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Ntourantonis D, Lianou I, Iliopoulos I, Pantazis K, Korovessis P, Panagiotopoulos E. Static Baropodometry for Assessing Short-Term Functional Outcome after Unilateral Total Knee Arthroplasty: Exploring Correlation between Static Plantar Pressure Measurements and Self-Reported Outcomes. J Clin Med 2023; 12:6917. [PMID: 37959381 PMCID: PMC10650917 DOI: 10.3390/jcm12216917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to investigate the association between objective baropodometric and radiological measurements and patient self-reported functional outcomes, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, it sought to evaluate the effectiveness of static baropodometry in predicting short-term KOOS results following unilateral total knee arthroplasty (TKA). We conducted a prospective single-center study involving 32 patients who underwent unilateral TKA for knee osteoarthritis (KOA). Patients were evaluated both preoperatively and six months postoperatively, utilizing objective measurements derived from static baropodometric analysis in a normal, relaxed, bipedal standing position using a multi-platform Plantar Pressure Analysis System (PPAS) and radiographic measurements of the femorotibial angle (FTA) and subjective assessments through the national validated version of the KOOS. The study found an insignificant average correction of -0.69° ± 4.12° in the preoperative FTA at the sixth month after TKA. Moreover, there were no significant differences in the KOOS based on different types of knee alignment (KA) both pre- and postoperatively (p > 0.05). No significant correlations were observed between the KOOS, and total average affected and unaffected plantar pressures (TAAPP and TAUPP) pre- and postoperatively, as well as KA pre- and postoperatively. However, significant changes were observed in TAAPP and TAUPP measurements after unilateral TKA. TAAPP demonstrated a significant increase postoperatively (mean change (SD) = 18.60 (47.71); p = 0.035). In conclusion, this study found no significant correlation between KA, static baropodometric measurements, including pre- and postoperative differences, and KOOS outcomes. Therefore, static plantar pressure measurements alone might not serve as a reliable predictor of short-term clinical outcomes after unilateral TKA, as reported by patients.
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Affiliation(s)
- Dimitrios Ntourantonis
- Emergency Department, University Hospital of Patras, 26504 Patras, Greece
- Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Ioanna Lianou
- Department of Orthopaedics, General Hospital of Patras, 26332 Patras, Greece; (I.L.)
| | - Ilias Iliopoulos
- Department of Orthopaedics, Aimis Healthcare Group, Larnaca 6309, Cyprus;
| | | | - Panagiotis Korovessis
- Department of Orthopaedics, General Hospital of Patras, 26332 Patras, Greece; (I.L.)
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Flury A, Hoch A, Cirigliano G, Hodel S, Kühne N, Zimmermann SM, Vlachopoulos L, Fucentese SF. Excessive femoral torsion is not associated with patellofemoral pain or instability if TKA is functionally aligned and the patella denervated. Knee Surg Sports Traumatol Arthrosc 2023; 31:3665-3671. [PMID: 36114342 PMCID: PMC10435632 DOI: 10.1007/s00167-022-07162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Recent data suggest that individual morphologic factors should be respected to restore preoperative patellofemoral alignment and thus reduce the likelihood of anterior knee pain. The goal of this study was to investigate the effect of excessive femoral torsion (FT) on clinical outcome of TKA. METHODS Patients who underwent TKA and complete preoperative radiographic evaluation including a long-leg radiograph and CT scan were included. 51 patients showed increased FT of > 20° and were matched for age/sex to 51 controls (FT < 20°). Thirteen patients were lost to follow-up. Thirty-eight matched pairs were compared after a 2 year follow-up clinically (Kujala and patellofemoral score for TKA) and radiographically (FT, frontal leg axis, TT-TG, patellar thickness, patellar tilt, and lateral displacement of patella). Functional alignment of TKA was performed (hybrid-technique). All patellae were denervated but no patella was resurfaced. RESULTS There was no significant difference between clinical scores two years after surgery between patients with normal and excessive FT (n.s.). Kujala score was 64.3 ± 16.7 versus 64.8 ± 14.4 (n.s.), and patellofemoral score for TKA was 74.3 ± 21 versus 78.5 ± 20.7 (n.s.) for increased FT group and control group, respectively. There was no correlation between preoperative FT and clinical scores. Other radiographic parameters were similar between both groups. No correlations between clinical outcomes and preoperative/postoperative frontal leg axis or total leg axis correction were found (n.s.). CONCLUSION If the leg axis deformity is corrected to a roughly neutral alignment during cemented TKA, including patellar denervation, then excessive FT was not associated with patellofemoral pain or instability. LEVEL OF EVIDENCE Prospective comparative study, level II.
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Affiliation(s)
- Andreas Flury
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Armando Hoch
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Gabriele Cirigliano
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Sandro Hodel
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Nathalie Kühne
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Stefan M Zimmermann
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Seki K, Seki T, Siigi E, Imagama T, Yamabe T, Sakai T. Comparing inter- and intraobserver reliability between two-dimensional and three-dimensional measurements in the tibial component position of unicompartmental knee arthroplasty. Acta Orthop Belg 2023; 89:316-325. [PMID: 37924549 DOI: 10.52628/89.2.10553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
In unicompartmental knee arthroplasty (UKA), the tibial component has a small coronal plane width, the tibia and tibial component rotations are mismatched, and the large tibial component posterior tilt may make accurate measurements of component positions difficult in radiography. The study aimed to assess the intra- and interobserver reliabilities of radiographic (2D) and 3D computed tomography (3D-CT) measurements and to determine the minimum detectable change (95% confidence level, MDC95) in the tibial component position measurements in UKA. The study included 23 females and 7 males. Two surgeons measured the tibial component position. Intraclass and interclass correlation coefficients (ICC) were calculated to obtain reliability, and Bland-Altman analysis was performed to assess systematic errors. The MDC95 was calculated according to MDC95 = standard error of measurement × 1.96 × √2. In the 2D and 3D- CT measurements, intraobserver reliability for coronal and sagittal positions of the tibial component were sufficiently reliable, where ICCs were >0.8. In the coronal plane, the ICCs for interobserver reliability were lower in 2D (ICC, 0.5-0.7) than in 3D-CT (ICC > 0.9). Bland-Altman plots showed systematic bias in sagittal alignment in the 2D assessment. In the 3D assessment of intra- and interobserver reliability, the MDC95 of the coronal, sagittal, and axial planes was <2°. In the 2D intra- and interobserver reliability, the MDC95 of the coronal and sagittal planes was >2°. The 2D measurement had a risk of misidentifying the tibial component position in UKA.
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He R, Xiong R, Sun ML, Yang JJ, Chen H, Yang PF, Yang L. Study on the correlation between early three-dimensional gait analysis and clinical efficacy after robot-assisted total knee arthroplasty. Chin J Traumatol 2023; 26:83-93. [PMID: 35798637 PMCID: PMC10071330 DOI: 10.1016/j.cjtee.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/23/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Robot-assisted technology is a forefront of surgical innovation that improves the accuracy of total knee arthroplasty (TKA). But whether the accuracy of surgery can improve the clinical efficacy still needs further research. The purpose of this study is to perform three-dimensional (3D) analysis in the early postoperative period of patients who received robot-assisted total knee arthroplasty (RATKA), and to study the trend of changes in gait parameters after RATKA and the correlation with the early clinical efficacy. METHODS Patients who received RATKA in the Center of Joint Surgery, the First Hospital Affiliated to Army Military Medical University from October 2020 to January 2021 were included. The imaging parameters, i.e., hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, posterior condylar angle were measured 3 months post-TKA. The 3D gait analysis and clinical efficacy by Western Ontario Mac Master University Index (WOMAC) score were performed pre-TKA, 3 and 6 months post-TKA. The differences in spatiotemporal parameters of gait, kinetic parameters, and kinematic parameters of the operated limb and the contralateral limb were compared. The correlation between gait parameters and WOMAC scores was analyzed. Paired sample t-test and Wilcoxon rank-sum test were used to analyze the difference between groups, and Spearman correlation coefficient was used to analyze the correlation. RESULTS There were 31 patients included in this study, and the imaging indexes showed that all of them returned to normal post-TKA. The WOMAC score at 3 months post-TKA was significantly lower than that pre-TKA, and there was no significant difference between at 3 and 6 months. The 3D gait analysis results showed that the double support time of the operated limb reduced at 3 and 6 months (all p < 0.05), the maximum extension and maximum external rotation of the knee joint increased at stance phase, and the maximum flexion angle, the range of motion and the maximum external rotation increased at swing phase. Compared with the preoperative data, there were significant improvements (all p < 0.05). Compared with the contralateral knee joint, the maximum external rotation of the knee joint at swing phase was smaller than that of the contralateral side, and the maximum flexion and extension moment was greater than that of the contralateral knee. The maximum external rotation moment of the joint was greater than that of the contralateral knee joint (p < 0.05). There was a negative correlation between the single support time pre-TKA and the WOMAC score at 3 months (p = 0.017), and the single support time at 3 months was negatively correlated with the WOMAC score at 6 months (p = 0.043). The cadence at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.031). The maximum knee extension at stance phase at 6 months was negatively correlated with the WOMAC score at 6 month (p = 0.048). The maximum external rotation at stance phase at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.024). CONCLUSION The 3D gait analysis of RATKA patients is more sensitive than WOMAC score in evaluating the clinical efficacy. Trend of changes in gait parameters shows that the knee joint support, flexion and extension function, range of motion, external rotation and varus deformity moment of the patient were significantly improved at 3 months after surgery, and continued to 6 months after surgery. Compared with the contralateral knee, the gait parameters of the operated limb still has significant gaps in functionality, such as the external rotation and flexion and extension. The single support time, cadence, knee extension, and knee external rotation of the operated limb have a greater correlation with the postoperative WOMAC score. Postoperative rehabilitation exercises should be emphasized, which is of great value for improving the early efficacy of RATKA.
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Affiliation(s)
- Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Ran Xiong
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Mao-Lin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Jun-Jun Yang
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Hao Chen
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Peng-Fei Yang
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China.
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Zhang L, Li H, Bai L, Ji N. Patients with Kashin-Beck Disease Obtained Lower Functional Activities but Better Satisfaction Than Patients with Osteoarthritis After Total Knee Arthroplasty: A Retrospective Study. Clin Interv Aging 2022; 17:1657-1662. [DOI: 10.2147/cia.s388401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
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Sharma N, Berera V, Petterwood J. Comparison of CT with intra-operative navigation reported implant position utilising a robotic assisted technique in total knee arthroplasty. Med Eng Phys 2022; 108:103881. [DOI: 10.1016/j.medengphy.2022.103881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/15/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
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Larrainzar-Garijo R, Molanes-Lopez EM, Murillo-Vizuete D, Garcia-Bogalo R, Escobar-Anton D, Lopez-Rodriguez J, Diez-Fernandez A, Corella-Montoya F. Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip-Knee-Ankle Angle in Varus Knees: A Navigation-Based Study. J Knee Surg 2022; 35:1285-1294. [PMID: 33472260 DOI: 10.1055/s-0040-1722694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
After knee replacement, postoperative lower limb alignment is influenced by the geometry of the prosthesis position and surrounding soft tissue that contributes to the hip-knee-ankle (HKA) angle. The purpose of this study is to determine the dynamic coronal HKA angle after mechanical alignment in total knee replacement using computer navigation. We conducted a pre-post design study of 71 patients with varus osteoarthritic knees on which total knee arthroplasty was performed. The HKA was measured before and at the end of the surgical procedure with the patient in the supine position using a navigation system at 30, 60, and 90 degrees of knee flexion. Postoperative implant position and flexion and extension gaps were assessed. HKA was clustered in three preoperative dynamic patterns (PDPs; Varus-Neutral, Varus-Valgus, and Varus-Varus). There were statistically significant differences in the dynamic coronal HKA between the preoperative and postoperative statuses after mechanically aligned knee replacement (with p < 0.0001) Before the surgical procedure, statistically significant differences were found between patterns at any angle of flexion confirming a well-differentiated preoperative dynamic behavior between the three groups. Postoperatively, 98.6% (71 out of 72) of the knees were within ± 3 degrees of the HKA at full extension. Fifty-eight knees (80.6%) were assessed to a "within-range" postoperative dynamic alignment at any grade of flexion considered. There are differences between the preoperative and postoperative status of the dynamic coronal HKA angle after mechanically aligned knee replacement. We proposed that an excellent dynamic HKA alignment is achieved not only at full extension within the range of 0 ± 3 degrees but also when this alignment is maintained at 30, 60, and 90 degrees.
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Affiliation(s)
- Ricardo Larrainzar-Garijo
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain.,Departamento Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Elisa M Molanes-Lopez
- Departamento de Estadística e Investigación Operativa, Unidad Departamental de Bioestadística, Facultad de Medicina, Universidad Complutense, Madrid Spain
| | - David Murillo-Vizuete
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Raul Garcia-Bogalo
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - David Escobar-Anton
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jesus Lopez-Rodriguez
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Angel Diez-Fernandez
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Fernando Corella-Montoya
- Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain.,Departamento Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Hörlesberger N, Zinggl C, Smolle MA, Leitner L, Lohberger B, Leithner A, Sadoghi P. Mechanically aligned total knee arthroplasty with the extension-first technique does not equally restore neutral knee alignment in all preoperative knee phenotypes. Knee Surg Sports Traumatol Arthrosc 2022; 31:1405-1411. [PMID: 36087129 PMCID: PMC10049937 DOI: 10.1007/s00167-022-07147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to determine the change in the long leg axis according to the preoperative knee phenotype using the mechanically aligned extension-first technique in total knee arthroplasty. The hypothesis of this study was that the knee phenotype would have an impact on the postoperative leg axis. METHODS This was a retrospective comparative study comprising 224 whole-leg radiographs of 112 patients. The leg axes of the pre- and postoperative radiographs were measured and categorized into three preoperative limb phenotypes (based on the hip-knee-ankle angle [HKA]) according to Hirschmann et al. (varus-HKA < 178.5°, neutral-HKA 178.5°-181.5°, and valgus-HKA > 181.5°). Additionally, femoral phenotypes (based on the femoral mechanical angle [FMA], i.e., the mechanical medial distal femoral angle [mMDFA], as well as the tibial phenotypes [based on the tibial mechanical angle, i.e., the medial proximal tibial angle (MPTA)] was calculated. The change in the long leg axis was analyzed and compared with the preoperative limb phenotype. RESULTS Significantly more patients with preoperative varus alignment shifted to neutral alignment (46.3%, n = 31) than did patients with preoperative valgus alignment (38.9%; n = 14). Moreover, 43.3% of patients (n = 29) with the varus phenotype remained in a varus alignment, compared with the 58.3% of patients with preoperative valgus phenotype (n = 21) remaining in valgus alignment. These findings were similar for both females (p < 0.001) and males (p = 0.015). CONCLUSION Using an extension-first mechanically aligned surgical technique, varus phenotypes predominantly result in neutral leg axes or remain varus, neutral phenotypes remain neutral, and valgus phenotypes remain valgus or change to neutral phenotypes. This study showed that preoperative knee phenotypes in valgus knees influence this technique more strongly than estimated in previous investigations, which is in line with modern alignment philosophies for TKA. LEVEL OF EVIDENCE Level IV, retrospective comparative study.
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Affiliation(s)
- Nina Hörlesberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Carina Zinggl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Six Commonly Used Postoperative Radiographic Alignment Parameters Do Not Predict Clinical Outcome Scores after Unrestricted Caliper-Verified Kinematically Aligned TKA. J Pers Med 2022; 12:jpm12091468. [PMID: 36143253 PMCID: PMC9503412 DOI: 10.3390/jpm12091468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Unrestricted caliper-verified kinematically aligned (KA) TKA restores patient’s prearthritic coronal and sagittal alignments, which have a wide range containing outliers that concern the surgeon practicing mechanical alignment (MA). Therefore, knowing which radiographic parameters are associated with dissatisfaction could help a surgeon decide whether to rely on them as criteria for revising an unhappy patient with a primary KA TKA using MA principles. Hence, we determined whether the femoral mechanical angle (FMA), hip–knee–ankle angle (HKAA), tibial mechanical angle (TMA), tibial slope angle (TSA), and the indicators of patellofemoral tracking, including patella tilt angle (PTA) and the lateral undercoverage of the trochlear resection (LUCTR), are associated with clinical outcome scores. Methods: Forty-three patients with a CT scan and skyline radiograph after a KA TKA with PCL retention and medial stabilized design were analyzed. Linear regression determined the strength of the association between the FMA, HKA angle, PTS, PTA, and LUCTR and the forgotten joint score (FJS), Oxford knee score (OKS), and KOOS Jr score obtained at a mean of 23 months. Results: There was no correlation between the FMA (range 2° varus to −10° valgus), HKAA (range 10° varus to −9° valgus), TMA (range 10° varus to −0° valgus), TSA (range 14° posterior to −4° anterior), PTA (range, −10° medial to 14° lateral), and the LUCTR resection (range 2 to 9 mm) and the FJS (median 83), the OKS (median 44), and the KOOS Jr (median 85) (r = 0.000 to 0.079). Conclusions: Surgeons should be cautious about using postoperative FMA, HKAA, TMA, TSA, PTA, and LUCTR values within the present study’s reported ranges to explain success and dissatisfaction after KA TKA.
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Miralles-Muñoz FA, Rubio-Morales M, Bello-Tejada L, González-Parreño S, Lizaur-Utrilla A, Alonso-Montero C. Varus alignment of the tibial component up to seven degrees is not associated with poor long-term outcomes in a neutrally aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:2768-2775. [PMID: 34175990 DOI: 10.1007/s00167-021-06627-3] [Citation(s) in RCA: 2] [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: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this retrospective study was to evaluate the effect of varus alignment of the tibial component on the outcomes with a minimum follow-up of 10 years. The hypothesis was that varus alignment of the tibial component might not affect the outcomes and survival of a neutrally aligned primary TKA. METHODS A matched case-control study was designed between 66 patients with varus alignment of the tibial component and 66 with neutral alignment with a minimum follow-up of 10 years. Functional outcome was assessed with the knee surgery scores (KSS) and reduced Western Ontario and MacMaster Universities questionnaire (WOMAC). Patient satisfaction was evaluated by a 0-10 visual analog scale. Radiological evaluation was performed at early postoperative and at final follow-up. RESULTS The mean follow-up was 11.9 (SD 2.6) years for both groups. The mean postoperative proximal tibial angle in the varus group was 85.0° (SD 0.9) and 88.8° (SD 0.9) in control group. At the final follow-up, there were no significant differences in KSS, WOMAC, range of motion or patient satisfaction. There were no differences in the coronal anatomical alignment of the TKA between groups. Revision of TKA was performed in four knees in the varus group, and one in control group, due to aseptic loosening of the tibial component in all cases. TKA survival at 10 years was not significantly different between groups. CONCLUSION The alignment of the tibial component up to 7° varus did not negatively affect implant survival, patient satisfaction, and function of a well-aligned TKA, with a minimum postoperative follow-up of 10 years. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Marta Rubio-Morales
- Department of Orthopaedic Surgery, University Hospital of Elda, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Laiz Bello-Tejada
- Department of Orthopaedic Surgery, University Hospital of Elda, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Santiago González-Parreño
- Department of Orthopaedic Surgery, University Hospital of Elda, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, University Hospital of Elda, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
- Faculty of Medicine, Department of Traumatology and Orthopaedics, Miguel Hernandez University, Elche, Alicante, Spain
| | - Carolina Alonso-Montero
- Faculty of Medicine, Department of Traumatology and Orthopaedics, Miguel Hernandez University, Elche, Alicante, Spain
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Shang G, Hu M, Guo J, Hao X, Xiang S. Using short knee radiographs to predict the coronal alignment after TKA: Is it an accurate proxy for HKA on full-length images? J Orthop Surg Res 2022; 17:340. [PMID: 35794578 PMCID: PMC9258175 DOI: 10.1186/s13018-022-03235-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/20/2022] [Indexed: 07/02/2024] Open
Abstract
Background The postoperative clinical outcomes has been extensively demonstrated to correlate with the coronal alignment after total knee arthroplasty (TKA). However, in different studies, either the hip-knee-ankle angle (HKA) on a full-length radiograph or the femorotibial angle (FTA) on a short knee film was used to categorize the postoperative coronal alignment. Meanwhile, several different FTA ranges were regarded as neutral alignment in different studies. As a result, it is still unknown that how FTA on short knee films and HKA related to each other. The FTA may be able to become an accurate proxy of HKA to predict the coronal alignment. The purpose of this study was to explore the correlation between the FTA and the HKA after TKA and to find the most accurate FTA range. Methods About 223 patients were included in this study and standard weight-bearing short knee films as well as full-length radiographs were acquired. The pre- and postoperative FTA, as well as the postoperative anatomical lateral distal femoral angle (aLDFA) and anatomical medial proximal tibial angle (aMPTA) were measured on short knee films by two orthopedic surgeons independently. On full-length films, the pre- and postoperative FTA, the pre- and postoperative HKA, as well as the postoperative mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were also recorded by two other surgeons independently. Pearson correlation analysis was performed to compare FTA and HKA, aMTPA and mMTPA, aLDFA and mLDFA, respectively. Results The postoperative FTA and HKA had a good correlation (r = 0.86). The agreements were reached 82.7%, 71.0%, and 68.2% of all patients using three previously reported FTA ranges. When analyzing the independent alignment of the tibial tray and the femoral component, 84.1% and 57.9% of all patients was reached an agreement on the classification. Conclusions On most occasions, the consistence between the FTA and HKA in assessing the coronal limb alignment of the lower extremity and the tibial component is satisfactory. However, the postoperative full-length film is still needed to evaluate accurately the coronal alignment of the femoral component.
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Tang J, Wu T, Shao H, Zhou Y. Malposition of components and Femorotibial mechanical Axis changes on pressure distribution in Total knee arthroplasty. Clin Biomech (Bristol, Avon) 2022; 96:105659. [PMID: 35588587 DOI: 10.1016/j.clinbiomech.2022.105659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/10/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND To the best of our knowledge, no report has analyzed the postoperative results of poor prosthesis position, particularly when the femoral and tibial components are abnormally positioned relative to neutral lower limb alignment. We aimed to investigate pressure distribution in the knee at different lower limb alignments with diverse positions of femoral and tibial components. METHODS We established a three-dimensional model of the lower limb using computed tomography and simulated total knee arthroplasty. Tibial and femoral components were changed to 7°, 5°, and 3° of valgus and neutral and 3°, 5°, and 7° of varus positions in the coronal plane. Finite element analysis was performed after applying pressure to simulate weight-bearing, and pressure distribution on the tibial surface was analyzed. We also conducted biomechanical testing using a weight-bearing rig with six cadavers. We measured the pressure at the tibial surface with the position of different components and lower limb alignment. FINDINGS Peak pressure on the medial or lateral side of the tibia was determined by the mechanical axis. When tibial components are in 3°,5° and 7° of valgus/varus and femoral components are in 3°,5° and 7° of varus/valgus correspondence, no peak pressure was detected with normal alignment, despite malpositioned components. INTERPRETATION Lower limb alignment is more critical than the position of the component. Medial and lateral tibial compartment pressures were evenly distributed if the alignment was neutral. Malpositioned femoral or tibial components changed the femorotibial mechanical axis, and peak pressure of the proximal tibia was positively related to alignment.
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Affiliation(s)
- Jing Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China.
| | - Tiemure Wu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China.
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China.
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing 100035, China.
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Charaya H, Gill HS, Bhan R. Functional Outcome Based on Mechanical Axis Alignment Following Total Knee Arthroplasty. Cureus 2022; 14:e22553. [PMID: 35371657 PMCID: PMC8958131 DOI: 10.7759/cureus.22553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is the most commonly performed and highly successful surgical intervention for end-stage osteoarthritis of the knee, and it offers patients pain relief, functional recovery, and improved quality of life. The success of knee arthroplasty depends on various factors such as precise surgical technique, alignment of the limb and components, patient selection, and compliance with rehabilitation. Mechanical alignment of the lower limb has been considered an important factor in planning and assessing the success of TKA. Optimal alignment remains a matter of controversy; hence, it is paramount to assess the alignment and functional outcomes. Aim and objective This study aimed to evaluate the reliability of conventional instrumentation in imparting the intended femoral and tibial coronal alignment, as well as study the functional outcome among the neutrally aligned outliers with respect to the mechanical axis of the lower limb using standing long-leg radiographs. Methodology This is a prospective, hospital-based, observational study that was conducted on 60 knees in 42 patients with primary osteoarthritis of the knee joint in the department of orthopedics, Satguru Partap Singh (SPS) Hospitals, Ludhiana. Patients undergoing total knee arthroplasty who fulfilled the inclusion criteria were included in our study and evaluated using Knee Society Score and knee flexion range at periodic follow-up till six months. Preoperative and postoperative standing long-leg radiographs were done for all the patients, and their functional outcome was compared among inliers and outliers. Results Out of these 60 total knee arthroplasties, 18 patients were operated on both knees, and 24 patients were operated on a single knee. There were 25 female patients and 17 male patients. The mean for pre-operative mechanical axis alignment angle was 11.88° ± 5.63° with a range from -3° to 27°, which changed to 2.90° ± 1.59° with a range from 0° to 8° at six months follow-up. It was observed that 42 of the knees were in the inliers, and the remaining 18 knees were in the outliers group. On comparison among inliers and outliers, we found that the mean range of motion was 108.29° ± 4.82° for the inliers group and 106.11° ± 4.04° for the outliers group (p = 0.091), depicting non-significant statistical comparison. Mean Knee Society Score values in inliers and outliers group were 152.45 ± 5.33 and 151.61 ± 3.55, respectively (p = 0.740), showing no statistical significance. Conclusion At six months follow-up, there is no difference in the knee range of motion and Knee Society Scores between mechanical axis inliers and outliers. Thus, we conclude that although every knee arthroplasty is intended to have neutral mechanical alignment, there is no effect of mild mechanical axis malalignment on functional outcome following total knee arthroplasty in the short term.
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Shin KH, Jang KM, Han SB. Residual varus alignment can reduce joint awareness, restore joint parallelism, and preserve the soft tissue envelope during total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:507-516. [PMID: 32743784 DOI: 10.1007/s00167-020-06201-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The objectives were to compare the coronal joint configuration of the knee joints, coronal gap imbalances requiring substantial medial release, and patient-reported outcomes, including the forgotten joint score, between knees in which residual varus alignment was intentionally allowed according to an individualised lower limb analysis and those with mechanical alignment in total knee arthroplasty for varus osteoarthritis. METHODS Consecutive primary navigated total knee arthroplasty procedures for varus osteoarthritis were retrospectively reviewed. The study cohort was stratified based on whether residual varus alignment was intentionally allowed. Propensity-score matching was performed based on the baseline characteristics, including demographic characteristics, preoperative radiological measurements, and the Western Ontario and McMaster University Osteoarthritis Index (mechanical alignment group vs residual varus group). The patient-reported outcomes and coronal joint line orientation of the knee (relative to the ground) and ankle were evaluated. Coronal gap differences and coronal gap imbalances were analysed using intraoperative gap measurements. RESULTS Relative to the ground and ankle, the postoperative knee joint line orientation slanted down laterally in the mechanical alignment group (- 3.05˚ ± 1.62, relative to the ground; - 2.65˚ ± 1.56, relative to the ankle joint), but was parallel in the residual varus group (- 0.75˚ ± 1.59, relative to the ground; - 0.95˚ ± 1.71, relative to the ankle joint). Coronal gap differences at extension and the proportion of coronal gap imbalances requiring substantial medial release were 1.27 ± 1.53 and 6% in the residual varus group and 2.32 ± 1.24 and 15% in the mechanical alignment group. Postoperatively, the residual varus group showed higher Western Ontario and McMaster University Osteoarthritis Index scores and total forgotten joint scores than the mechanical alignment group (6.97 ± 4.75 vs. 10.31 ± 5.74 and 56.42 ± 12.85 vs. 45.69 ± 14.49, respectively). CONCLUSION Intentionally allowed residual varus alignment with individualised analysis of lower limb alignment restored the parallel joint line of the knees, preserved the soft tissue envelope, and reduced joint awareness after total knee arthroplasty for varus osteoarthritis. LEVEL OF EVIDENCE Therapeutic, Level III retrospective case-control study.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
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15
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Sappey-Marinier E, Batailler C, Swan J, Malatray M, Cheze L, Servien E, Lustig S. Primary osteoarthritic knees have more varus coronal alignment of the femur compared to young non-arthritic knees in a large cohort study. Knee Surg Sports Traumatol Arthrosc 2022; 30:428-436. [PMID: 32488367 DOI: 10.1007/s00167-020-06083-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Many surgeons are performing total knee arthroplasty (TKA) with an aim to reproducing native anatomical coronal alignment. Yet, it remains unclear if primary osteoarthritic and non-osteoarthritic populations have similar knee coronal alignment. This study aims to describe and compare the distribution of femoral and tibial coronal alignment in a large primary osteoarthritic cohort and a young non-osteoarthritic cohort. METHODS This is a retrospective analysis of a monocentric prospectively gathered data, from 1990 to 2019, of 2859 consecutive primary osteoarthritic knees in 2279 patients. Patients underwent standardized long-leg radiographs. Femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were digitally measured using software. Femoral, tibial and knee phenotypes were analyzed, and descriptive data were reported. Data were compared to a young non-osteoarthritic population previously described. RESULTS In osteoarthritic knees, the mean FMA was 91° ± 2.9° (range 86°-100°) and the mean TMA was 87° ± 3.1° (range 80°-94°). No significant difference was observed for FMA and TMA between genders. The most common femoral and tibial phenotypes were varus (38.7%) and neutral (37.1%). The most frequent knee phenotype was a varus femoral phenotype with a neutral tibial phenotype (15.5%), which is different to the non-osteoarthritic population. CONCLUSION This study showed the wide distribution of knee phenotypes in a large osteoarthritic cohort. There was more varus distribution of the femoral coronal alignment compared to a non-osteoarthritic population, suggesting consideration and potential adaptation of the realignment strategy of the femoral component during TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elliot Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France.
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France
| | - John Swan
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France
| | - Matthieu Malatray
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France
| | - Laurence Cheze
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR LBMC UMR-T9406, 69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital de la Croix Rousse, 103 grande rue, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR LBMC UMR-T9406, 69622, Lyon, France
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16
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Zimmermann M, Moser L, Moret C, Iordache E, Amsler F, Rasch H, Hügli R, Hirschmann MT. Under-correction of preoperative varus alignment does not lead to a difference in in-vivo bone loading in 3D-SPECT/CT compared to neutral alignment. Knee 2022; 34:259-269. [PMID: 35077945 DOI: 10.1016/j.knee.2022.01.005] [Citation(s) in RCA: 2] [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: 06/13/2021] [Revised: 11/15/2021] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim was to investigate the correlation of bone tracer uptake (BTU) in SPECT/CT and changes in coronal knee alignment after total knee arthroplasty (TKA). We questioned if undercorrection of preoperative varus alignment leads to a difference in BTU compared to neutral alignment. METHODS Consecutive 66 patients who received SPECT/CT before and after TKA were retrospectively included. Adjusted mechanical alignment was the alignment target. The alignment of the knee was measured on 3D-CT by selecting standardized landmarks. Maximum (mean ± SD) and relative BTU (ratio to the reference) were recorded using a previously validated localization scheme (p < 0.05). RESULTS In the native group, 20 knees were aligned (30.3%) in valgus (HKA > 181.5°), 12 (18.2%) in neutral (178.5°-181.5°) and 34 (51.5%) in varus (HKA < 178°). Overall TKA changed the alignment towards neutral. 48.5% remained in the same groups, whereas 50% of native valgus and 33% of varus knees changed to neutral after TKA. In native varus alignment mean BTU was significantly higher in some medial tibial and femoral regions (fem1ia (p = 0.010), fem1ip (p = 0.002), tib1a.mid (p = 0.005), tib1a.tray (p = 0.000), tib1p.tray (p = 0.000)); in native valgus alignment mean BTU was higher in the corresponding lateral tibial and femoral regions (fem2ip (p = 0.001), tib2a.tray (p = 0.011), tib2p.tray (p = 0.002)). After TKA, a significant decrease in femoral and tibial BTU (femoral preoperative BTU 1.64 +/-0.69; femoral postoperative BTU 0.95 +/-0.42; p = 0.000// tibial preoperative BTU 1.65 +/- 0.93; tibial postoperative BTU 1.16 +/- 0.48; p = 0.000) and an increase in patellar BTU was observed (p = 0.025). Native varus alignment correlated with a higher medial BTU decrease medially. Undercorrection of preoperative varus alignment showed no higher BTU after TKA. CONCLUSION Preoperative varus alignment correlated with a higher decrease in BTU in specific femoral and tibial medial regions. Preoperative valgus alignment correlated with a higher decrease in the corresponding lateral regions. Undercorrection of preoperative varus alignment did not lead to higher bone loading reflected by BTU after TKA.
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Affiliation(s)
- M Zimmermann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland; University of Basel, Basel, Switzerland
| | - L Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - C Moret
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland; University of Basel, Basel, Switzerland
| | - E Iordache
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland; University of Basel, Basel, Switzerland
| | - F Amsler
- Amsler Consulting, Basel, Switzerland
| | - H Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - R Hügli
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - M T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland; University of Basel, Basel, Switzerland.
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Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2021; 29:3170-3177. [PMID: 32556430 DOI: 10.1007/s00167-020-06097-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The objectives of this study were to examine the relation between clinical outcomes 1 year postoperatively, in a cohort of mechanically aligned total knee arthroplasties (TKA), and (1) the degrees of alignment change of the tibial, femoral and the hip-knee-ankle (HKA) angle; (2) the change of phenotype; (3) the postoperative knee joint line orientation to the floor. METHODS Pre-operative and postoperative long-leg X-rays of 90 patients were used to determine the coronal alignment. The absolute difference between the pre-operative and postoperative measurements was determined and the outcomes were categorized in whether or not a change in phenotype had occurred. Finally, the orientation of the knee joint line relative to the floor (tibial joint line angle-TJLA) was measured. Clinical outcomes were determined with the KOOS and KSS at 1-year follow-up. RESULTS The clinical outcomes (1) did not correlate with the absolute difference of the alignment measured; (2) did not show a difference between patients with or without a change in phenotype; and (3) were higher (KOOS ADL, Sport and QoL) in patients with a medial open TJLA. CONCLUSION This study showed no correlation between clinical outcomes and joint line restoration of the femur, tibia or HKA in patients after TKA. Leaving the prosthesis with some degrees of under correction on the coronal plane maintaining the phenotype, was not associated to better clinical results compared to TKA overcorrection. Nevertheless, the results showed that patients with a medial open TJLA had better clinical outcomes than patients with a lateral open TJLA. LEVEL OF EVIDENCE III.
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18
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Kazarian GS, Lieberman EG, Hansen EJ, Nunley RM, Barrack RL. Clinical impact of component placement in manually instrumented total knee arthroplasty : a systematic review. Bone Joint J 2021; 103-B:1449-1456. [PMID: 34465158 DOI: 10.1302/0301-620x.103b9.bjj-2020-1639.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA). METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included. Study quality was assessed, evidence was graded (one-star: no evidence, two-star: limited evidence, three-star: moderate evidence, four-star: strong evidence), and recommendations were made based on the available evidence. RESULTS A total of 49 studies were identified for inclusion. With respect to PROMs, there was two-star evidence in support of mechanical axis alignment (MAA), femorotibial angle (FTA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), femoral rotation, tibial and combined rotation/mismatch, and implant size/overhang or offset on PROMs, and one-star evidence in support of tibial sagittal angle (TSA), impacting PROMs. With respect to survival, there was three- to four-star evidence in support FTA, FCA, TCA, and TSA, moderate evidence in support of femoral rotation, tibial and combined rotation/mismatch, and limited evidence in support of MAA, FSA, and implant size/overhang or offset impacting survival. CONCLUSION Overall, there is limited evidence to suggest that PROMs are impacted by the accuracy of implant placement, and malalignment does not appear to be a significant driver of the observed high rates of patient dissatisfaction following TKA. However, FTA, FCA, TCA, TSA, and implant rotation demonstrate a moderate-strong relationship with implant survival. Efforts should be made to improve the accuracy of these parameters in order to improve TKA survival. Cite this article: Bone Joint J 2021;103-B(9):1449-1456.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth G Lieberman
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Erik J Hansen
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
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Kaneko T, Igarashi T, Takada K, Yoshizawa S, Ikegami H, Musha Y. Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements. Knee 2021; 31:64-76. [PMID: 34118583 DOI: 10.1016/j.knee.2021.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/06/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study was to compare the accuracy of prosthetic alignment with three-dimensional computed tomography (3DCT) measurements following total knee arthroplasty (TKA) performed using a robotic-assisted surgical technique versus a conventional TKA. METHODS 41 TKAs were performed with a handheld robotic-assisted surgical procedure (Robot group) between 2019 and 2020. Another 41 patients underwent TKA with a conventional manual surgical procedure (Manual group) using the same prosthesis. The operation durations between both groups were investigated. 3DCT scans of the entire lower extremities were taken before and after the surgery and femoral and tibial alignments in the coronal, sagittal, and axial planes were measured using computer software. The differences in prosthetic alignment and translation between the preoperative 3DCT plan and postoperative 3DCT image were also measured. RESULTS There were no statistically significant differences in the post-operative outliers of the femorotibial angle between the groups. In the tibial-axial plane, the mean of prosthetic alignment in the anteroposterior plane was 4.0° in the Robot group and 6.7° in the Manual group (p < 0.01). The rate of outliers for tibial-axial alignment in the Robot group was significantly less than in the Manual group (p < 0.01). There were no statistically significant differences in prosthetic translation in the proximal-distal, anterior-posterior and medial-lateral orientations between the groups. CONCLUSIONS In a radiologic study using 3DCT, robotic-assisted TKA reduced the outliers for rotational alignment of the tibial prosthesis in comparison to conventional TKA, which can lead to improved tracking of the femoral-tibial bearing surfaces.
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Affiliation(s)
- Takao Kaneko
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | | | - Kazutaka Takada
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | - Shu Yoshizawa
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
| | - Yoshiro Musha
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
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Liu C, Zhao G, Chen K, Lyu J, Chen J, Shi J, Huang G, Chen F, Wei Y, Wang S, Xia J. Tibial component coverage affects tibial bone resorption and patient-reported outcome measures for patients following total knee arthroplasty. J Orthop Surg Res 2021; 16:134. [PMID: 33579313 PMCID: PMC7881541 DOI: 10.1186/s13018-021-02250-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/20/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose The aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points. Methods The study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student’s t test, and one-way ANOVA together with Tukey’s post hoc test (or Games-Howell post hoc test) were used in the analyses. Results Tibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial (p = 0.003) and lateral (p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score (p = 0.004) and positively related with WOMAC pain score (p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) (p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later. Conclusion Under-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient’s prognosis, while the alignment of components might not be as important. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02250-7.
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Affiliation(s)
- Changquan Liu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Guanglei Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Kangming Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jinyang Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jie Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jingsheng Shi
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Gangyong Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Feiyan Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Yibing Wei
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Siqun Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China
| | - Jun Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12, Wulumuqi Rd., Jing'an District, Shanghai, China.
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Laoruengthana A, Rattanaprichavej P, Tantimethanon T, Eiamjumras W, Teekaweerakit P, Pongpirul K. Usefulness of an accelerometer-based navigation system in bilateral one-stage total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:164. [PMID: 33568132 PMCID: PMC7877091 DOI: 10.1186/s12891-021-04027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Bilateral one-stage total knee arthroplasty (BTKA) have increased because it provides a number of advantages. Recently, Accelerometer-based navigation (ABN) system which guide the cutting plane without intramedullary disturbance might result in less endothelial and microvascular damage. Therefore, we hypothesized that the ABN may reduce blood loss, reduce postoperative pain, and better restore BTKA alignment compared to conventional instruments. Methods We retrospectively compared 44 consecutive patients receiving ABN assisted BTKA (iBTKA) to 57 patients with conventional instruments (cBTKA). Identical pre- and post-operative care was utilized to all patients. The outcome measures assessed were hemoglobin (Hb), calculated blood loss (CBL), blood transfusion, VAS score for pain, morphine consumption, knee flexion angle, and length of stay (LOS). Radiographic assessment included mechanical axis (MA) and component positioning at 3–6 months of follow up. Results Both iBTKA and cTKA groups had equivalent demographic data. Postoperative Hb of the cBTKA group was significantly lower than those in the iBTKA group at 24 h (p = 0.02), but there was no significant difference in drain volume, CBL, and blood transfusion rate. For radiographic measures, the iBTKA group had more accurate MA and component orientation, and had a lower number of outliers than those in the cBTKA group (p ≤ 0.01), except for the sagittal femoral component angle. Conclusion The ABN assisted BTKA could not reduce blood loss or postoperative pain more than cBTKA, nor improve functional recovery. However, the ABN significantly improved the accuracy of MA and prostheses positioning. Trial registration The protocol of this study was registered in the Thai Clinical Trials Registry database No. TCTR20180731001# on 25 July 2018.
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Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand
| | - Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand.
| | - Thanawat Tantimethanon
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand
| | - Watcharapong Eiamjumras
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand
| | - Passakorn Teekaweerakit
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, 99 Moo 9 Thapho, Phitsanulok, 65000, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pailhé R. Total knee arthroplasty: Latest robotics implantation techniques. Orthop Traumatol Surg Res 2021; 107:102780. [PMID: 33333275 DOI: 10.1016/j.otsr.2020.102780] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/24/2020] [Indexed: 02/03/2023]
Abstract
The recent introduction of new robotic systems for total knee arthroplasty (TKA) has created somewhat of a craze. Nevertheless, we can ask ourselves whether it is justified to use these new but very costly technologies. The results and limitations of these robotic tools must be analyzed systematically before confirming their benefits. Most of the newest robotic systems are interactive ones. These systems can accurately restore the mechanical axis and can improve the ligament balance and implant positioning. Theoretically, this can lead to better survival, function and outcomes. Recent studies have shown that use of robotics for TKA implantation does not increase the surgery time and does not cause more complications. Nevertheless, the long-term advantages of robotics use in this context remains to be proven. This task will be more difficult since there is currently no consensus as to the ideal positioning of TKA implants for a given patient. The aim of this study is to summarize this topic by answering the following questions: What are the different types of robots that can be used for TKA implantation? Which steps of the TKA surgical procedure are done with robotic arm assistance? What are the outcomes of these new implantation techniques? What are the limitations of these new implantation techniques? LEVEL OF EVIDENCE: V; expert opinion.
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Affiliation(s)
- Régis Pailhé
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, hôpital Sud, CHU de Grenoble-Alpes, avenue de Kimberley, BP 338, 38434 Échirolles, France.
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Varus alignment after total knee arthroplasty results in greater axial rotation during deep knee bend activity. Clin Biomech (Bristol, Avon) 2020; 77:105051. [PMID: 32464429 DOI: 10.1016/j.clinbiomech.2020.105051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/01/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS The correlation between in vivo knee kinematics and alignment has not been fully elucidated. Recently, similar or better clinical outcomes have been reported by restoration of mild varus alignment after total knee arthroplasty for preoperative varus knees. The aim of this study was to evaluate the effect of postoperative alignment on knee kinematics during a deep knee bend activity. METHODS In vivo knee kinematics of 36 knees (25 patients) implanted with tri-condylar total knee arthroplasty were analyzed with a three dimensional model fitting approach using fluoroscopy. Under fluoroscopic surveillance, individual video frames were digitized at 30° increments from full extension to maximum flexion. Postoperative coronal and sagittal alignments were assessed using radiographs, and rotational alignment was assessed with computed tomography. Pearson correlation coefficients were calculated to determine the correlations between the alignment data and kinematic factors. FINDINGS Correlation analysis showed that coronal alignment was significantly correlated with knee kinematics. The varus alignment of the limb and tibial component led to a greater axial rotation from full extension to maximum flexion and more rotated position in the mid to deep flexion range. Neither the rotational alignment of the femoral nor tibial components showed significant correlation with axial rotation from full extension to maximum flexion. INTERPRETATION Varus alignment resulted in greater axial rotation, which could represent near-normal knee kinematics. The current study can be a kinematic rationale reporting similar or better clinical and functional outcomes for the total knee arthroplasty with residual varus alignment.
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Liu HM, Wang YF, Wu JM, Li BY, Dong F, Lu DF, Li HX, Zhang ZT, Yu C, Lian YY. A comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease. INTERNATIONAL ORTHOPAEDICS 2020; 44:1719-1726. [PMID: 32232536 DOI: 10.1007/s00264-020-04542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy of total knee arthroplasty (TKA) in the treatment of primary osteoarthritis (OA) and osteoarthritis of Kashin-Beck disease (KBD). METHODS This study enrolled 77 KBD patients (77 knees, KBD-TKA) and 75 OA patients (75 knees, OA-TKA) who underwent TKA from September 2008 to June 2018. Clinical assessments for each patient were performed pre-operatively and last follow-up. The efficacy measures included the visual analogue scale (VAS) pain score, range of motion (ROM), Hospital for Special Surgery (HSS) score, and short form 36 Health Survey (SF-36) as well as related influencing factors between the two groups. RESULTS All patients were followed up; the follow-up time of KBD-TKA was 14-132 months, with an average of 72.68 ± 37.55 months; OA-TKA was 15-120 months, with an average of 49.2 ± 28.91 months. There was no difference in pre-operative VAS score (7.29 vs. 7.24) and SF-36 (PCS) score (4.87 vs. 5.49) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse pre-operative ROM (75.48° vs. 82.87°), HSS score (36.40 vs. 41.84), and SF-36 (MCS) score (26.28 vs. 28.73) (P < 0.05). At the final follow-up, there was no significant difference in VAS score (1.13 vs. 1.16), ROM (105.79 vs. 105.79), and HSS score (92.06 vs. 92.25) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse SF-36 (PCS) score (36.90 vs. 42.00) and SF-36 (MCS) score (55.16 vs. 59.70) (P < 0.05). In a multivariate regression, controlling for multiple potential confounders, diagnosis of KBD was associated with poor quality of life after surgery, whereas pre-operative pain was specifically associated with post-operative pain. However, preoperative gender, age, BMI, and the angles of knee prosthesis (before and after surgery) were not associated with post-operative outcome. CONCLUSION Patients with KBD undergoing primary TKA have excellent outcomes, comparable with OA at the final follow-up, in spite of worse pre-operative ROM, HSS score, and SF-36(MCS) score. However, KBD patients are worse than OA in terms of general health. Pre-operative age, gender, BMI, and the angles of knee prosthesis were not the factors influencing the clinical efficacy of TKA. The diagnosis of KBD was an independent risk factor for poor quality of life after TKA. Pre-operative pain was a clinically important predictor of outcome.
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Affiliation(s)
- Hui-Min Liu
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Ya-Fei Wang
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jian-Min Wu
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Bo-Yuan Li
- Department of Orthopaedic Surgery, Heilongjiang Provincial Hospital, No 82, Zhongshan road, Harbin city, Heilongjiang province, China
| | - Feng Dong
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Dai-Feng Lu
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Hong-Xi Li
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Zhi-Tao Zhang
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Cong Yu
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Yong-Yun Lian
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital Of Harbin Medical University, No. 37, Yiyuan street, Nangang District, Harbin City, Heilongjiang Province, China.
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25
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Giorgini A, Zambianchi F, Lombardi M, Francioni E, Marcovigi A, Catani F. Mechanical alignment changes during flexion in total knee arthroplasty without affecting clinical outcomes. Clin Biomech (Bristol, Avon) 2020; 72:63-68. [PMID: 31838212 DOI: 10.1016/j.clinbiomech.2019.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary aim of this study is to investigate if Hip-Knee-Ankle angle, measured in the coronal plane, changes with knee flexion after total knee arthroplasty. The secondary aim is to assess the relationship between Hip-Knee-Ankle during knee flexion and clinical outcome at mid-term follow up. METHODS 334 computer assisted total knee arthroplasties were retrospectively evaluated. A total of 233 patients were available for assessment of clinical outcomes at last follow up (mean 35 months). Hip-Knee-Ankle angle at different degrees of knee flexion and components' alignment were recorded intraoperatively. FINDINGS Patients were stratified based on the preoperative alignment: 202 varus knees, 99 neutral knees, and 33 valgus knees. In the varus knee group, 146 patients (89%) maintained a neutral overall limb alignment when flexed to 20°, 118 (72%) remained neutrally aligned at 45° and 92 (54%) at 90°. In valgus knee group, 26 (90%) remained neutrally aligned at 20°, 22 (75%) at 45° and 16 (55%) at 90°. In neutrally-aligned knee group, 88 (96%) remained neutrally aligned at 20°, 73 (79%) at 45° and 61 (66%) at 90°. Femoral component external rotation was correlated with varus alignment in flexion. Good outcomes were reported in 181 (78%) cases, fair results in 28 (12%) cases, poor results in 24 (10%) of cases. Poor results were not correlated to Hip-Knee-Ankle angle at different knee flexion angles. INTERPRETATION This study demonstrates that intraoperative Hip-Knee-Ankle angle changes as the knee moves into deeper flexion. However, neutral Hip-Knee-Ankle through the range of motion does not correlate with superior outcomes.
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Affiliation(s)
- Andrea Giorgini
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy.
| | - Francesco Zambianchi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Martina Lombardi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Elena Francioni
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Andrea Marcovigi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Fabio Catani
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy.
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Khatib Y, Xia A, Naylor JM, Harris IA, Sorial RM. Different targets of mechanical alignment do not improve knee outcomes after TKA. Knee 2019; 26:1395-1402. [PMID: 31477332 DOI: 10.1016/j.knee.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/06/2019] [Accepted: 08/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate alignment is a basic principle of TKA surgery, but achieving alignment within this target may not translate into superior outcomes after surgery. PURPOSE To assess if neutral TKA mechanical alignment was associated with superior knee outcomes and to examine the effect of various aspects of pre-operative and post-operative alignment on knee function. METHODS Analysis of a database of 444 TKA patients between June 2009 and October 2016. Knee outcomes (WOMAC, AKSS and knee range of motion) were collected before surgery and during follow-up at a minimum of six months. RESULTS Analysis included 444 TKA patients (62% female, mean age 66 years, mean follow-up 23 months). Deformity varied from 21° varus (mean = 7.9, SD = 2.8) to 17° valgus deformity (mean = 7.7, SD = 2.8). Pre-operatively, 101 (23%) knees were in native neutral mechanical alignment, while 278 (63%) were in varus and 65 (15%) were in valgus. Post-operatively, a group of 365 (82%) TKA were found to be in neutral mechanical alignment and a group of 79 (18%) TKA were noted to be 'Outliers' (17 [4%] TKA > 3° varus and 62 [14%] TKA > 3° valgus alignment). Restoration of the target of alignment of 0 ± 3° or 0 ± 1°, did not have better functional outcomes scores, range of motion or prosthesis longevity than those in the outlier range. CONCLUSION Neutral TKA alignment did not appear to be a significant contributing factor to the improvement in knee function in short-medium term follow-up.
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Affiliation(s)
- Yasser Khatib
- Nepean Hospital, 2 Hope St, PO Box 949, Penrith, NSW 2750, Australia.
| | - Andrew Xia
- Nepean Hospital, Derby St, Penrith, NSW 2750, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Australia; C/O Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC 1871, Sydney, NSW, Australia.
| | - Ian A Harris
- C/O Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC 1871, Sydney, NSW, Australia; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Australia
| | - Rami M Sorial
- Sydney University, Nepean Hospital, Derby St, Penrith, NSW 2750, Australia; Nepean Hospital, 60A Derby St, Penrith, NSW 2750, Australia
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Popescu R, Haritinian EG, Cristea S. Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement. INTERNATIONAL ORTHOPAEDICS 2019; 44:119-128. [PMID: 31655885 DOI: 10.1007/s00264-019-04424-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
AIM OF THE STUDY To identify the most reliable anatomical landmarks and imaging techniques for assessing the rotation of the tibial component in total knee arthroplasty (TKA). METHODS An extensive literature review (from January 2016 to March 2019) was performed. We included studies about primary TKA with details concerning the anatomical landmarks used for implanting the tibial component and also imaging studies assessing tibial component rotation. The final selection comprises only thirty-five articles consistent with the inclusion criteria. RESULTS Extra-articular landmarks are not always reliable (even though the tibial tubercle is one of the most popular extra-articular landmarks used to assess the rotation of the tibial component), mainly because they vary and can lead to malrotation of the tibial component. Akagi's line (an intra-articular landmark) is considered to be the most reliable and easy to find during surgery and likewise is not affected by articular deformities. The anterior tibial cortex (intra-articular landmark) also proved to be accurate and reliable with the main advantage being that is palpable after tibial resection. Radiography provides a good and inexpensive option for imaging, but it is insufficient. Magnetic resonance imaging (MRI) is used in some cases but not routinely for assessing TKA components or their orientation. Computed tomography (CT), used together with a well-defined protocol (Berger's method being the preferred choice), remains the "gold standard" for evaluating the rotation of the tibial component after TKA. CONCLUSION Currently, the most accurate and reliable anatomical landmarks are represented by Akagi's line and the anterior cortex of the tibia. Post-operatively, through CT and well-established protocols, the rotation of the tibial component can be accurately determined.
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Affiliation(s)
- Roman Popescu
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania
| | - Emil G Haritinian
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania. .,Clinical Hospital of Orthopedics and Traumatology and Osteoarticular TB "Foișor", Ferdinand Blvd, no. 35-37, District 2, 021382, Bucharest, Romania.
| | - Stefan Cristea
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania. .,Department of Orthopaedics and Traumatology, Saint Pantelimon Emergency Hospital, Pantelimon Road, no. 340-342, District 2, 021659, Bucharest, Romania.
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Yoshino K, Hagiwara S, Nakamura J, Tsukeoka T, Tsuneizumi Y, Ohtori S. Intra- and interobserver reliability and agreement in three-dimensional computed tomography measurements of component positions after total knee arthroplasty. Knee 2019; 26:1102-1110. [PMID: 31340892 DOI: 10.1016/j.knee.2019.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate evaluation of the postoperative position of total knee arthroplasty (TKA) components is crucial in the analysis of the association of alignments with clinical outcomes. The aim of this study was to investigate the reliability of measurements of component positions after TKA using three-dimensional computed tomography (3D-CT) reconstruction. METHODS Two independent orthopedic surgeons (an attending surgeon and a fellow) examined 30 knees after primary TKA. The coronal, sagittal, and rotational positions of the femoral and tibial components were measured twice at an interval of six weeks on 3D-CT images reconstructed using ZedKnee software. Mean intra- and interobserver differences of measured angles were calculated, and the intra- and interobserver reliability was determined using intraclass correlation coefficients (ICCs), with agreement assessed by Bland-Altman analysis. RESULTS The mean intraobserver difference between alignment measurements for femoral and tibial components was <2° (range 0.23-1.17°) and the mean interobserver difference was <1° (range 0.22-0.97°). The intra- and interobserver ICCs were >0.8 for all component positions. The only systematic bias found in the intra- and interobserver agreements occurred for the sagittal position of the femoral component. CONCLUSION Three-dimensional-CT measurements of component positions after TKA showed good intra- and interobserver reliability for the femoral and tibial components in coronal, sagittal and rotational positions. The intra- and interobserver agreements were favorable for all but the sagittal position of the femur. These results suggest that 3D-CT can be used to evaluate the alignment of all TKA components except for the sagittal position of the femur.
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Affiliation(s)
- Kensuke Yoshino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Orthopaedic Surgery, Chiba Rehabilitation Center, Chiba, Japan.
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tadashi Tsukeoka
- Department of Orthopaedic Surgery, Chiba Rehabilitation Center, Chiba, Japan
| | | | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Figueroa F, Wakelin E, Twiggs J, Fritsch B. Comparison between navigated reported position and postoperative computed tomography to evaluate accuracy in a robotic navigation system in total knee arthroplasty. Knee 2019; 26:869-875. [PMID: 31171424 DOI: 10.1016/j.knee.2019.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 04/04/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer navigation increases reproducibility compared to non-navigated total knee arthroplasty (TKA). Robotics navigation is a branch of computer navigation technology that might further improve accuracy of implant placement. The aim of this study is to assess the accuracy achieved in TKA with a robotic navigation system. METHODS One hundred seventy three knees. System studied: Omni navigation System (OMNI, Raynham, MA). Navigated femoral and tibial cuts were compared to postoperative computed tomography (CT). Measurements reviewed: femoral coronal alignment (FCA), femoral sagittal alignment (FSA), femoral rotational alignment (FRA), tibial coronal alignment (TCA), tibial sagittal alignment (TSA) and hip-knee-ankle (HKA) angle. Statistical analysis was made using R. RESULTS The mean differences between the navigated reported and the CT positions were: FCA: 0.1 ± 1.2° more varus (P = 0.58), FSA: 1.5 ± 0.3° more flexed (P < 0.001), FRA: 0.0 ± 1.7° (P = 0.93), TCA: 0.7 ± 1.1° more varus (P < 0.001), TSA: -1.3 ± 1.5 more negative slope (P < 0.001), HKA angle: 0.4 ± 2.4 more varus (P < 0.049). The percentages of concordance inside a three degree difference were: FCA: 98% (169 knees), FSA: 100% (173 knees), FRA: 94% (162 knees), TCA: 99% (171 knees), TSA: 93% (161 knees) and HKA angle: 83% (144 knees). CONCLUSIONS The current study showed that the robotic navigation system studied is highly accurate regarding final implant positioning for FCA, FRA and TCA. It has less accuracy in FSA, TSA and the HKA angle.
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Affiliation(s)
- Francisco Figueroa
- Clínica Alemana-Universidad del Desarrollo, Chile; Hospital Sótero del Río, Chile.
| | | | | | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney, Australia
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30
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Ueyama H, Minoda Y, Sugama R, Ohta Y, Yamamura K, Nakamura S, Takemura S, Nakamura H. Two-dimensional measurement misidentifies alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements. Knee Surg Sports Traumatol Arthrosc 2019; 27:1497-1503. [PMID: 30284009 DOI: 10.1007/s00167-018-5175-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Two-dimensional (2D) and three-dimensional (3D) measurements of prosthetic alignment and "outliers" after total knee arthroplasty (TKA) might not necessarily be comparable. The aim of this study was to compare the use of 2D and 3D measurements in the identification of prosthetic alignment and outliers after TKA. METHODS This cross-sectional study included 159 consecutive TKAs. All patients underwent plain radiography, fluoroscopy-guided radiography, and computed tomography after TKA. The same baseline was used for 2D and 3D measurements. The reliability of prosthetic alignment and outlier identification (> 3° from neutral alignment) was compared between the 2D and 3D measurements. RESULTS The mean prosthetic alignment and rate of outliers were not significantly different the between 2D and 3D measurements. The inter- and intra-observer reliabilities were higher for the 3D measurements than for the 2D measurements. The agreement between 2D and 3D measurements in outlier identification was poor, except for femoral coronal alignment. Cohen's κ coefficients were 0.19 in femoral sagittal (poor), 0.02 in tibial coronal (poor), and 0.10 in tibial sagittal (poor) on plain radiography. The values were 0.23 in tibial coronal (poor) and 0.002 in tibial sagittal (poor) on fluoroscopy-guided radiography. CONCLUSIONS The agreement between 2D and 3D measurements in the identification of outliers was poor, even on fluoroscopy-guided radiography. Since 2D measurements have an inherent risk of misidentifying alignment outliers, this finding is clinically relevant. To properly analyze the correlation between outliers and clinical results, such as longevity, patient satisfaction, and patient-reported outcome, 3D measurements for prosthetic alignment are desirable. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan.
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
| | - Ryo Sugama
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
| | - Yoichi Ohta
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
| | - Kazumasa Yamamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
| | - Susumu Takemura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno Ward, Osaka, 545-8585, Japan
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Yeo JH, Seon JK, Lee DH, Song EK. No difference in outcomes and gait analysis between mechanical and kinematic knee alignment methods using robotic total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1142-1147. [PMID: 30220048 DOI: 10.1007/s00167-018-5133-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes and perform gait analysis during walking to identify differences in kinematic and kinetic parameters between two alignment methods in robotic-assisted total knee arthroplasty (TKA). METHODS Sixty patients were randomly assigned to undergo robotic-assisted TKA using either mechanical (30 patients) or kinematic (30 patients) alignment method. Clinical outcomes including varus and valgus laxities, range of motion (ROM), Hospital for Specific Surgery (HSS), Knee Society Score (KSS), and Western Ontario and McMaster Universities (WOMAC) scores and radiological outcomes were evaluated. Gait analysis of 3D spatiotemporal, kinetic, and kinematic parameters during walking was then performed for 10 age and gender matched patients of each group to determine differences between the two alignment methods. RESULTS The median follow-up duration of the mechanical method group was 8.7 (range 8.1-9.4) years and that of the kinematic method group was 8.4 (range 8.0-9.1) years. Clinical outcomes between the two groups showed no significant difference in HSS, WOMAC, ROM, KS pain, or function score at the last follow-up. No significant difference in varus and valgus laxity assessment, mechanical alignment of the lower limb, or perioperative complications was shown between the two groups. In gait analysis, no significant difference in kinematic or kinetic parameters was found except for varus angle (p < 0.05) and mediolateral ground reaction force (p < 0.05). CONCLUSIONS Results of this study show that mechanical and kinematic knee alignment methods provide comparable clinical and radiological outcomes after robotic total knee arthroplasty with an average follow-up of 8 years. There were no functional difference during walking between the two alignment methods either. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Je-Hyoung Yeo
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, South Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, South Korea.
| | - Dong-Hyun Lee
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, South Korea
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Bitgoeul Hospital, 80, Deoknamgil, Nam-gu, Gwangju, South Korea
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Lee SS, Kwon KB, Lee YI, Moon YW. Navigation-Assisted Total Knee Arthroplasty for a Valgus Knee Improves Limb and Femoral Component Alignment. Orthopedics 2019; 42:e253-e259. [PMID: 30763446 DOI: 10.3928/01477447-20190211-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the influence of navigation-assisted surgery on radiographic and clinical outcomes after total knee arthroplasty (TKA) for a valgus knee. The authors identified all patients who underwent TKA for a valgus knee between January 2005 and December 2015. Among 83 conventional TKA cases and 55 navigation-assisted TKA cases, propensity score matching was performed for age, sex, body mass index, and preoperative lower limb mechanical axis. Fifty knees were matched to 50 knees. Each case was evaluated regarding lower limb mechanical axis, mechanical lateral distal femoral angle, medial proximal tibial angle, patellar tilt angle, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society score, and range of motion. Lower outliers of lower limb mechanical axis (30% vs 8%, P=.008) and mechanical lateral distal femoral angle (24% vs 10%, P=.046) were found in navigation-assisted TKA. However, outliers of medial proximal tibial angle, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society score, and range of motion were similar between the 2 different surgical techniques. Navigation-assisted surgery is correlated with fewer outliers of postoperative lower limb alignment and femoral component position but not tibial component position in TKA for preoperative valgus knee. Clinical outcomes for navigation-assisted TKA were not superior to those for conventional TKA. [Orthopedics. 2019; 42(2):e253-e259.].
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Rassir R, van de Bunt F, Sierevelt IN, Nolte PA. The value of postoperative prosthesis alignment and patellar height measurements on standard X-rays after Total Knee Arthroplasty: Does it relate to knee function after 5 years? Knee 2019; 26:213-221. [PMID: 30467023 DOI: 10.1016/j.knee.2018.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this retrospective cohort study was to investigate the influence of parameters of malalignment on knee function 5 years post TKA and, additionally, to explore alterations in patellar height after TKA. METHODS All 661 patients undergoing TKA between 2010 and 2011 were considered for inclusion. Preoperative and 1-year postoperative short-leg radiographs were assessed for malalignment parameters: coronal tibial angle (cTA), sagittal tibial angle (sTA), femoral flexion angle (FFA) and mediolateral tibial mismatch. Patellar height was measured using the modified Insall-Salvati ratio. We determined improvements in knee function utilizing the Knee Society Score (Function score, KSS-F), Oxford Knee Score (OKS) and Algofunctional index (AI). Influences of malalignment parameters were analyzed univariate and selected (p < 0.10) for multivariate linear regression analysis. Inter-observer reproducibility was assessed by test-retest analysis of 30 randomly selected radiographs and calculation of an intra-class correlation coefficient (ICC) for all radiographic parameters. RESULTS Three-hundred and four patients were included. Multivariate regression showed degrees of cTA malalignment to be significantly associated with only the KSS-F (β = -3.52). Correction of coronal deformity was stronger associated with knee function (KSS-F β = 2.81; AI β = -0.36). Patellar height was significantly reduced after TKA (1.51 vs 1.44). Decrease of patellar height was weakly associated with the OKS (β = 10.69). ICC scores were: cTA 0.81, sTA 0.57, IS 0.72, FFA 0.75. CONCLUSION Postoperative coronal tibial plate alignment and correction of preoperative coronal deformity are associated with improved knee function 5 years post TKA. Decrease in patellar height was weakly associated with knee function. Short-leg radiography can be a sufficient screening tool for prosthesis alignment.
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Affiliation(s)
- Rachid Rassir
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, 2134AT Hoofddorp, the Netherlands.
| | - Fabian van de Bunt
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, 2134AT Hoofddorp, the Netherlands
| | - Inger N Sierevelt
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, 2134AT Hoofddorp, the Netherlands
| | - Peter A Nolte
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, 2134AT Hoofddorp, the Netherlands
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Brown MJC, Deakin AH, Picard F, Riches PE, Clarke JV. Lower limb alignment becomes more varus and hyperextended from supine to bipedal stance in asymptomatic, osteoarthritic and prosthetic neutral or varus knees. Knee Surg Sports Traumatol Arthrosc 2019; 27:1635-1641. [PMID: 30415388 PMCID: PMC6527790 DOI: 10.1007/s00167-018-5273-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Knee alignment is a fundamental measurement in the assessment, monitoring and surgical management of patients with osteoarthritis. There is a lack of data regarding how static tibiofemoral alignment varies between supine and standing conditions. This study aimed to quantify the relationship between supine and standing lower limb alignment in asymptomatic, osteoarthritic (OA) and prosthetic (TKA) knees. METHODS A non-invasive position capture system was used to assess knee alignment for 30 asymptomatic controls and 31 patients with OA both before and after TKA. Coronal and sagittal mechanical femorotibial angles were measured supine with the lower limb in extension and in bipedal stance. Changes between conditions were analysed using paired ttests. Vector plots of ankle centre displacement relative to the knee centre from supine to standing were produced to allow three-dimensional visualisation. RESULTS All groups showed a trend towards varus and extension when going from supine to standing. Mean change for asymptomatic knees was 1.2° more varus (p = 0.001) and 3.8° more extended (p < 0.001). For OA knees this was 1.1° more varus (p = 0.009) and 5.9° more extended (p < 0.001) and TKA knees 1.9° more varus (p < 0.001) and 5.6° more extended (p < 0.001). CONCLUSION The observed consistent changes in lower limb alignment between supine and standing positions across knee types suggests the soft tissue envelope restraining the knee may have a greater influence on dynamic alignment changes than the underlying bony deformity. This highlights the importance of quantifying soft tissue behaviour when planning, performing and evaluating alignment dependent surgical interventions of the knee. When routinely assessing any type of knee, clinicians should be aware that subtle consistent alignment changes occur under weightbearing conditions and tailor their treatments accordingly. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Michael J C Brown
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, West Dunbartonshire, Clydebank, G81 4DY, UK.
| | - Angela H Deakin
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, West Dunbartonshire, Clydebank, G81 4DY, UK
| | - Frederic Picard
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, West Dunbartonshire, Clydebank, G81 4DY, UK
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, Scotalnd, UK
| | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, Scotalnd, UK
| | - Jon V Clarke
- Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, West Dunbartonshire, Clydebank, G81 4DY, UK
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Nakajima A, Sonobe M, Akatsu Y, Aoki Y, Takahashi H, Suguro T, Nakagawa K. Association between limb alignment and patient-reported outcomes after total knee arthroplasty using an implant that reproduces anatomical geometry. J Orthop Surg Res 2018; 13:320. [PMID: 30558616 PMCID: PMC6296124 DOI: 10.1186/s13018-018-1030-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background A kinematically aligned (KA) total knee arthroplasty (TKA) is expected to improve patient satisfaction, but its effect remains controversial. We investigated differences in patient-reported outcomes (PROs) between KA and non-KA TKAs using an implant that reproduces anatomical geometry. Methods TKAs for varus deformity were performed in consecutive 129 patients (149 knees) via a measured resection technique with conventional instruments. The femorotibial angle (FTA), hip-knee-ankle angle (HKAA), and the angle between the joint line and the line perpendicular to the mechanical axis (AJLMA) were measured postoperatively (mean 13.6 months), and an AJLMA of ≥ 2° was defined as kinematic alignment. Patients were assigned to two or three alignment categories in each measurement method, and the Knee Society Scores (KSS) and Japanese Knee Injury and Osteoarthritis Outcome Scores (J-KOOS) was compared among the groups. Results For patients assessed by FTA, an ADL-related J-KOOS subscale (J-KOOS-A) showed a significant difference between valgus and varus outliers (p < 0.05). When assessed by HKAA, neither the KSS nor J-KOOS subscales were significantly different among groups. When assessed by AJLMA, J-KOOS-A was significantly different between groups, and a group for AJLMA of ≥ 2° had higher scores than a group for AJLMA of < 2° (95% CI 0.323–7.763; p < 0.05). Conclusions Patients with an AJLMA of ≥ 2° reported significantly higher patient’s satisfaction regarding ADL. This suggests the importance of restoration of the physiological joint line which can be achieved via KA TKAs.
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Affiliation(s)
- Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan.
| | - Masato Sonobe
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Yorikazu Akatsu
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Yasuchika Aoki
- Department of General Medical Sciences, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan.,Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane-shi, Chiba, 283-8686, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
| | - Toru Suguro
- Japan Research Institute of Artificial Joint, 725-1 Sugo, Kisarazu-shi, Chiba, 292-0036, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan
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Cerquiglini A, Henckel J, Hothi H, Rotigliano N, Hirschmann MT, Hart AJ. 3D patient imaging and retrieval analysis help understand the clinical importance of rotation in knee replacements. Knee Surg Sports Traumatol Arthrosc 2018; 26:3351-3361. [PMID: 29520668 PMCID: PMC6208955 DOI: 10.1007/s00167-018-4891-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/28/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of the present study was to correlate highly accurate CT measurements of pre-revision total knee arthroplasty (TKA) implant position with findings of retrieval analysis post-revision, to understand the clinical relevance of TKA orientation. METHODS This study involved 53 retrieved TKA implants with pre-revision 3D-CT scans used to determine coronal (varus-valgus), sagittal (tibial slope) and rotational (internal rotation-external rotation) TKA orientation as well as tibiofemoral leg axis. Differences between femoral and tibial angles to describe the "relative rotational mismatch" were also calculated. All tibial inserts were forensically analyzed using the Hood score. Statistical analysis was performed to investigate correlations between TKA component orientation and surface damage (p < 0.05). RESULTS Femoral components were found to have axial rotations mainly within ± 3° (68%), whilst 45% of the tibial components and 66% of the relative rotational mismatches were > 3° and < - 3°, respectively. The majority of femoral and tibial components (87% in both cases), as well as the femorotibial angle (70%), showed coronal orientations within ± 3°. The 64% of the tibial components showed posterior tibial slopes out of both the 0°-3° and 5°-7° ranges. There was a significant correlation between tibial slope and damage score on polyethylene tibial inserts (r = 0.2856; p = 0.0382) as well as a significant correlation between implants' position in the axial plane and damage score on polyethylene tibial inserts (r = 0.6537, p = 0.0240). CONCLUSIONS This is the first study to use accurate measurements from pre-revision 3DCT to compare tibial and femoral orientation in all three planes with retrieval findings in total knee replacements. A significant correlation between implant position and polyethylene surface damage was found. These results showed the importance of optimizing component position to minimize polyethylene damage. Further analysis involving more accurate polyethylene wear measurements are fundamental to fully understand the role of components' orientation in TKAs.
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Affiliation(s)
- Arianna Cerquiglini
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Niccoló Rotigliano
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland
| | - Alister J. Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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Hirschmann MT, Behrend H. Functional knee phenotypes: a call for a more personalised and individualised approach to total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2018; 26:2873-2874. [PMID: 29744530 DOI: 10.1007/s00167-018-4973-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
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Saragaglia D, Sigwalt L, Refaie R, Rubens-Duval B, Lateur G, Pailhé R. Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities: does a slight residual varus improve the results? INTERNATIONAL ORTHOPAEDICS 2018; 43:1621-1626. [PMID: 30109405 DOI: 10.1007/s00264-018-4092-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/02/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Some recent articles have suggested that in the case of large varus deformity, it may be advantageous to leave some residual post-operative varus as a means of improving functional outcome. The objective of this study is to compare the results of total knee replacement (TKR) performed for significant varus deformity (HKA < 170°) where there is a residual post-operative varus (HKA < 180°) to the results of TKR for significant varus deformity with either neutral post-operative (HKA = 180°) or mild valgus post-operative alignment (HKA > 180°). METHODS This series was made up of 208 knees. The mean pre-operative HKA angle was 166 ± 3° (154-169°), of which 150 were followed up for a mean 8.5 years (58 lost to follow-up). Based on post-operative radiographs, two groups were formed: group 1 (88 knees) in which post-operative alignment was 177.8 ± 1° (175-179°) and group 2 (62 knees) in which post-operative alignment was 181 ± 1° (180-184°). RESULTS The mean international knee society (IKS) score for group 1 was 178.8 ± 22 points (113-200) and 181.7 ± 22 points (95-200) for group 2. Oxford knee score was 20.4 ± 9 points (12-45) in group 1 and 19.2 ± 9 (12-50) in group 2. The results were slightly better in group 2 (in slight valgus) but this difference was not statistically significant (p = 0.44 and 0.4). CONCLUSION The results of knee replacement performed for severe varus deformity are not adversely affected by post-operative valgus alignment. There is in fact a trend towards superior results for neutral or valgus alignment than slight residual varus, but this difference was not statistically significant.
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Affiliation(s)
- Dominique Saragaglia
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France.
| | - Loïc Sigwalt
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Ramsay Refaie
- Department of Trauma and Orthopaedics, Wansbeck Hospital, Ashington, Northumberland, UK
| | - Brice Rubens-Duval
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Gabriel Lateur
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Régis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
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Panni AS, Ascione F, Rossini M, Braile A, Corona K, Vasso M, Hirschmann MT. Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:1636-1644. [PMID: 29247357 DOI: 10.1007/s00167-017-4823-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes. METHODS A detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the Google Scholar databases was performed using the keyword terms "total knee arthroplasty", "total knee replacement", "tibial alignment", "tibial malalignement", "tibial rotation", "rotational error", "axis", "angle", "tibial malrotation", "clinical outcome", in several combinations. The modified Coleman scoring methodology (mCMS) was used. All the primary TKAs studies analyzing correlation between clinical results and tibial rotation were included. RESULTS Five articles met the inclusion criteria. A total of 333 arthroplasties were included in this review; 139 had tibial component malalignment, while 194 were in control groups. The mean age of patients was 67.3 (SD 0.57) years. The mean average postoperative follow-up delay was 34.7 months (range 21-70). The mean mCMS score was 59.2 points indicating good methodological quality in the included studies. Functional outcomes were assessed through KSS, OKS, KOOS and VAS, negatively related to tibial internal rotation. CONCLUSIONS Our review confirmed that excessive internal rotation of the tibial TKA component represents a significant risk factor for pain and inferior functional outcomes after TKA (> 10° of internal rotation demonstrated the common value), since external rotation does not affect the results. However, a universal precise cut-off value has not been found in the available literature and there remains a debate about CT rotation assessment and surgical intra-operative landmarks. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alfredo Schiavone Panni
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Ascione
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Naples, Italy.
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.
| | - Marco Rossini
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Adriano Braile
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | - Michele Vasso
- Multidisciplinary Department of Orthopedic and Dentistry Specialties, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
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Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT. Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc 2018; 26:1602-1609. [PMID: 29026941 DOI: 10.1007/s00167-017-4744-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The optimal coronal alignment is still under debate. However, in most of the studies, alignment was only assessed using radiographs, which are not accurate enough for assessment of tibial and femoral TKA position. The primary purpose of this study was to assess the relationship between coronal TKA alignment using 3D-reconstructed CTs and clinical outcome in patients with preoperative varus in comparison with patients with natural or valgus deformity. It was the hypothesis that neutral limb alignment shows a better outcome after TKA. METHODS Prospectively collected data of 38 patients were included. The clinical and radiological follow-up was 24 months. The patients were grouped into two groups with regard to their preoperative limb alignment. Group A (varus) consisted of 21 patients with preoperative varus of 3° or more, while group B (non-varus) consisted of 17 patients with neutral (- 3 < 0 > + 3) or valgus alignment (> + 3). For assessment of TKA component position and orientation, 3D-reconstructed CT was used. The measurements of the deviation from the whole limb mechanical axis (HKA angle) and the joint line alignment in the femoral (mLDFA) and the tibial side (MPTA) were assessed in the preoperative leg as well as during follow-up after TKA. For clinical outcome assessment, the Knee Society Score (KSS) was used at 1 and 2 years postoperatively. Correlation between KSS score and each variable was done using a linear and quadratic regression model (p < 0.05). RESULTS The mean postoperative HKA angle was - 1.3 (varus) in the varus group and + 1.4 (valgus) in the non-varus group. Overall, significant correlations between the preoperative and postoperative alignments were found. In the preoperatively non-varus group, a highly significant correlation was found between neutral limb alignment (HKA = 0° ± 3°) and higher KSS (r 2 = 0.74, p = 0.00). In the varus group, no correlation was found between the postoperative whole limb alignment and the components' position in the coronal plane to KSS score. CONCLUSION A significant correlation was found between neutral limb alignment and higher KSS only in patients with preoperative non-varus alignment. The concept of constitutional varus alignment is still under debate. Moreover, it appears that one should aim for a more individualized, alignment target based on the individual knee morphotype. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Omer Slevin
- Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Liestal, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Laufen, Switzerland
| | - Anna Hirschmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Filippo F Schiapparelli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Liestal, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Laufen, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Rolf W Huegli
- University of Basel, Basel, Switzerland.,Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland. .,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Liestal, Switzerland. .,Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Laufen, Switzerland. .,University of Basel, Basel, Switzerland.
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Coronal femoral TKA position significantly influences in vivo patellar loading in unresurfaced patellae after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3605-3610. [PMID: 28653182 DOI: 10.1007/s00167-017-4627-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE As patellar tracking and loading is influenced by tibial tuberosity and trochlear groove (TT-TG) distance, patellar height, thickness and tilt as well as TKA component position, it was our hypothesis that these parameters significantly correlate with patellar BTU intensity and localization in SPECT/CT. The purpose of the study was to investigate whether TKA component position as well as the height, thickness and tilt of the unresurfaced patella influences the intensity and the distribution pattern of BTU in SPECT/CT. METHODS A total of 62 consecutive patients who underwent primary TKA without patellar resurfacing were prospectively included. Demographic data such as age, gender, side and type of primary TKA were noted. All patients underwent clinical and radiological examination in a specialized knee clinic, including standardized radiographs (anterior-posterior and lateral weight bearing, patellar skyline view) and Tc-99m-HDP-SPECT/CT before, 12 and 24 months after TKA. SPECT/CT images were analysed on 3D reconstructed images. Rotational, sagittal and coronal position of the tibial and femoral TKA components was assessed using a previously validated analysis software. Measurements of BTU including intensity and anatomical distribution pattern were also performed from 3D data. The patellar height, thickness and tilt were measured, and the distance between TT and TG was measured using axial CT images. Univariate analysis was performed to identify any correlations between BTU and TKA component position and patellar measurements (p < 0.05). RESULTS The highest median BTU was measured in the superior posterior parts of the patella. A statistically significant correlation was found between valgus alignment of the femoral TKA and increased BTU at the lateral patellar regions (p < 0.05). External rotation of the tibial TKA correlated with increased BTU at the lateral superior joint adjacent part (p < 0.05). No correlation was found between the tibial TKA position (varus-valgus, anterior and posterior slope), TT-TG distance, patellar height and patellar BTU values. CONCLUSIONS A significant correlation of increased patellar BTU was found with femoral valgus TKA alignment. These findings highlight the importance of femoral TKA position in coronal plane with regard to post-operative patellar tracking. Moreover, these facts might explain anterior knee pain in unhappy TKA with femoral valgus alignment. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Barthassat E, Afifi F, Konala P, Rasch H, Hirschmann MT. Evaluation of patients with painful total hip arthroplasty using combined single photon emission tomography and conventional computerized tomography (SPECT/CT) - a comparison of semi-quantitative versus 3D volumetric quantitative measurements. BMC Med Imaging 2017; 17:31. [PMID: 28482817 PMCID: PMC5422986 DOI: 10.1186/s12880-017-0204-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background It was the primary purpose of our study to evaluate the inter- and intra-observer reliability of a standardized SPECT/CT algorithm for evaluating patients with painful primary total hip arthroplasty (THA). The secondary purpose was a comparison of semi-quantitative and 3D volumetric quantification method for assessment of bone tracer uptake (BTU) in those patients. Methods A novel SPECT/CT localization scheme consisting of 14 femoral and 4 acetabular regions on standardized axial and coronal slices was introduced and evaluated in terms of inter- and intra-observer reliability in 37 consecutive patients with hip pain after THA. BTU for each anatomical region was assessed semi-quantitatively using a color-coded Likert type scale (0-10) and volumetrically quantified using a validated software. Two observers interpreted the SPECT/CT findings in all patients two times with six weeks interval between interpretations in random order. Semi-quantitative and quantitative measurements were compared in terms of reliability. In addition, the values were correlated using Pearson`s correlation. A factorial cluster analysis of BTU was performed to identify clinically relevant regions, which should be grouped and analysed together. Results The localization scheme showed high inter- and intra-observer reliabilities for all femoral and acetabular regions independent of the measurement method used (semiquantitative versus 3D volumetric quantitative measurements). A high to moderate correlation between both measurement methods was shown for the distal femur, the proximal femur and the acetabular cup. The factorial cluster analysis showed that the anatomical regions might be summarized into three distinct anatomical regions. These were the proximal femur, the distal femur and the acetabular cup region. Conclusions The SPECT/CT algorithm for assessment of patients with pain after THA is highly reliable independent from the measurement method used. Three clinically relevant anatomical regions (proximal femoral, distal femoral, acetabular) were identified.
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Affiliation(s)
- Emilienne Barthassat
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland Bruderholz, Liestal, Laufen, Switzerland.,Basel University, Basel, Switzerland
| | - Faik Afifi
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland Bruderholz, Liestal, Laufen, Switzerland
| | - Praveen Konala
- Fellow- Musculoskeletal Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Helmut Rasch
- Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland-Bruderholz, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland Bruderholz, Liestal, Laufen, Switzerland. .,Basel University, Basel, Switzerland.
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