

    • Anterior-posterior translation during radiological drawer-test

    • Rotation


Radiological anterior drawer permits to associate TKR and a new osteotomy in the same time

  • Flexion : 20°

  • 9 kg load

  • Free translation

  • Free rotation

« Knee instability after injury to the anterior cruciate ligament

Quantification of the Lachman test »

JL Lerat, B Moyen, F Cladière, JL Besse, H Abidi

J. Bone Joint Surgery VOL. 82-B, N°1, January 2000, 42-47.


Radiological anterior drawer permits to associate TKR and a new osteotomy in the same time

  • Flexion : 20°

  • 9 kg load

  • Free translation

  • Free rotation

Anterior drawer

6.5 ± 5.4 mm(6-16)

n = 34


Posterior drawer permits to associate TKR and a new osteotomy in the same time

Test used for PCL rupture :

Lateral view with harmstrings contracted

Flexion : 70°

Posterior drawer

7.3 ± 4.7mm(1-15)

n = 65


UCOR permits to associate TKR and a new osteotomy in the same time

Post drawer Ant drawer

Post drawer : 10 mm ± 4 Ant drawer : 4.3 mm ± 5

n = 14 n = 10


Study of the mobility of mobile bearing
Study of the mobility of mobile bearing permits to associate TKR and a new osteotomy in the same time

Anterior-posterior translation


Combination of translation and rotation
Combination of translation and rotation permits to associate TKR and a new osteotomy in the same time


Study of the position of the Mobile plateau permits to associate TKR and a new osteotomy in the same time

  • In full extension in one leg standing position

  • At 30° of flexion in one leg standing position

  • AT 50-60° of flexion in one leg standing position


Mobility of mobile bearing permits to associate TKR and a new osteotomy in the same time

Extension in standing position

n = 40

The MB is situated post. to metal : 2.2± 2.4 mm

33 cases : posteriorly (3.4 mm)

7 cases : anteriorly (3.7 mm)


Flexion 30° in standing position permits to associate TKR and a new osteotomy in the same time

n = 21

The MB is situated post to metal : 2.7± 2.4 mm

17 cases : behind (4 mm)

4 cases : before (3 mm)


Flexion 50° in standing position permits to associate TKR and a new osteotomy in the same time

n = 9

The plateau is always situated post to metal : 4.3 ± 2.7 mm


Position of the mobile bearing in ant. and post. drawer permits to associate TKR and a new osteotomy in the same time

Post drawer : 7.3 ± 4.7 mm

  • M B situated 1.7 mm post to metal

    35 cases post : 4.5 mm

    18 cases ant : 2.8 mm

    n = 53 cases

    Ant drawer : 6.5 ± 5.4 mm

  • M B situated 4 mm post. to metal

    3 cases ant : 2.5 mm

    24 cases post : 4.4 mm

    n = 24 cases


Total A-P translation of Mobile Bearing permits to associate TKR and a new osteotomy in the same time:

5.7 ± 3.9 mm (0.5 - 14.2) range : 13.7 mm

Posterior drawer + Anterior drawer


X-ray Mobility Study permits to associate TKR and a new osteotomy in the same timeINNEX CR & INNEX UCORE. Berthonnaud, J. DimnetLaboratoire de Biomécanique du mouvementCentre Hospitalier Lyon-Sud


Study of the rotation - Preliminary results permits to associate TKR and a new osteotomy in the same time

3 balls in the polyethylene


Calculation of the pe mobility with one x ray
Calculation of the PE mobility with one X-ray permits to associate TKR and a new osteotomy in the same time

X-ray plate

INNEX with 3 steel balls embedded in the PE

.

X-ray source

Known :- Distance between X-ray source and X-ray plate.- Position of the X-ray source on the X-ray.

Known :

- The size of the INNEX (tibial base plate)

- The interdistances between balls in PE.

Measured :

The position of rotation axis

The position of the balls

The position of the tibial plots

Calculated:

- The rotation  between the PE and the tibial base plate.

- The translation t between the PE and the tibial base plate.


Mobility of the pe plateau vs tibial component first results
Mobility of the PE plateau vs tibial component permits to associate TKR and a new osteotomy in the same time(first results)

Total amount of rotation from full extension to 50° of flexion in standing position

10.5°

4.5°

3.5°

3,5°

The study is just starting and should be multicentric


1 an permits to associate TKR and a new osteotomy in the same time

Tiroir antérieur et pente tibiale favorisant la bascule


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