JII BCS Exam: Knee Issues! Quiz

ITB friction or traction syndrome is a relatively common injury associated with running and is frequently reported in relation to total knee arthroplasty.

• True

• False

Which clinical paper reported ITB syndrome in JBCS Knees?

• Bellman (2010)

• Luckyx et al (2010)

• Haas et al (2010)

• Synder et al (2010)

Which clinical paper reported dislocation in JBCS Knees?

• Bourne et al (2011)

• Laskin (2011)

• Arnout et al (2011)

• Hass et al (2011)

Luyckx et al (2010) reported outcomes for 1,070 JBCS knees at a mean follow up of 2.5 years. Device survival of 98% was reported, with partial or total revision as the primary endpoint. However, symptoms of iliotibial band (ITB) syndrome were observed in ___ % of patients at a mean of six months follow-up. After further rehabilitation, pain during flexion persisted in 2% of these patients resulting in surgical ITB release. (Fill in the blank)

The iliotibial tract or iliotibial band (also known as Maissiat's band or IT Band) is a longitudinal fibrous reinforcement of the fascia lata.

• True

• False

What did Luyckx et al (2010) suggest contributed to the ITB traction syndrome?

• Inadequate translation of the femur in flexion leading to increased eccentric loading of the ITB in some patients

• The normal screw home position of the JBCS which allowed the knee to rest in its normal anatomical position

• Excessive translation of the femur in flexion leading to increased eccentric loading of the ITB in some patients

• A & B

Of primary importance is the alignment of the JBCS tibial component relative to the femoral component as the two are coupled by the guided motion mechanism. According to Ries et al (2010) which of the following tibial component issues contribute to increased tension in the ITB?

• Aseptic loosening of the tibial component

• Excessive external rotation of the tibial component

• Excessive posterior position of the tibial component

• B & C

Arnout et al (2011) reported on four cases (0.3%) of posterior dislocation of the tibia relative to the femur in a series of 1,350 cases. The authors concluded that consistent soft-tissue stretch occurred in these patients. Which factors were noted as potentially contributing to dislocation? 

• High flexion - during flexion the cam rises onto the post towards maximal flexion and in the case of a loose flexion space the cam could in theory become dislocated over the post

• Low jump distance - due to the relative position of the cam, low height of the post combined with a rounded post design

• Excessive femoral rollback - may contribute to consistent stretch on soft tissues leading to laxity, especially in flexion

• All of the above

The final JBCS complication reported in the literature was that of stiffness requiring manipulation under anesthesia (MUA). Digennaro et al (2014) attribute the reported cases of stiffness and anterolateral joint pain to…

• Excessive medial and lateral tibiofemoral posterior translation

• Patella maltracking

• Excessive medial and lateral tibiofemoral anterior translation

• Chronic preoperative osteoarthritis

Which of the following did Arnout et al (2011) recommend in relation to JBCS to overcome the issue of soft tissue stretching and dislocation of the  implant?

• Design modification allowing the femur to rest posteriorly in full extension

• The use of a knee joint balancer in order to optimally balance the flexion space

• Design modifications in regards to the height of the polyethylene post in the JBCS implant as well as the relative position of the cam on the femoral component

• B & C

The Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) Annual Report identified the  JOURNEY BCS Knee as having a higher than expected revision rate. The Incidence of ITB pain is likely to have contributed to the Journey BCS revision rate in the AOA NJRR.

• True

• False