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Kinetic Sensors for Ligament Balance and Kinematic Evaluation in Anatomic Bi-Cruciate Stabilized Total Knee Arthroplasty. SENSORS 2021; 21:s21165427. [PMID: 34450869 PMCID: PMC8399549 DOI: 10.3390/s21165427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022]
Abstract
Sensor technology was introduced to intraoperatively analyse the differential pressure between the medial and lateral compartments of the knee during primary TKA using a sensor to assess if further balancing procedures are needed to achieve a “balanced” knee. The prognostic role of epidemiological and radiological parameters was also analysed. A consecutive series of 21 patients with primary knee osteoarthritis were enrolled and programmed for TKA in our unit between 1 September 2020 and 31 March 2021. The VERASENSE Knee System (OrthoSensor Inc., Dania Beach, FL, USA) has been proposed as an instrument that quantifies the differential pressure between the compartments of the knee intraoperatively throughout the full range of motion during primary TKA, designed with a J-curve anatomical femoral design and a PS “medially congruent” polyethylene insert. Thirteen patients (61.90%) showed a “balanced” knee, and eight patients (38.10%) showed an intra-operative “unbalanced” knee and required additional procedures. A total of 13 additional balancing procedures were performed. At the end of surgical knee procedures, a quantitatively balanced knee was obtained in all patients. In addition, a correlation was found between the compartment pressure of phase I and phase II at 10° of flexion and higher absolute pressures were found in the medial compartment than in the lateral compartment in each ROM degree investigated. Moreover, those pressure values showed a trend to decrease with the increase in flexion degrees in both compartments. The “Kinetic Tracking” function displays the knee’s dynamic motion through the full ROM to evaluate joint kinetics. The obtained kinetic traces reproduced the knee’s medial pivot and femoral rollback, mimicking natural knee biomechanics. Moreover, we reported a statistically significant correlation between the need for soft tissue or bone resection rebalancing and severity of the initial coronal deformity (>10°) and a preoperative JLCA value >2°. The use of quantitative sensor-guided pressure evaluation during TKA leads to a more reproducible “balanced” knee. The surgeon, evaluating radiological parameters before surgery, may anticipate difficulties in knee balance and require those devices to achieve the desired result objectively.
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[Adjusted mechanical alignment: operative technique-Tips and tricks]. DER ORTHOPADE 2020; 49:562-569. [PMID: 32494903 DOI: 10.1007/s00132-020-03929-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mechanical alignment (MA) is a standardized procedure that aims to achieve a neutrally aligned leg axis. An alignment of the prosthesis closer to the patient's anatomy can be an approach for better clinical outcomes. The surgical technique of adjusted mechanical alignment (aMA) presented here is a modified extension-gap-first technique that takes into account the natural ligamentous tension of the knee joint so that ligamentous releases can be avoided as far as possible. INDICATION The aMA technique can be used for primary and secondary varus gonarthrosis of up to 20° of varus. SURGICAL TECHNIQUE The aim of the operation is to achieve a balanced ligament tension through a femoral osseous correction rather than ligament releases. TEA and the sulcus line are marked to control the ligament-based femoral rotation. The osteophytes are removed to ensure a reliable ligament tension. A quantitative ligament tensioner is stretched with great care, and gap width as well as medial and lateral ligament tension are read off. In order to correct an extension gap asymmetry, instead of the typical medial soft tissue release, the asymmetry is compensated by a special femoral cutting block. Now, the flexion gap is assessed, whereby the transverse femoral rotation follows the soft tissue tension. The tensioner adjusts a rectangular flexion gap with balanced ligament tension. After a final balancing of the gaps, the femoral preparation is completed and the trial components are inserted. Here, the rotation of the tibial component is set by repeated flexion-extension cycles. DISCUSSION AND CONCLUSION The technique presented combines a measured-resection technique with individual ligament tension. The maximum deviation of the femoral alignment in the coronal plane from the neutral alignment is 2.5°. In order to avoid problems, it is recommended, as with the described technique, to achieve a component alignment based on the patient anatomy by adjusting the femoral component. The measured-resection technique carries the risk of flexion instability. With the gap-balancing technique symmetrical ligament tension can be achieved, assuming precise proximal tibial cuts. When aligning the femoral component rotation, flexion gap stability and patella tracking should be considered. Long-term studies of high case numbers are necessary to evaluate the good short-term results of the presented surgical technique.
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Ghirardelli S, Bala A, Peretti G, Antonini G, Indelli PF. Intraoperative Sensing Technology to Achieve Balance in Primary Total Knee Arthroplasty: A Review of the Literature. JBJS Rev 2019; 7:e4. [PMID: 31663921 DOI: 10.2106/jbjs.rvw.19.00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Instability following total knee arthroplasty has been reported as a major cause for early or delayed total knee arthroplasty revision.» Balancing the knee remains an inexact art with no standardized protocol to optimize soft-tissue tension.» The sensing technology reviewed in this article allows surgeons to intraoperatively analyze several parameters, including tibiofemoral rotational alignment, quantitative pressure at peak contact points in the medial and lateral compartments during both total knee arthroplasty trialing and final implant positioning, evaluation of the kinematics of the prosthetic knee, and, finally, correcting soft-tissue imbalance in real time.» This technology has the potential for improved outcomes, reduction in constrained implant utilization, increased patient satisfaction, and lower revision rates.
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Affiliation(s)
- Stefano Ghirardelli
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
- San Carlo Borromeo Hospital, Milan, Italy
| | - Abiram Bala
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | | | | | - Pier F Indelli
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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Peersman G, Taeymans K, Jans C, Vuylsteke P, Fennema P, Heyse T. Malrotation deformities of the lower extremity and implications on total knee arthroplasty: a narrative review. Arch Orthop Trauma Surg 2016; 136:1491-1498. [PMID: 27531495 DOI: 10.1007/s00402-016-2554-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a successful procedure for the management of osteoarthritis (OA) of the knee. Axial plane deformities are more common than suspected in patients presenting with osteoarthritis of the knee joint. Recent research has indicated that torsional deformities could play an important role in the development of anterior knee pain (AKP). METHODS In a narrative review of the literature, the aetiology of maltorsion deformity of the lower extremity in both, childhood and adulthood, as well as the development of postoperative femoral axial plane deformities are examined. This includes the numerous surgical interventions that have been described for the treatment of maltorsion syndrome, and the role of patient-specific instrumentation. Finally, correcting for maltorsion deformity during and its potential implications for the current clinical care pathway, in terms of both pre- and perioperative practices is discussed. DISCUSSION AND CONCLUSION Axial plane alignment is considered the 'third dimension' in TKA. Correct axial alignment the lower extremity and of prosthetic components is deemed an important prerequisite for a postoperatively stable and painless knee. Identification of and, where appropriate, adjustment for any pre-existing maltorsion deformities is thought to significantly reduce the proportion of patients with residual complaints following TKA. Well-designed and well-conducted clinical studies are required to support our hypotheses.
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Affiliation(s)
- Geert Peersman
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
| | - Kim Taeymans
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Christophe Jans
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Philippe Vuylsteke
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Peter Fennema
- AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
| | - Thomas Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, 35043, Marburg, Germany
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Kinematic femoral alignment with gap balancing and patient-specific instrumentation in total knee arthroplasty: a randomized clinical trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:683-688. [DOI: 10.1007/s00590-016-1865-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
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Yang JH, Dahuja A, Kim JK, Yun SH, Yoon JR. Alignment in knee flexion position during navigation-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2422-9. [PMID: 25854497 DOI: 10.1007/s00167-015-3589-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 03/26/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to demonstrate the lower limb alignment in knee flexion position after navigation-assisted total knee arthroplasty using the gap technique and to identify the correlative factors. METHODS One hundred and twenty consecutive osteoarthritic knees (120 patients) were prospectively enrolled for intraoperative data collection. All TKA surgeries were performed using the navigation system (OrthoPilot™, version 4.0; B. Braun Aesculap, Tuttlingen, Germany). Before and after final prosthesis implantation, the lower limb navigation alignment in both knee extension (0°) and knee flexion (90°) position was recorded. The knee flexion alignment was divided into three groups: varus, neutral and valgus alignment. To determine the factors of the alignment in knee flexion position, preoperative demographics, radiologic and intraoperative data were obtained. Pearson's correlation (r) analysis was performed to find the correlation. The Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were compared between groups. RESULTS Although all postoperative extension alignment was within neutral position (between -2° and +2°), postoperative knee flexion alignment was divided into three groups: varus (≤-3°), 24 cases (20 %); neutral (between -2° and +2°), 85 cases (70.8 %) and valgus (≥+3°) alignment, 11 cases (9.2 %). There were a good correlation of alignment in knee flexion position with the rotation of femoral component relative to posterior condylar axis (r = -0.502, p = 0.000) and weak correlations with posterior femoral cut thickness (lateral condyle) (r = 0.207, p = 0.026), medial flexion (90°) gap after femoral component rotation adjustment (r = 0.276, p = 0.003). Other variables did not show correlations. There were no statistical clinical differences between varus, neutral and valgus knee flexion alignment groups. CONCLUSION About 30 % of the cases showed malalignment of more than 3° in knee flexion position although with neutral alignment in extension position. The knee flexion alignment had a good correlation with the rotation of femoral component relative to posterior condylar axis. Neutral alignment in knee flexion position may be adjusted by femoral component rotation especially by the use of navigation system. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Republic of Korea
| | - Anshul Dahuja
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Republic of Korea
| | - Jin-Kak Kim
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Republic of Korea
| | - Se-Hyeok Yun
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Republic of Korea
| | - Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Republic of Korea.
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Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feng Y, Tsai TY, Li JS, Rubash HE, Li G, Freiberg A. In-vivo analysis of flexion axes of the knee: Femoral condylar motion during dynamic knee flexion. Clin Biomech (Bristol, Avon) 2016; 32:102-7. [PMID: 26777272 PMCID: PMC4779404 DOI: 10.1016/j.clinbiomech.2015.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transepicondylar axis and geometrical center axis are widely used for investigation of the knee kinematics and component alignment in total knee arthroplasty. However, the kinematic characteristics of these knee axes are not well defined in literature. This study investigated the femoral condylar motion during a dynamic flexion of the knee using different flexion axes. METHODS Twenty healthy knees (10 males and 10 females) were CT scanned to create 3D anatomic models. The subjects performed a single leg flexion from full extension to maximum flexion while the knees were imaged using fluoroscopes. The femoral condyle translations in anterior-posterior and proximal-distal directions were described using clinical transepicondylar axis, surgical transepicondylar axis and geometrical center axis. FINDINGS The subjects achieved -9.4° (SD 3.0°) hyperextension at full extension and 116.4° (SD 9.0°) at maximum flexion of the knee. The anterior-posterior translations of the three flexion axes were different for the medial condyle, but similar for the lateral condyle. Substantial variations of the condylar motion in proximal-distal direction were measured along the flexion path using these axes. While the surgical transepicondylar axis maintained condyle heights from full extension to 60° of flexion, geometrical center axis showed little changes in condyle heights from 30° to maximum knee flexion. The condyles moved distally beyond 90° flexion using both transepicondylar axes. INTERPRETATION The femoral condylar motion measurement is sensitive to the selection of flexion axis. The different kinematic features of these axes provide an insightful reference when selecting a flexion axis in total knee arthroplasty component alignment.
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Affiliation(s)
- Yong Feng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States.
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States.
| | - Jing-Sheng Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States.
| | - Harry E Rubash
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States.
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States.
| | - Andrew Freiberg
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States.
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Hommel H, Perka C. Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg 2015; 135:1603-8. [PMID: 26315332 DOI: 10.1007/s00402-015-2315-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Combining patient-specific instrumentation (PSI) with a balancer device in total knee arthroplasty (TKA) to achieve functional femoral rotational alignment is a novel technique. The primary goal of this study was to introduce a new method to combine PSI with a gap-balancing technique and to determine the impact of the technique on rotation of the femoral component. MATERIALS AND METHODS Twenty-five primary TKAs (15 women, 10 men) were prospectively studied. All TKAs involved PSI with an associated gap-balancing device. Front plane alignment was performed intraoperatively with the PSI, followed by rectangular, symmetrical extension and creation of a flexion gap using the balancer device to set the femoral rotation. RESULTS Femoral component rotation was between 3° internal and 6° external rotation versus the transepicondylar axis. There were no postoperative signs of patellofemoral dysfunction. In no cases was the resulting joint line displacement >3 mm. The mean elevation was 1.2 ± 0.9 mm (range 0-3). The leg axis was straight in all cases (±3°), at a mean of 1.6° ± 1.0° varus (range 0°-3° varus). CONCLUSIONS PSI was with the gap-balancing technique was successfully used without affecting anatomical alignment. With the balancer device, PSI can be used more widely than techniques based solely on landmarks, as the soft-tissue tension can be taken into account, thus virtually eliminating flexion instabilities.
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Affiliation(s)
- Hagen Hommel
- Orthopedic Department, Hospital Märkisch Oderland, Section Wriezen, Sonnenburger Weg 3, 16269, Wriezen, Germany.
| | - Carsten Perka
- Center for Musceloskeletal Surgery, Orthopedic Department, Charité Universitätsmedizin, Berlin, Germany
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Mobile-bearing prosthesis and intraoperative gap balancing are not predictors of superior knee flexion: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2015; 23:1986-92. [PMID: 24435222 DOI: 10.1007/s00167-014-2838-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Range of motion is a crucial measure of the outcome of total knee arthroplasty. Gap balancing technique and mobile-bearing prosthesis can improve postoperative range of motion. The purpose of this study was to determine the factors that are predictive of the postoperative range of motion. METHODS A total of 94 knees with varus osteoarthritis were prospectively randomized to receive either a posterior-stabilized mobile-bearing or a posterior-stabilized fixed-bearing prosthesis. All preoperative and postoperative protocols and operative techniques were identical in the two groups. Extension and flexion joint gaps were measured using a tensor device during the operation. Multiple regression analysis was conducted to determine the best predictors of the knee flexion angle 2 years after the operation. The independent variables were type of prosthesis (mobile-bearing or fixed-bearing), difference between flexion and extension joint gaps (mm), age, gender, body mass index (BMI), preoperative and intraoperative knee flexion angles, change in posterior condylar offset, and posterior tilt of the tibial plateau. RESULTS The mean difference between flexion and extension joint gaps was 0.8 ± 1.3 (mean ± SD) mm for mobile-bearing and 0.8 ± 1.9 mm for fixed-bearing prosthesis. The mean flexion angle for mobile-bearing and fixed-bearing groups was 120 ± 16° and 116 ± 20° preoperatively (n.s.), 142 ± 9° and 141 ± 12° intraoperatively (n.s.), and 129 ± 10° and 128 ± 13° at 2 years postoperatively (p = 0.773), respectively. Predictors were identified in the following three categories: (1) preoperative flexion angle, (2) intraoperative radiographic flexion angle, and (3) BMI (R = 0.603, p < 0.001). CONCLUSIONS Mobile-bearing prosthesis and optimal gap balancing did not result in superior postoperative flexion angle. Better preoperative and intraoperative flexion angles and lower BMI were the significant predictors for better postoperative flexion angle. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Seo JG, Moon YW, Kim SM, Park SH. How to minimize rotational conflict between femoral & tibial component in total knee arthroplasty: the use of femoro-tibial axial synchronizer (Linker). Yonsei Med J 2015; 56:454-9. [PMID: 25683995 PMCID: PMC4329358 DOI: 10.3349/ymj.2015.56.2.454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the correlation between rotational axes of femur and tibia with the use of Linker. MATERIALS AND METHODS This study was carried out from August 2009 to February 2010 on 54 patients (106 knees), who were diagnosed with simultaneous bilateral total knee arthroplasty. With the use of postoperative computed tomography scans, it was investigated how much the rotational angle of femoral and tibial components matched. RESULTS The tibial component was internally rotated for the femoral component at an angle of 0.8°. The femoral component was externally rotated for the surgical transepicondylar axis (TEA) at an angle of 1.6 (range: from 4.8° of internal rotation to 7.9° of external rotation, SD=2.2°), and the tibial component was externally rotated for the surgical TEA at an average angle of 0.9 (range: from 5.1° of internal rotation to 8.3° of external rotation, SD=3.1°). CONCLUSION The femoro-tibial synchronizer helped to improve the orientation and positioning of both femoral component and tibial component, and also increase the correlation of the rotational axes of the two components.
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Affiliation(s)
- Jai-Gon Seo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wan Moon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Min Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Hoon Park
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
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Stephens BF, Hakki S, Saleh KJ, Mihalko WM. Clinical alignment variations in total knee arthroplasty with different navigation methods. Knee 2014; 21:971-4. [PMID: 24894686 DOI: 10.1016/j.knee.2014.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/24/2014] [Accepted: 03/04/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND We compared the resulting alignment in 90° of flexion and in full extension after total knee arthroplasty (TKA) with two navigation systems using different techniques: a measured resection (MR) system and a gap - balancing (GB) system. METHODS Varus and valgus alignment in extension and flexion was compared in 100 consecutive patients who had TKA with an MR distal-femoral-cut-first technique at one institution and 100 consecutive patients in whom a GB tibial-cut-first technique was used at another institution. Alignment deviation of three degrees or more from neutral was considered an outlier. RESULTS No significant difference between the groups in coronal alignment in extension or flexion was found, but there were three times the number of outliers for clinical alignment in flexion for the MR group compared to the GB group. CONCLUSIONS The use of the GB tibial-cut-first computer-assisted TKA navigation may provide a more consistent clinical alignment in flexion than systems using an MR technique. LEVEL OF EVIDENCE Therapeutic study. Level 2.
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Affiliation(s)
- Byron F Stephens
- University of Tennessee - Campbell Clinic Department of Orthopaedics & Biomedical Engineering, 1211 Union Ave, Suite 510, Memphis, TN 38104, USA
| | - Sam Hakki
- Department of Orthopaedic Surgery, Bay Pines Veterans Administration Health Care System, 10000 Bay Pines Boulevard North, Bay Pines, FL 33744, USA
| | - Khaled J Saleh
- Southern Illinois University, Division of Orthopaedic Surgery, 520N 4th St # 202 Springfield, IL 62702, USA
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 956 Court Ave, Suite E226, Memphis, TN 38163, USA.
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Iacono F, Bruni D, Bignozzi S, Colle F, Marcacci M. Does total knee arthroplasty modify flexion axis of the knee? Knee Surg Sports Traumatol Arthrosc 2014; 22:1728-35. [PMID: 24832694 DOI: 10.1007/s00167-014-3054-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To prospectively investigate whether preoperative functional flexion axis in patients with osteoarthritis- and varus-alignment changes after total knee arthroplasty and whether a correlation exists both between preoperative functional flexion axis and native limb deformity. METHODS A navigated total knee arthroplasty was performed in 108 patients using a specific software to acquire passive joint kinematics before and after implant positioning. The knee was cycled through three passive range of motions, from 0° to 120°. Functional flexion axis was computed using the mean helical axis algorithm. The angle between the functional flexion axis and the surgical transepicondylar axis was determined on frontal (α (F)) and axial (α (A)) plane. The pre- and postoperative hip-knee-ankle angle, related to femur mechanical axis, was determined. RESULTS Postoperative functional flexion axis was different from preoperative only on frontal plane, while no differences were found on axial plane. No correlation was found between preoperative α (A) and native limb deformity, while a poor correlation was found in frontal plane, between α (F) and preoperative hip-knee-ankle angle. CONCLUSIONS Total knee arthroplasty affects functional flexion axis only on frontal plane while has no effect on axial plane. Preoperative functional flexion axis is in a more varus position respect to the transepicondylar axis both in pre- and postoperative conditions. Moreover, the position of the functional axis on frontal plane in preoperative conditions is dependent on native limb alignment, while on axial plane is not dependent on the amount of preoperative varus deformity.
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Affiliation(s)
- F Iacono
- 2nd Orthopaedics and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy,
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