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Kim SH, Park YB, Baek SH, Lee J, Lee HJ. "Boot Sign" of Anterior Femoral Condylar Resectional Shape during Total Knee Arthroplasty Is More Frequent in Asian Patients. J Pers Med 2023; 13:1684. [PMID: 38138911 PMCID: PMC10745112 DOI: 10.3390/jpm13121684] [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: 10/15/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE There is lack of intraoperative consensus on the distal femur anterior resected surface shape that allows reliable rotational alignment assessment during total knee arthroplasty (TKA). We aimed to evaluate the ratio and prevalence of anterior femoral resection surface intraoperatively. MATERIALS AND METHODS The study included 234 osteoarthritis patients with varus knees and not valgus knees or deformities. After conventional medial parapatellar approach, measured resection technique based on the mechanical axis of the femur and preoperative TEA-PCA angle on CT with anterior reference was used among all the patients. The anteroposterior (AP) lengths after distal femoral resection were measured as the femoral lateral AP (FLAP) and femoral medial AP (FMAP) lengths. Based on the medial (MD) and lateral condyle (LD) vertical distance ratios of the femur anterior resected surface, the groups were classified into "boot sign", "grand-piano", and "butterfly sign" groups. For comparison of the mean values, the data were assessed for normality with the Shapiro-Wilk test. One-way ANOVA with post hoc analysis using Tukey's honestly significant difference (HSD) test was used to compare the mean values among the groups. The correlations between the MD/LD and variables were analyzed using the Pearson correlation coefficient. Linear regression analyses were used to find the associated factors to the anterior femoral resection surface shape. RESULTS Mean intraoperative femoral rotation and distal femoral cutting angles were 4.9° ± 1.2 and valgus 5.0° ± 0.7, respectively. Mean FLAP was 52.9 ± 4.2 mm. Mean MD/LD (0.61 ± 0.13) was lower than that of typical "grand-piano sign". The morphological shape incidence of the "boot sign" was 62.4%. In the "boot sign" group, the FLAP was found to be smaller than that in the other groups (52.4 ± 4.2 vs. 53.7 ± 4.2 vs. 54.9 ± 2.7; p = 0.02), while the intraoperative femoral rotation angle was found to be larger than in the other groups (5.0 ± 1.2 vs. 4.6 ± 1.1 vs. 4.7 ± 1.2; p = 0.039). The MD/LD-associated factors were FLAP, intraoperative femoral rotation, and distal femoral cutting angles (R2 = 0.268). CONCLUSION The femur anterior resection surface shape in TKA was found in the "boot sign" rather than the "grand-piano sign" in Korean ethnics owing to an asymmetric morphology of femoral condyles. Ethnic differences, including distal femoral morphology, should be considered for assessment of the femoral rotation angle using the femur anterior resection surface shape.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110 Deokan-ro, Gwangmyeong-si 14353, Republic of Korea
| | - Suk Ho Baek
- Madisesang Hospital, 890 Dongil-ro, Jungnang-gu, Seoul 02038, Republic of Korea
| | - Jeuk Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea
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Maciąg BM, Kordyaczny T, Żarnovsky K, Budzińska M, Jegierski D, Łapiński M, Maciąg GJ, Stolarczyk A. Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5901-5907. [PMID: 37000268 PMCID: PMC10064952 DOI: 10.1007/s00402-023-04857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION During the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients' dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate. MATERIALS AND METHODS A total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit. RESULTS There was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0-12) in curve-on-curve technique group vs 2° (IQR-1-7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17). CONCLUSION In this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland.
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Martyna Budzińska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa St., 04-749, Warsaw, Poland
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Maciąg BM, Kordyaczny T, Jegierski D, Łapiński M, Dorocińska M, Żarnovsky K, Maciąg GJ, Adamska O, Stolarczyk A. Differences in joint line level and posterior condylar offset during total knee replacement with use of gap-balancing and measured resection techniques-matched cohort study. BMC Musculoskelet Disord 2023; 24:610. [PMID: 37491199 PMCID: PMC10367383 DOI: 10.1186/s12891-023-06722-1] [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: 11/08/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Total knee replacement (TKR) is considered one of the most common elective orthopaedic procedures. The main focus of TKR is to offer patient's symptomatic relief from persistent knee pain. To achieve this it is crucial to restore joint biomechanics by performing proper bone cuts. Some surgeons favor the measured resection technique, others prefer gap balancing technique. The researchers of the presented study performed TKR using these two techniques. The aim of this study was to compare the postoperative change in joint line and posterior condylar offset after TKR with use of anatomic knee design implants between gap balancing and measured resection techniques. METHODS Two hundred twenty-five X-rays of patients who underwent TKR performed by a single surgeon between 2020 and 2021 were analyzed. The first group of patients (101) was operated with the use of gap balancing technique and the second group (124) was operated with the use of measured resection technique. Patients included in the study were > 50 years of age, had confirmed primary knee osteoarthritis, underwent primary TKR with a PS (posterior stabilized) knee implants without patella resurfacing and had at least 15 degree flexion contracture. T-student test and U Mann-Whitney test were used in statistical analysis of results, according to the normality of distribution examined with the Shapiro-Wilk test. Post-hoc analysis was performed using the Dwass-Steel-Crichtlow-Fligner test (DSCF). RESULTS The postoperative analysis showed a significantly elevated joint line level in the gap balancing group (-2.6 ± 4.1 vs -0.7 ± 4.8, p < 0.0005). In the gap balancing group significantly more patients had joint lines elevated > 2 mm comparing to measured resection technique. The difference between pre- and postoperative PCO (posterior condylar offset) and PCOR (posterior condylar offset ratio) results had no significant differences (100.8 ± 11.8 vs 101 ± 12.5, p > 0.05) between the groups. CONCLUSIONS The results of the study suggest that when it comes to restoring joint line level measured resection technique seems to be superior in comparison to the gap balancing technique. What is more, results indicate measured resection is equal in terms of restoring posterior condylar offset to the gap balancing technique. TRIAL REGISTRATION NCT04164147, date of registration: November 14, 2019.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland.
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Monika Dorocińska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, Str. 2 Bursztynowa, 04-749, Warsaw, Poland
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Maciąg BM, Kordyaczny T, Maciąg GJ, Łapiński M, Jegierski D, Świderek J, Tsitko H, Dorocińska M, Żarnovsky K, Świercz M, Stępiński P, Adamska O, Stolarczyk A. Comparison of Femoral Component Rotation between Robotic-Assisted vs. Soft-Tissue Tensor Total Knee Arthroplasty with Anatomic Implants. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050880. [PMID: 37241112 DOI: 10.3390/medicina59050880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic-assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher's exact, Kruskal-Wallis and Dwass-Steel-Crichtlow-Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Grzegorz J Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Jakub Świderek
- Faculty of Medicine, Medical University of Białystok, 15-089 Białystok, Podlaskie Voivodeship, Poland
| | - Hanna Tsitko
- Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Lubelskie Voivodeship, Poland
| | - Monika Dorocińska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Maciej Świercz
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Piotr Stępiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, 04-749 Warsaw, Masovian Voivodeship, Poland
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Hao K, Wei M, Ji G, Jia Y, Wang F. Comparison of the Imaging and Clinical Outcomes among the Measured Resection, Gap Balancing, and Hybrid Techniques in Primary Total Knee Arthroplasty. Orthop Surg 2022; 15:93-102. [PMID: 36377906 PMCID: PMC9837215 DOI: 10.1111/os.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although many studies have compared the measured resection (MR) technique to the gap balancing (GB) technique, few studies have investigated the hybrid technique. In this study, we compared imaging and clinical outcomes of the MR, GB, and hybrid techniques in primary total knee arthroplasty (TKA). METHODS From January 2016 to January 2019, we conducted a retrospective study on 90 patients who underwent unilateral primary TKA; 30 received the MR technique, 30 received the GB technique, and 30 received the hybrid technique. Radiological outcomes, including joint line level, mechanical alignment of the lower limb, positions of the femoral and tibial components, and rotation of the femoral component, and clinical outcomes, including the visual analog scale score for pain, the Knee Society Score, and the range of motion, were assessed among the three groups. One-way analysis of variance and Dunnett's test were performed for normally distributed data. Kruskal-Wallis H test and Dunn-Bonferroni test were conducted for non-normally distributed data. RESULTS No significant difference in the mechanical alignment (p = 0.151) and the positions of the tibial and femoral components (p = 0.230 for α angle, p = 0.517 for β angle, p = 0.686 for femoral flexion angle, and p = 0.918 for tibial slope angle) was found among the three groups. No significant difference in the elevation of the joint line between the MR and the hybrid groups was found (2.1 ± 0.3 mm vs 2.1 ± 0.1 mm, p = 0.627), but the GB group (2.8 ± 0.2 mm) differed significantly from the other two groups (p < 0.001). Although rotation of the femoral component in the GB group was larger than that of the MR and hybrid groups, the difference was not significant (1.8° ± 0.2° vs 1.7° ± 0.3° vs. 1.7° ± 0.2°, p = 0.101). The clinical outcomes were not significantly different (p > 0.05), although the results in the hybrid group were slightly higher. CONCLUSION The hybrid technique helped to restore the mechanical alignment of the lower limb and realize optimal positions of the femoral and tibial components without significant differences relative to the MR and GB techniques. The hybrid technique was more helpful for maintaining the original height of the joint line, which was similar to the MR technique. Additionally, although the improvement in the clinical outcomes in the hybrid group was slightly higher, it was not significantly different among the three groups.
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Affiliation(s)
- Kuo Hao
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Maozheng Wei
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Gang Ji
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Yanfeng Jia
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
| | - Fei Wang
- Department of Joint SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangPeople's Republic of China
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Kato T, Motoyama M, Adachi N, Deie M. Cartilage assessment using preoperative planning MRI for femoral component rotational alignment. Knee 2022; 38:107-116. [PMID: 36007477 DOI: 10.1016/j.knee.2022.07.005] [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: 06/02/2021] [Revised: 12/02/2021] [Accepted: 07/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical planning of posterior referencing total knee arthroplasty (TKA) using computed tomography (CT) might lead to over-rotation of the femoral component because CT could not detect cartilage thickness of the posterior femoral condyle. The purpose of this study was to examine the rotational alignment difference of the femoral component between magnetic resonance imaging (MRI) and CT. METHODS For elderly varus osteoarthritic patients, 66 varus osteoarthritic knee patients that underwent primary TKA were selected. Twenty-seven young patients who underwent primary anterior cruciate ligament reconstruction were selected as control. After the transepicondylar axis (CEA), the surgical epicondylar axis (SEA) and the posterior femoral condylar line (PCL) were drawn on CT and on MRI at the same angles as CT. Then, the practical PCL was drawn on MRI considering the cartilage thickness (the cartilage PCL). The angle between the SEA and the cartilage PCL (the cartilage posterior condylar angle (PCA)) was measured as preoperative planning. To investigate the accuracy of preoperative MRI measurement, the cartilage thickness on posterior femoral condyles was directly measured during TKA. RESULTS The cartilage PCA for varus osteoarthritic patients averaged 1.3 ± 1.3°. The cartilage PCA was 1.8 ± 1.0° significantly smaller than the bone PCA (the PCA measured on CT). Meanwhile, the cartilage PCA was 0.2 ± 0.4° significantly larger than the bone PCA in young people. The preoperative angle measurement on MRI strongly correlated with the direct measurement of cartilage thickness during TKA. CONCLUSION There was 1.8° of divergence between MRI and CT in varus osteoarthritic patients due to cartilage degeneration of the medial femoral condyle. Cartilage assessment using MRI was useful for femoral component rotational alignment.
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Affiliation(s)
- Tomohiro Kato
- Aichi Medical University, Nagakute-city, Aichi Prefecture, Japan.
| | | | | | - Masataka Deie
- Aichi Medical University, Nagakute-city, Aichi Prefecture, Japan
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Popescu R, Cristea S, Oleksik V, Pascu AM, Haritinian EG. Finite element analysis of the tibial component alignment in a transverse plane in total knee arthroplasty. J Appl Biomed 2021; 19:234-239. [PMID: 34907743 DOI: 10.32725/jab.2021.020] [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: 05/17/2021] [Accepted: 09/20/2021] [Indexed: 11/05/2022] Open
Abstract
The research aims to analyze the tibial component rotation using the finite element method by resecting the tibia in a transverse plane at an angle between 1.5° (external rotation) and -1.5° (internal rotation). We used a three-dimensional scanner to obtain the tibia's geometrical model of a cadaveric specimen. We then exported the surfaces of the tibial geometrical model through the Computer-Aided Three-dimensional Interactive Application (CATIA), which is a Computer-Aided Design (CAD) program. The CAD program three-dimensionally shaped the tibial component, polyethylene, and cement. Our analysis determined that the maximum equivalent stress is obtained in the case of proximal tibial resection at -1.5° angle in a transverse plane (internal rotation) with a value of 12.75 MPa, which is also obtained for the polyethylene (7.693 MPa) and cement (6.6 MPa). The results have shown that detrimental effects begin to occur at -1.5°. We propose the use of this finite element method to simulate the positioning of the tibial component at different tibial resection angles to appreciate the optimal rotation.
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Affiliation(s)
- Roman Popescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Stefan Cristea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Saint Pantelimon Emergency Hospital, Department of Orthopaedics and Traumatology, Bucharest, Romania
| | - Valentin Oleksik
- University of Sibiu, Faculty of Engineering, Department of Industrial Machinery and Equipments, Sibiu, Romania
| | - Adrian Marius Pascu
- University of Sibiu, Faculty of Engineering, Department of Industrial Machinery and Equipments, Sibiu, Romania
| | - Emil George Haritinian
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Hospital of Orthopaedics and Traumatology and Osteoarticular TB "Foisorr", Bucharest, Romania
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Robertson EL, Hengherr M, Amsler F, Hirschmann MT, Mathis DT. A comparison of femoral component rotation after total knee arthroplasty in Kanekasu radiographs, axial CT slices and 3D reconstructed images. Skeletal Radiol 2021; 50:1389-1397. [PMID: 33398456 PMCID: PMC8119264 DOI: 10.1007/s00256-020-03702-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the posterior condylar angle measured with Kanekasu radiograph and 2D-CT with the gold standard 3D-CT following primary total knee arthroplasty (TKA). METHODS Eighty-two knees with pain following TKA were included in this retrospective study. Two independent raters measured the anatomical and surgical posterior condylar angles twice on each Kanekasu radiograph and 2D-CT. These measurements were compared against the 3D-CT measurement. The intra- and interrater reliability of the Kanekasu radiograph and 2D-CT and the correlation with 3D-CT were calculated. RESULTS The intra- and interrater reliability for measurements of the anatomical posterior condyle angle for the Kanekasu radiograph and the 2D-CT were excellent for both raters (0.85-0.92). For the less experienced rater 1, the intrarater reliability was significantly better for 2D-CT than Kanekasu radiograph for measuring both the surgical (p < 0.01) and anatomical posterior condyle angles (p < 0.05). For the experienced rater 2, the intrarater reliability was significantly better for Kanekasu radiograph than 2D-CT for measurement of the surgical posterior condyle angle (p < 0.05). The correlation with 3D-CT is higher in 2D-CT than in Kanekasu radiograph (p < 0.01). While the Kanekasu radiograph predicts the 3D-CT angle with 65.9%, 2D-CT can measure the true angle with 82.9% certainty. CONCLUSION Measurements using the anatomical transepicondylar axis are easier to replicate compared to the surgical transepicondylar axis. In comparison with the gold standard 3D-CT, 2D-CT showed a significantly higher correlation with 3D-CT than the Kanekasu measurements. If 3D-CT is available, it should be preferred over 2D-CT and Kanekasu view radiograph for femoral component rotation measurements.
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Affiliation(s)
- Emma L. Robertson
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
| | - Martin Hengherr
- Department of Radiology, 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 ,University of Basel, 4051 Basel, Switzerland
| | - Dominic T. Mathis
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
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Reasons for failure in primary total knee arthroplasty - An analysis of prospectively collected registry data. J Orthop 2020; 23:60-66. [PMID: 33456217 DOI: 10.1016/j.jor.2020.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The aim of this study was to determine the causes leading to a first revision of primary total knee arthroplasty (TKA) in a specialized knee centre and compare the results with previously published data. Methods Prospectively collected data of a consecutive number of 195 patients after primary TKA and who underwent first revision surgery after completing the diagnostic algorithm for persistent knee pain were included. Data was prospectively collected from a specialized knee centre in which the patients presented between 2015 and 2020 and retrospectively analysed. Indications for revision surgery were categorized using all available information from patients' records. Patients were divided into early (up to two years) and late revision (more than two years). Results Overall mean time from index to revision surgery was 3.6 years. 49% of knee revisions occurred in the first two years, 51% after two years. 86% of the patients were referred to the knee centre from other surgeons. The most frequent reason for revision was instability, followed by patellofemoral problems, extensor mechanism insufficiency and malalignment. The most frequently performed revision was complete removal and re-implantation of a semi constrained implant design (52.5%) followed by revision using a full constrained implant design (16%). Secondary patella-resurfacing as part of complete revision was carried out in 71.5% of the cases. The majority of the patients showed concurrent reasons for TKA failure with significant correlations amongst another. Furthermore, correlations were identified between indications for revision surgery and revision implant designs. Conclusion In a specialized knee centre the most common indications for the first TKA revision were instability and patellofemoral and/or extensor mechanism insufficiency followed by malalignment. In most patients there was not only one failure mode, but a combination of many. It is important to establish a standardized diagnostic algorithm to facilitate comprehensive and efficient diagnostics and the optimal treatment.
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Mahran MA, Khalifa AA, Ahmed MA, Bakr HM, Khalifa YE. Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA, Egyptian population radiographic study. J Clin Orthop Trauma 2020; 13:99-105. [PMID: 33717884 PMCID: PMC7920017 DOI: 10.1016/j.jcot.2020.12.004] [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: 10/20/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Femoral component rotational alignment is critical for successful TKA. The primary study objective is to measure the preoperative distal femoral torsion (DFT) of an Egyptian patient's cohort using a seated posteroanterior (PA) knee radiograph. The secondary objectives are to check the intraoperative reliability of using the posterior condylar line (PCL) as a reference for rotation and to measure postoperative component rotation using the same radiographic technique. METHODS 100 arthritic knees, 22 males, 78 females, 95 Varus and five valgus. A long anteroposterior radiograph [Hip to knee to ankle (HKA)] for coronal alignment assessment, and the anatomical posterior condylar angle (aPCA) between the anatomical transepicondylar axis (aTEA) and the PCL was measured in the seated PA knee radiographs for evaluating the DFT and component rotation. Intraoperative rotation was adjusted to 3° external rotation to the PCL. RESULTS HKA improved from a preoperative mean 170.4° ± 6.2 to a postoperative mean 178.3° ± 1.5 (p < 0.005). DFT was internal in all knees; the mean aPCA was -4.5 ± 2.4 (0° to -9°), femoral component rotation significantly changed to a mean aPCA of -3.6 ± 2.3 (0° to -7°) (p = 0.005). Acceptable intraoperative patellar tracking in 94%, and patellar subluxation needed a lateral retinacular release in 2% (two valgus knees). The preoperative DFT was not affected by sex or direction of coronal deformity; more external DFT noticed in severe varus deformity. CONCLUSIONS All keens had an internal DFT not affected by sex, or coronal deformity direction. Using PCL as a guide to adjust femoral component rotation is a valid technique in our population.
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Affiliation(s)
- Mohamed A. Mahran
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt,Corresponding author. Orthopaedic and Traumatology Department, Qena University Hospital, South Valley University, Qena, Egypt.
| | | | - Hatem M. Bakr
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser E. Khalifa
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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