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Sasaki R, Kaneda K, Yamada Y, Niki Y, Nakamura M, Nagura T, Jinzaki M. Extra-articular location of the three-dimensional mechanical axis in advanced knee osteoarthritis: an upright computed tomography study. Jpn J Radiol 2023; 41:1405-1413. [PMID: 37440161 DOI: 10.1007/s11604-023-01468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE One of the most widely used benchmarks of lower-limb alignment is the mechanical axis (MA), which passes through the centers of the femoral head and the ankle in the weight-bearing position. However, where the MA passes through three-dimensionally (3D) is unclear. We investigated the MA in 3D (3D-MA) in knee osteoarthritis (OA) using upright computed tomography (CT). MATERIALS AND METHODS This study included 66 varus OA knees from 38 patients [age 70.0 (64.8-77.0) years; median (interquartile range)]. The 3D-MA was determined using upright CT data and compared among Kellgren-Lawrence (KL) grades. Further, correlations between the 3D-MA and other parameters were evaluated. RESULTS The 3D-MA was located at 5.3 (1.3-14.4)% medially and 7.1 (0.7-15.3)% posteriorly on the tibial plateau in KL-1, and was translated medioposteriorly with increased KL grade. The 3D-MA in KL-3 [30.6 (22.6-42.6)% medially and 50.9 (45.8-80.2)% posteriorly] and KL-4 [56.7 (48.5-62.9)% medially and 92.3 (50.2-127.1)% posteriorly] was located extra-articularly. The mediolateral position of the 3D-MA correlated with the femorotibial angle [correlation coefficient (CC) = - 0.85, p < 0.001], and the anteroposterior position of the 3D-MA correlated with the knee flexion angle (CC = - 0.93, p < 0.001). CONCLUSION Our analysis demonstrated that the 3D-MA in low-grade OA knees passes slightly medial and posterior to the knee center, and the 3D-MA is translated medioposteriorly with the progression of knee OA. Further, the 3D-MA is translated medially with varus progression and posteriorly with the progression of knee flexion contracture.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kazuya Kaneda
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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da Rosa BN, Camargo EN, Candotti CT. Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis. J Chiropr Med 2023; 22:72-84. [PMID: 36844994 PMCID: PMC9947998 DOI: 10.1016/j.jcm.2022.03.005] [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: 05/22/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 10/17/2022] Open
Abstract
Objective The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.
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Affiliation(s)
- Bruna Nichele da Rosa
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Nunes Camargo
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia Tarragô Candotti
- School of Physical Education, Physiotherapy and Dance, Federal University of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Allen BC, Welling BD, Villamaria LJ, Munoz-Maldonado Y. Sagittal mechanical ratio: A novel technique to define sagittal alignment of the femur independent of distal anatomic landmarks. Knee 2023; 40:192-200. [PMID: 36495653 DOI: 10.1016/j.knee.2022.11.018] [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: 10/20/2021] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiographic measurements to study sagittal alignment in the setting of knee are frequently difficult to evaluate due the presence of a prosthesis or implant that obscures traditional radiographic landmarks. In this paper we present a novel method of determining sagittal femoral alignment in the presence of obscuring implants. METHODS 98 full-length femoral radiographs were reviewed and divided into two groups. In Group 1, the Distal Mechanical Point (DMP) was used to calculate the Distal Mechanical Ratio (DMR), defined as the ratio of the linear distance from the DMP to the anterior cortical axis divided by the distance from the anterior cortical axis to posterior condylar cortex. In group 2, the sagittal mechanical axis was measured using the true DMP (tDMP) and then separately measured using the DMR to find the calculated DMP (cDMP), and the angular variance between the calculated (cSMA) and true (tSMA) sagittal mechanical axis was calculated, as well as the linear distance between the tDMP and cDMP. Twenty additional patients with knee replacements were then selected and two observers used a cSMA to determine a femoral prosthesis flexion angle (FPFA), with intraobserver correlation calculated. RESULTS The mean DMR was found to be 0.24, with high intraobserver correlation and normal distribution. Validation of the model demonstrated angular variance between tSMA and cSMA less than 1 degree and linear distance between tDMP and cDMP less than 1 mm. Calculation of cCMA in the presence of total knee arthroplasty revealed very strong intraobserver correlation of 0.89. CONCLUSION The Distal Mechanical Ratio reliably predicted the true Sagittal Mechanical Axis within 1 degree and true Distal Mechanical Point within 1 mm, indicating that it may be a valuable tool for evaluating sagittal femoral alignment in cases where anatomic landmarks may be absent or obscured.
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Affiliation(s)
- Bryce C Allen
- Baylor Scott and White Medical Center - Temple, Department of Orthopaedic Surgery, 2401 South 31st Street, Temple, TX 76508, USA.
| | - Benjamin D Welling
- Baylor Scott and White Medical Center - Temple, Department of Orthopaedic Surgery, 2401 South 31st Street, Temple, TX 76508, USA
| | - Luke J Villamaria
- Baylor Scott and White Medical Center - Temple, Department of Orthopaedic Surgery, 2401 South 31st Street, Temple, TX 76508, USA
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Dardenne G, Borotikar B, Letissier H, Zemirline A, Stindel E. Optimal definitions for computing HKA angle in caos: an in-vitro comparison study. Comput Assist Surg (Abingdon) 2022; 27:27-34. [PMID: 35559720 DOI: 10.1080/24699322.2022.2066023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The goal of this study was to assess and compare the precision and accuracy of nine and seven methods usually used in Computer Assisted Orthopedic Surgery (CAOS) to estimate respectively the Knee Center (KC) and the Frontal Plane (FP) for the determination of the HKA angle (HKAA). An in-vitro experiment has been realized on thirteen cadaveric lower limbs. A CAOS software application was developed and allowed the computation of the HKAA according to these nine KC and seven FP methods. The precision and the accuracy of the HKAA measurements were measured. The HKAA precision was highest when the FP is determined using the helical method. The HKAA accuracy was highest using the helical approach to determine the FP and either the notch or the tibial spines to determine the KC. This study shows that the helical approach to determine the FP and either the notch or the middle of tibia spines are the combinations that provide both a good enough accuracy and precision to estimate the HKA.
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Affiliation(s)
- Guillaume Dardenne
- CHU Brest, Brest, France.,LaTIM, Inserm, UMR 1101, SFR IBSAM, Brest, France
| | - Bhushan Borotikar
- CHU Brest, Brest, France.,LaTIM, Inserm, UMR 1101, SFR IBSAM, Brest, France
| | - Hoel Letissier
- CHU Brest, Brest, France.,LaTIM, Inserm, UMR 1101, SFR IBSAM, Brest, France.,Université de Bretagne Occidentale, UBL, Brest, France
| | | | - Eric Stindel
- CHU Brest, Brest, France.,LaTIM, Inserm, UMR 1101, SFR IBSAM, Brest, France.,Université de Bretagne Occidentale, UBL, Brest, France
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Zhang X, Wang Q, Xu X, Chen D, Bao Z, Yao Y, Wu D, Wang B, Xu Z, Jiang Q. Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA? J Orthop Surg Res 2021; 16:701. [PMID: 34863226 PMCID: PMC8643007 DOI: 10.1186/s13018-021-02822-7] [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: 09/12/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the influence of sagittal femoral bowing on sagittal femoral component alignment, and whether there was correlation between sagittal femoral component alignment and coronal femoral component alignment. METHODS We retrospectively reviewed 77 knees in 71 patients who had undergone primary TKA for advanced osteoarthritis. All surgeries were performed by using a standard medial parapatellar approach. The osteotomy was performed with a conventional technique using an intramedullary rod for the femur and a mechanical extramedullary guiding system for the tibia. All patients enrolled in the study were evaluated with full-length lower extremity load-bearing standing scanograms, and the patients had preoperative and postoperative radiographs of the knees. Coronal femoral bowing angle (cFBA), sagittal femoral bowing angle (sFBA), and postoperatively, mechanical tibiofemoral angle of the knee (mTFA), β angle (femoral component flexion angle) were measured. The radiographic results of both groups were compared using Student's t test. A two-sided Pearson correlation coefficient was obtained to identify the correlations between FBA in the coronal and sagittal planes, as well as FBA and age or BMI, sFBA and β angle, cFBA and mTFA. Comparison of FSB incidence between different genders was made using Chi-square test. The p value < 0.05 indicates a statistically significant difference. RESULTS The mean sFBA, cFBA, β angle, mTFA were 9.34° ± 3.56°(range 1°-16°), 3.25° ± 3.79°(range - 7° to -17°), 3.91° ± 3.15°(range - 1° to -13°), 0.60° ± 1.95°(range - 3° to -6°), respectively. There was no correlation between age and sFBA (CC = 0.192, p = 0.194) or cFBA (CC = 0.192, p = 0.194); similarly, there was no correlation between age and sFBA (CC = 0.067, p = 0.565) or cFBA (CC = 0.069, p = 0.549). The sFBA was correlated with cFBA and β angle (CC = 0.540, p < 0.01; CC = 0.543, p < 0.01, respectively), and the cFBA was correlated with mTFA (CC = 0.430, p < 0.01). There was no significant difference (p = 0.247) of cFBA between the patients with sFSB and the patients without sFSB. CONCLUSIONS The current study showed that the sFBA was correlated with cFBA in the patients undergoing TKA and the patients with sFSB usually presented non-cFSB. We also found that sFSB could affect the femoral component alignment in the sagittal plane and cFSB could affect the femoral component alignment in the coronal plane. The sFBA or cFBA was not correlated with age, BMI, or gender.
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Affiliation(s)
- Xiaofeng Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Qianjin Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xingquan Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Dongyang Chen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Zhengyuan Bao
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yao Yao
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Dengxian Wu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Bin Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
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Kikuchi N, Yoshioka T, Okuno K, Kanamori A, Yamazaki M. Characterization of bone remodeling of two different porous types of β-tricalcium phosphates: a quantitative site-by-site analysis using computed tomography. J Artif Organs 2021; 25:254-261. [PMID: 34846598 DOI: 10.1007/s10047-021-01304-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/05/2021] [Indexed: 02/03/2023]
Abstract
This study compared the process of bone remodeling using spherical porous β-tricalcium phosphate (SPTCP) and unidirectional porous β-tricalcium phosphate (UDPTCP) by quantitative computed tomography (CT) analysis. We retrospectively analyzed the data of 16 patients (4 men, 12 women; age, 43-78 years) who underwent medial opening wedge high tibial osteotomy (MOWHTO) and were followed up for 1 year postoperatively. Nine patients used SPTCP spacers and seven patients used UDPTCP spacers. CT was performed at 1 week, 6 months, and 1 year postoperatively. CT attenuation values were measured at three sites on the axial slice and sagittal slice, i.e., the superior, center, and inferior sites and the lateral, center, and medial sites for UDPTCP and SPTCP, respectively. CT attenuation values were lower for UDPTCP than for SPTCP in all sites at 6 months and 1 year postoperatively (p < 0.05). CT attenuation values decreased in the superior and inferior sites for UDPTCP (p < 0.05), and CT attenuation values decreased in the lateral site for both SPTCP and UDPTCP (p < 0.05). The process of bone remodeling differed between the two over a short-term follow-up of 1 year postoperatively.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Tomokazu Yoshioka
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. .,Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Kosuke Okuno
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akihiro Kanamori
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Ishii Y, Noguchi H, Sato J, Takahashi I, Ishii H, Ishii R, Ishii K, Toyabe SI. Alignment evaluation using different distal reference points after total knee arthroplasty. J Orthop 2021; 25:186-190. [PMID: 34045821 DOI: 10.1016/j.jor.2021.05.013] [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: 04/12/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022] Open
Abstract
Background To assess alignment for total knee arthroplasty, the center of the ankle has been used as the main reference point for the distal tibia; however, the true load-bearing mechanical axis should be determined as a line from the center of the femoral head to the lowest point of calcaneus. Thus, the purpose of this study was to compare the differences in alignment. Methods Patients with medial osteoarthritis who underwent primary total knee arthroplasty (Group A, center of ankle reference, or Group C, calcaneal contact reference) were recruited. We determined (1) the total number with calcaneal contact point lateral to the center of ankle and compared (2) percentage of displacement of the load-bearing axis at the level of the knee, (3) anatomical axis angle, (4) mechanical axis angle, and (5) tibial component angle. Results The study included 94 patients (128 knees), with the calcaneal contact reference point located lateral relative to the center of the ankle in 88.3% (113/128 knees). Using calcaneal contact point references, displacement of the load-bearing axis at the knee was greater (p < 0.0001, 38.7% vs 34.0%), and angles demonstrated significantly valgus alignment (p < 0.0001, 5.6° vs. 4.8° for anatomical axis angle, -3.0° vs. -4.2° for mechanical axis angle, and 89.9° vs. 88.6°for tibial component angle). Conclusions Varus alignment measured by the ankle reference method might correspond to the neutral alignment by the amount of valgus alignment indicated by the calcaneal reference. Surgeons should take this into account when preoperative planning, performing intraoperative procedures, and during postoperative evaluation.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Ikuko Takahashi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- Kanazawa Medical University, School of Plastic Surgery, 1-1 Daigaku, Uchinada, Ishikawa, 920-0253, Japan
| | - Ryo Ishii
- Sado General Hospital, 161 Chikusa Sado, Niigata, 952-1209, Japan
| | - Kei Ishii
- Iwate Prefectural Ninohe Hospital, 38 Horino, Ninohe, Iwate, 028-6193, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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Mekhael M, Kawkabani G, Saliby RM, Skalli W, Saad E, Jaber E, Rachkidi R, Kharrat K, Kreichati G, Ghanem I, Lafage V, Assi A. Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2495-2503. [PMID: 33638719 DOI: 10.1007/s00586-021-06778-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore 3D hip orientation in standing position in subjects with adult spinal deformity (ASD) presenting with different levels of compensatory mechanisms. METHODS Subjects with ASD (n = 159) and controls (n = 68) underwent full-body biplanar X-rays with the calculation of 3D spinopelvic, postural and hip parameters. ASD subjects were grouped as ASD with knee flexion (ASD-KF) if they compensated by flexing their knees (knee flexion ≥ 5°), and ASD with knee extension (ASD-KE) otherwise (knee flexion < 5°). Spinopelvic, postural and hip parameters were compared between the three groups. Univariate and multivariate analyses were then computed between spinopelvic and hip parameters. RESULTS ASD-KF had higher SVA (67 ± 66 mm vs. 2 ± 33 mm and 11 ± 21 mm), PT (27 ± 14° vs. 18 ± 9° and 11 ± 7°) and PI-LL mismatch (20 ± 26° vs - 1 ± 18° and - 13 ± 10°) when compared to ASD-KE and controls (all p < 0.05). ASD-KF also had a more tilted (34 ± 11° vs. 28 ± 9° and 26 ± 7°), anteverted (24 ± 6° vs. 20 ± 5° and 18 ± 4°) and abducted (59 ± 6° vs. 57 ± 4° and 56 ± 4°) acetabulum, with a higher posterior coverage (100 ± 6° vs. 97 ± 7° for ASD-KE) when compared to ASD-KE and controls (all p < 0.05). The main determinants of acetabular tilt, acetabular abduction and anterior acetabular coverage were PT, SVA and LL (adjusted R2 [0.12; 0.5]). CONCLUSIONS ASD subjects compensating with knee flexion have altered hip orientation, characterized by increased posterior coverage (acetabular anteversion, tilt and posterior coverage) and decreased anterior coverage which can together lead to posterior femoro-acetabular impingement, thus limiting pelvic retroversion. This underlying mechanism could be potentially involved in the hip-spine syndrome.
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Affiliation(s)
- Mario Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Georges Kawkabani
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Renée Maria Saliby
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Elena Jaber
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Rami Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Khalil Kharrat
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Gaby Kreichati
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Virginie Lafage
- Department of Orthopedic surgery, Hospital for Special Surgery, New York, USA
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon. .,Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
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A radiological study of bone remodeling with two different types of porous β-tricalcium phosphate in humans. Sci Rep 2020; 10:19886. [PMID: 33199789 PMCID: PMC7669875 DOI: 10.1038/s41598-020-77011-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
In this study we compared the bone remodeling of unidirectional (UDPTCP) and spherical porous β-tricalcium phosphate (SPTCP) radiologically in humans. We performed a retrospective analysis of the data of 14 patients (sex, nine men and five women; age, 37–70 years) who underwent medial opening-wedge high tibial osteotomy (MOWHTO) and were followed up for 12 months after surgery. Two wedge-shaped β-TCPs (one UDPTCP and one SPTCP) were cut and placed parallel to each other in the gap. In Group A (eight knees), UDPTCP was implanted anteriorly and SPTCP posteriorly, while in Group B (six knees), SPTCP was implanted anteriorly and UDPTCP posteriorly. Computed tomography (CT) was performed at 1 week, 6 months, and 12 months after surgery, with the CT attenuation values calculated for UDPTCP and SPTCP. In Groups A and B, the CT attenuation values for UDPTCP were significantly lower at 6 and 12 months after surgery compared to those at 1 week (P < 0.05); nevertheless, no statistical difference in the comparison with SPTCP was observed. After a short-term follow-up of 12 months following MOWHTO, UDPTCP provided earlier bone remodeling than SPTCP. This outcome was achieved regardless of the position, anterior or posterior, in the MOWHTO gap.
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Matassi F, Cozzi Lepri A, Innocenti M, Zanna L, Civinini R, Innocenti M. Total Knee Arthroplasty in Patients With Extra-Articular Deformity: Restoration of Mechanical Alignment Using Accelerometer-Based Navigation System. J Arthroplasty 2019; 34:676-681. [PMID: 30685259 DOI: 10.1016/j.arth.2018.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) in patients with post-traumatic extra-articular deformity (EAD) is difficult to manage using conventional instrumentation techniques. In this study, we evaluate whether accelerometer navigation system can be a valuable option to make accurate bone resections and restore the neutral mechanical axis in complex TKA patients with EAD. METHODS From May 2015 to June 2017, 18 consecutive TKA were performed in 18 patients with knee osteoarthritis with associated EAD. An accelerometer-based navigation system was used to guide tibial and femoral resection in the coronal and sagittal plane. Postoperative lower limb alignment in coronal plane and component position in coronal and sagittal plane was measured through full-leg weight-bearing X-ray. Clinical score were recorded using the Knee Society Score at the final follow-up. RESULTS The mean hip-knee-ankle angle was 0.9° ± 1.4° varus alignment. The coronal alignment of the femoral component was 89.2° ± 1.9°, and the coronal alignment of the tibial component was 89.4° ± 2.1°. The sagittal alignment of the femoral component was 93.2°± 1.9°, and the sagittal alignment of the tibial component was 84.4° ± 3.1°. At the final follow-up, the Knee Society Score was 89 points (range, 82-100), and the functional score was 86.7 points (range, 60-100). No intraoperative and postoperative surgical complications were reported using this technology. CONCLUSION Accelerometer-based navigation is accurate in achieving neutral mechanical alignment and optimal implant position after TKA in patients with EAD. This system should be considered a valuable option to the more complex technique of computer navigation or robotic surgery.
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Affiliation(s)
| | | | | | - Luigi Zanna
- University of Florence, Orthopaedic Clinic CTO, Florence, Italy
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11
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Wang WJ, Sun MH, Palmer J, Liu F, Bottomley N, Jackson W, Qiu Y, Weng WJ, Price A. Patterns of Compartment Involvement in End-stage Knee Osteoarthritis in a Chinese Orthopedic Center: Implications for Implant Choice. Orthop Surg 2018; 10:227-234. [PMID: 30152607 DOI: 10.1111/os.12395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/04/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Knee osteoarthritis (OA) is a prevalent disease in the elderly, causing pain and contributing to poor quality of life. Surgical intervention, such as knee arthroplasty, can be used in those with end-stage knee OA. Total knee arthroplasty (TKA) is one of the most common surgical procedures for end-stage knee OA, with promising clinical outcomes. However, a large proportion of patients with isolated compartment OA can be treated with unicompartmental knee arthroplasty (UKA) instead. UKA has shown better patient-reported functional outcomes, and lower mortality and major complication rates than TKA. The percentage of UKA in knee arthroplasty varied in different orthopedic centers, and we believed that the requirement for UKA was underestimated in many centers. A retrospective study was carried out on our Chinese patient population presenting for knee arthroplasty; it aimed to identify the proportion of patients that might be suitable for UKA. METHODS A retrospective cross-sectional study of 155 consecutive patients (168 knees) awaiting TKA for end-stage primary OA was performed. The pattern and grade of OA was recorded from preoperative weight-bearing anteroposterior and non-weight-bearing lateral radiographs. The medial, lateral, patellofemoral compartment was given an individual Kellgren-Lawrence grade on the radiographs, and those grade ≥3 were defined as end-stage OA. The compartments involvement was established then. The integrity of the anterior cruciate ligament (ACL) was determined by the modified Keyes classification on lateral radiographs. The applicability for total or partial knee arthroplasty was determined according to the compartments involvement. RESULTS Medial compartment involvement was found in 154 (91.7%) knees, while the involvement of the lateral compartment and patellofemoral joint was found in 54 (32.1%) and 57 (33.9%) knees, respectively. Eighty-one (48.2%) of the knees showed medial compartment OA with or without patellofemoral joint involvement, and modified Keyes classification grade 1, indicating an intact ACL, and, hence, potential suitability for medial UKA. Isolated lateral OA indicating possible suitability for lateral UKA was identified in 11 knees (6.5%). No patients showed isolated patellofemoral joint OA. The other 76 (45.2%) knees could be treated by TKA. CONCLUSIONS The medial compartment was the most commonly affected in our Chinese patients indicated for knee arthroplasty. More than half of the patients in this group could be treated by either medial or lateral UKA.
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Affiliation(s)
- Wei-Jun Wang
- Department of Orthopaedics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Ming-Hui Sun
- Department of Orthopaedics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jonathan Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Fei Liu
- Department of Orthopaedics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Nicholas Bottomley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - William Jackson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Yong Qiu
- Department of Orthopaedics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Wen-Jie Weng
- Department of Orthopaedics, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
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12
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Imai N, Miyasaka D, Suzuki H, Tsuchiya K, Ito T, Minato I, Endo N. The anteroposterior axis of the tibia is adjusted to approximately a right angle to the anterior pelvic plane in the standing position in patients with hip dysplasia similar to normal subjects: a cross-sectional study. J Orthop Surg Res 2018; 13:105. [PMID: 29720218 PMCID: PMC5930825 DOI: 10.1186/s13018-018-0816-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We previously described that the anteroposterior (AP) axis of the tibia is approximately perpendicular to the transverse axis of the anterior pelvic plane (APP) in the standing position in healthy subjects. The purpose of this study was to investigate the rotational alignment between the APP and clinical epicondylar axis and the AP axis of the tibia relative to pelvic coordination in the standing position in normal subjects and in women with developmental dysplasia of the hip (DDH) to aid decision making for surgeons in the alignment of implants in total hip or knee arthroplasty. METHODS This study included 77 Japanese women. Twenty-nine in the DDH group underwent curved periacetabular osteotomy; 48 women without lumbago and knee pain were included in the normal group. Femoral neck anteversion (FNA), condylar twist angle, and knee rotation angle were measured in femoral coordination. The angle between the femoral neck axis and clinical epicondylar axis (CEA) was measured, the transverse axis of the APP was also measured, and the angle between the AP axis of the tibia and transverse axis of the APP was calculated. RESULTS There was a moderate negative correlation between FNA and CEA relative to the APP. This finding indicated a trend towards greater FNA leading to more internal rotation. Knee rotation angle (KRA) relative to the APP was 1.65° ± 5.58° in the normal group and - 2.65° ± 7.57° in the DDH group. This finding indicated that the tibia AP axis was approximately perpendicular to the APP in the standing position both in the normal and DDH groups. CONCLUSION We found that the tibia AP axis was at approximately a right angle to the transverse axis of the APP in the standing position in both the normal and DDH groups, while the KRA was different in the normal and DDH groups. These findings may prove helpful for positional alignment investigations needed for implantation in total hip or knee arthroplasty and gait analysis.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 9518510 Japan
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510 Japan
| | - Dai Miyasaka
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510 Japan
| | - Hayato Suzuki
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510 Japan
| | - Kazuki Tsuchiya
- Division of Advanced Materials Science and Technology, Niigata University Graduate School of Science and Technology, Niigata, 9502181 Japan
| | - Tomoyuki Ito
- Department of Orthopedic Surgery, Saiseikai Niigata Daini Hospital, Niigata, 9501104 Japan
| | - Izumi Minato
- Department of Orthopedic Surgery, Niigata Rinko Hospital, Niigata, 9508725 Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510 Japan
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Kuriyama S, Hyakuna K, Inoue S, Kawai Y, Tamaki Y, Ito H, Matsuda S. Bone-femoral component interface gap after sagittal mechanical axis alignment is filled with new bone after cementless total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1478-1484. [PMID: 28194499 DOI: 10.1007/s00167-017-4452-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study retrospectively evaluated the fate of mismatch between an uncemented femoral component and each femoral cut surface (i.e., wedge-shaped gap) relative to sagittal mechanical alignment in total knee arthroplasty (TKA). METHODS Primary TKA was performed on 99 consecutive knees. The femoral components were aligned to the sagittal mechanical axis with CT-based navigation. All patients were assessed with postoperative true lateral radiographs. Bone-side surfaces of the uncemented femoral component were divided into five zones: anterior flange, anterior chamfer, posterior chamfer, posterior part, and distal part, which were defined as zones 1 to 5, respectively. Bone filling of wedge-shaped gaps in each zone was evaluated after 1 year. RESULTS Femoral anterior notching did not occur. However, wedge-shaped gaps were observed in at least one zone in 23 of 99 knees (23%), most frequently in zone 5 (18%). There were 9 and 7 gaps in zones 1 and 2, respectively. The femoral component showed malpositioning of approximately 3° of flexion in cases with wedge-shaped gaps in zones 2 and/or 5. After one year, 67% (6/9) of zone 1, 100% (7/7) of zone 2, and 94% (17/18) of zone 5 wedge-shaped gaps were filled in with new bone. CONCLUSIONS Femoral alignment relative to sagittal mechanical axis caused wedge-shaped gaps due to unstable anterior bone cutting through hard bone, but the small gaps were not clinically significant and filled in within one year. Sagittal setting of the femoral component should aim for the anatomical axis rather than the mechanical axis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Katsufumi Hyakuna
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Satoshi Inoue
- Department of Orthopaedic Surgery, Nakae Hospital, Wakayama, Japan
| | - Yasutsugu Kawai
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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14
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Imai N, Miyasaka D, Ito T, Suzuki H, Minato I, Endo N. The anteroposterior axis of the tibia is approximately perpendicular to the anterior pelvic plane in the standing position in healthy Japanese subjects. J Orthop Surg Res 2017; 12:136. [PMID: 28946924 PMCID: PMC5613396 DOI: 10.1186/s13018-017-0642-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/17/2017] [Indexed: 11/22/2022] Open
Abstract
Background We previously reported that the clinical epicondylar axis (CEA) was approximately parallel to the transverse axis of the anterior pelvic plane (APP) in the standing position in normal subjects. The purpose of this study was to investigate the rotational alignment between APP in the standing position and the anteroposterior (AP) axis of the tibia relative to pelvic coordination in normal subjects. Methods This study included 68 healthy Japanese, 24 males and 44 females, without lumbago and knee pain. Femoral neck anteversion (FNA), condylar twist angle, and knee rotation angle were measured in femoral coordination. The angle between the femoral neck axis and CEA transverse axis of APP was also measured, and the angle between the AP axis of the tibia and the transverse axis of APP was calculated. The mean value of knee rotation angle was 0.23° and 2.06° in male and female subjects, respectively. Results There was a moderate positive correlation between FNA and the femoral axis angle relative to the transverse axis of APP. The knee rotation angle relative to APP was 0.33° and 1.56° in male and female subjects, respectively, and the tibia AP axis was approximately perpendicular to the transverse axis of APP in the standing position. Regarding validation, we obtained high interclass correlation coefficients for both intraobserver and interobserver reliability. Conclusion We found that the knee rotation angle was almost 0° and that the tibia AP axis was approximately perpendicular to the CEA. The tibia AP axis was also approximately perpendicular to the transverse axis of the APP in standing position.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 9518510, Japan. .,Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan.
| | - Dai Miyasaka
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
| | - Tomoyuki Ito
- Department of Orthopedic Surgery, Saiseikai Niigata Daini Hospital, Niigata, 9501104, Japan
| | - Hayato Suzuki
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
| | - Izumi Minato
- Department of Orthopedic Surgery, Niigata Rinko Hospital, Niigata, 9508725, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
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15
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What is the Ideal Degree of Extension After Primary Total Knee Arthroplasty? J Arthroplasty 2017; 32:2717-2724. [PMID: 28487091 DOI: 10.1016/j.arth.2017.03.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have examined flexion contracture at the time of primary total knee arthroplasty (TKA) or how flexion contracture changes over time. The purpose of this study was to assess the ideal degree of extension immediately after TKA and to document postoperative changes in extension and clinical outcomes over 5-year follow-up. METHODS This retrospective cohort study included 215 cases of primary TKA. Radiographic evaluations were performed on sagittal radiographs with the patient in the supine position and the knee in gravity and in passive extension using a stress device. Clinical outcomes were also measured. Four groups were defined on the basis of the extension angle during radiological evaluation: group 1, -10° to 0°; group 2, >0° to +5°; group 3, >+5° to +10°; group 4, >+10° in gravity. RESULTS There were statistically significant differences in passive extension and gravity extension angles in groups 1, 3, and 4 with time-dependent and time*group (passive vs gravity) analyses, but not in group 2. The flexion contracture angles over 10° in gravity were decreased, although over 5° of flexion contracture remained at the final follow-up. Clinical outcomes were worse in groups 1 and 4 at the final follow-up. CONCLUSION An extension angle between 0° and 5° in the passive extension position immediately after TKA can be considered ideal up to 5 years of follow-up. Patients with flexion contracture greater than 5° in passive extension and patients with hyperextension should be followed up to assess whether the condition will worsen.
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16
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Głowacki M, Walecki J, Kołakowski P, Kolońska D. Importance of Radiological Evaluation of Global Spinal Balance Together with Lower Limb Alignment in Planning Lumbar Spine Deformity Surgery - Illustrative Case Presentation. Pol J Radiol 2017. [PMID: 28638492 PMCID: PMC5459268 DOI: 10.12659/pjr.899975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The presented case illustrates the critical role of a detailed preoperative radiological evaluation in complex spine surgery. Case Report A 49-year-old patient was admitted for a revision surgery after L3–L5 fusion. Preoperative assessment showed preserved sagittal balance, coronal imbalance and valgus knee deformity. The patient reported pain of 8–10 in VAS (Visual Analogue Scale) and had an ODI (Oswestry Disability Index) of 60%. The first step of the surgery was L2–S1 fusion with decompression and spine deformity correction. The second step involved anti-valgus osteotomy of the right tibial bone. Conclusions The assessment of global spinal balance together with lower extremity alignment should be strongly recommended.
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Affiliation(s)
- Mariusz Głowacki
- Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.,Department of Neurosurgery, St. Elisabeth Hospital, Warsaw, Poland
| | - Jerzy Walecki
- Department of Radiology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | | | - Danuta Kolońska
- Department of Neurosurgery, 2 Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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17
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Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2476-82. [PMID: 26581366 DOI: 10.1007/s00167-015-3863-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to investigate the relationship between preoperative femoral axes and femoral implant position and to determine how femoral sagittal axes, including femoral anterior bowing, influence the femoral component position in total knee arthroplasty (TKA). METHODS The relationship between femoral axes (femoral anterior bowing, mechanical axis and the anterior cortical line, intramedullary axis) and implant position was compared in 50 conventional and 50 navigated TKAs. Outliers with more than a 3° margin of error in placement of the femoral component compared with the mechanical axis in the sagittal plane were calculated. RESULTS The femoral component flexion angle was 3.1° in the conventional group and 1.6° in the navigation group (p < 0.001). Anterior femoral bowing correlated positively with the angle between the mechanical axis and implant (r = 0.360, p = 0.010) in the conventional group and negatively with the angle between the anterior cortical line and flange of the femoral component (r = -0.355, p = 0.010) in navigated TKAs. Incidence of outliers was 48 % (24 patients) in the conventional group compared with 10 % (five patients) in the navigated group (p = 0.008). CONCLUSIONS Femoral anterior bowing was an influential factor for implant position and could be a risk factor for both femoral implant flexion in conventional TKAs and notching in navigated TKAs. The results of this study should be considered by surgeons when assessing the risk factors for femoral geometry before performing TKAs, as these results may help them to avoid an overly flexed or extended position of the femoral component, which would affect clinical long-term survival. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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18
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Changes in the three-dimensional load-bearing axis after mobile-bearing total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:537-43. [PMID: 27100865 DOI: 10.1007/s00590-016-1772-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this study was to assess changes in the three-dimensional (3D) load-bearing mechanical axis (LBMA) preoperatively and at 3 weeks and more than 1-year follow-up after total knee arthroplasty (TKA), and effects of the degree of constraint in the anteroposterior (AP) direction because of the retention of the posterior cruciate ligament (PCL) and the implant design on the changes in LBMA. METHODS We evaluated 157 knees from 131 patients, including 79 knees that received meniscal-bearing-type (PCL-retaining) and 78 knees that received rotating-platform-type (PCL-substituting) prostheses. Quantitative 3D computed tomography was used to assess changes in the location of the pre- and postoperative LBMA at the tibial plateau level. RESULTS Changes in the 3D axis were mainly found from medial to lateral and posterior to anterior in both implant designs with no significant differences. Change in the mediolateral (ML) direction was improved soon after TKA, but change in the AP direction improved more gradually over time. The different constraints in the AP direction because of the retention of the PCL and different implant designs did not affect the changes in the LBMA. CONCLUSIONS The LBMA in the AP direction more than 1 year postoperatively, as well as the LBMA in the ML direction at 3 weeks, appears to shift toward the location found in normal knees after TKA, regardless of the type of prosthetic constraint. These changes may be an important factor that influences the periarticular knee bone mineral density which load bearing may be related to. LEVEL OF EVIDENCE Level II, Prognostic study.
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Minoda Y, Watanabe K, Iwaki H, Takahashi S, Fukui M, Nakamura H. Theoretical risk of anterior femoral cortex notching in total knee arthroplasty using a navigation system. J Arthroplasty 2013; 28:1533-7. [PMID: 23507072 DOI: 10.1016/j.arth.2013.02.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 02/08/2013] [Accepted: 02/11/2013] [Indexed: 02/01/2023] Open
Abstract
Two important requirements for navigation systems in total knee arthroplasty (TKA), perpendicular cut from the distal femoral condyle to the femoral mechanical axis and prevention of notching of the anterior femoral cortex, might be difficult to meet simultaneously. The potential risk of notching was investigated using three-dimensional (3D) computed tomography data of 50 entire lower extremities of 50 female Japanese candidates for TKA and a 3D template system. Navigation systems for TKA carry the potentially higher risk of notching of the anterior femoral cortex (34% to 51%) than conventional technique (11%) (P<0.001). More anterior setting of the reference point for navigation systems on the distal femur and more external setting of the femoral component were risk factors for notching (P<0.001).
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Affiliation(s)
- Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka 545-8585, Japan
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20
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Sugama R, Minoda Y, Kobayashi A, Iwaki H, Ikebuchi M, Takaoka K, Nakamura H. Conventional or navigated total knee arthroplasty affects sagittal component alignment. Knee Surg Sports Traumatol Arthrosc 2012; 20:2454-9. [PMID: 22261992 DOI: 10.1007/s00167-012-1889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 01/10/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Navigation systems have recently been developed to achieve highly reliable prosthetic alignment in total knee arthroplasty (TKA). However, component alignment in the sagittal plane is less reliable than that in the coronal plane even when navigation systems are used. Previous reports examining men showed differences in targeted sagittal prosthetic alignments of TKA achieved using the conventional technique and various navigation systems. However, there have been few studies examining the use of this technique in women, who are the primary candidates for TKA. METHODS Radiographs of the entire lower extremity were obtained from 20 elder women while standing and sagittal prosthetic alignments in TKA were planned using the conventional technique as well as three navigation approaches to establish reference frames, and the observations were compared. RESULTS Sagittal alignments simulated using the radiographs for the conventional technique and navigation systems differed within a mean of 3.2° ± 1.7° (mean ± SD) to 6.3° ± 2.0°. The use of different reference points on the distal femoral condyles (insertion point of the intramedullary rod, center of the anteroposterior direction of the femoral condyles, and most distal point of the femoral condyles) for each navigation system resulted in differences in the sagittal plane up to 3.0° ± 1.5°. The use of navigation systems resulted in a more hyperextended position between the femoral and tibial components compared to that for the conventional technique. CONCLUSIONS Targeted sagittal prosthetic alignments of TKA achieved using the conventional technique and various navigation systems differed in elderly women. The use of different reference points on the distal femoral condyle for navigation systems resulted in different alignment in the sagittal plane. This study showed that alignment tendencies are similar in men and women. LEVEL OF EVIDENCE Prognostic studies, IV.
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Affiliation(s)
- Ryo Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka 545-8585, Japan
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Lu ZH, Yu JK, Chen LX, Gong X, Wang YJ, Leung KKM. Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50 years. J Arthroplasty 2012; 27:1216-20. [PMID: 22365487 DOI: 10.1016/j.arth.2011.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 12/20/2011] [Indexed: 02/01/2023] Open
Abstract
Surgeons do not give enough weight to the effects of bowing of the sagittal femoral shaft in total knee arthroplasty (TKA), which can result in damage to the cortex, fractures, or malalignment of the femoral component. To determine gender differences in bowing, we used spiral computed tomography to scan the femurs of 26 men and 47 women older than 50 years who required TKA. Skeletal extraction of the total sagittal femoral shaft from computed tomographic images was done by a matrix laboratory. The extracted curves were evenly divided into 3 sections. Comparison of the curvature on different sections of the same side of the femur showed that the distal third was significantly bowed. In addition, the curvature of the distal third was significantly larger in women than in men. Such morphological characteristics put forward new requirements in how intramedullary guide rods are used in TKA.
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Affiliation(s)
- Zhi-Hua Lu
- Institute of Sports Medicine of Peking University Third Hospital, Beijing, China
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Ishii Y, Noguchi H, Takeda M, Sato J, Ezawa N, Toyabe SI. Changes in lower extremity 3-dimensional load-bearing axes before and after mobile-bearing total knee arthroplasty. J Arthroplasty 2012; 27:1203-9. [PMID: 22305436 DOI: 10.1016/j.arth.2011.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 12/10/2011] [Indexed: 02/01/2023] Open
Abstract
This study evaluated changes in the lower extremity 3-dimensional load-bearing mechanical axes in the anteroposterior and mediolateral directions before and at 3 weeks after mobile-bearing total knee arthroplasty. The effects of the degrees of anteroposterior constraint of the designs on the location of the load-bearing mechanical axis at the knee joint level were also assessed. We evaluated 151 knees from 134 patients with 74 knees receiving meniscal bearing-type and 77 knees receiving rotating platform-type prostheses. In the mediolateral direction, both designs showed significant improvements, whereas in the anteroposterior direction, they revealed no improvements postoperatively and were worsened significantly in meniscal bearing type. Differences in the degree of bone and soft tissue involvement for the correction of alignment may explain the findings.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
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Sugama R, Minoda Y, Kobayashi A, Iwaki H, Ikebuchi M, Hashimoto Y, Takaoka K, Nakamura H. Sagittal alignment of the lower extremity while standing in female. Knee Surg Sports Traumatol Arthrosc 2011; 19:74-9. [PMID: 20407756 DOI: 10.1007/s00167-010-1137-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 03/29/2010] [Indexed: 11/28/2022]
Abstract
There is only limited information available on the sagittal alignment of the lower extremity of normal subjects under weight-bearing conditions. Our aim was to determine the sagittal alignment of the lower extremity under such conditions. Anteroposterior and lateral radiographs were taken of the 20 lower extremities of 20 healthy female volunteers while standing. The coronal mechanical axis passed through 29% medial to the proximal tibial articulating surface. The sagittal mechanical axis passed through 44% anterior to the distal femoral condyle and 33% anterior to the proximal tibial articulating surface, and also passed 3 mm anterior to the intercondylar notch. Our study showed that the coronal and sagittal mechanical axes of the lower extremity do not always pass through the center of the knee. Our results will provide important information for alignment in surgery of lower extremity such as knee arthroplasty and osteotomy.
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Affiliation(s)
- Ryo Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
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The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2010; 18:718-22. [PMID: 19784625 DOI: 10.1007/s00167-009-0927-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/08/2009] [Indexed: 10/20/2022]
Abstract
Use of navigation systems has recently been introduced in total knee arthroplasty (TKA) to achieve more reliable prosthetic alignment. In the sagittal plane, there are two important requirements for navigation systems: (1) perpendicular cut to the femoral mechanical axis and (2) prevention of notching of anterior femoral cortex. These two requirements, however, may conflict. The angles between the line of the anterior femoral cortex and four sagittal femoral mechanical axes for navigation systems using radiographs of the entire lower extremity, while standing were measured and compared. These four sagittal axes simulated on the radiographs in navigation systems were in extension relative to the line of the anterior femoral cortex in 40-85% of cases in male and 65-100% in elderly female. The present study showed that navigation systems have the potential risk for notching of anterior femoral cortex.
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Three-dimensional lower extremity alignment in the weight-bearing standing position in healthy elderly subjects. J Orthop Sci 2010; 15:64-70. [PMID: 20151253 DOI: 10.1007/s00776-009-1414-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 09/13/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although assessment of lower extremity alignment is important for the treatment and evaluation of diseases that present with malalignment of the lower extremity, it has generally been performed using only plain radiographs seen in two dimensions (2D). In addition, there is no consensus regarding the criteria for quantitative three-dimensional (3D) evaluation of the relative angle between the femur and tibia. The purpose of this study was to establish assessment methods and criteria for quantitatively evaluating lower extremity alignment in 3D and to obtain reference data from normal elderly subjects. METHODS The normal alignment of 82 limbs of 45 healthy elderly subjects (24 women, 21 men; mean age 65 years, range 60-81 years) was analyzed in 3D with regard to flexion, adduction-abduction, and rotational angle of the knee in the weight-bearing, standing position. The obtained computed tomography (CT) and biplanar computed radiography (CR) data were used to define several anatomical axes of the femur and tibia as references. RESULTS In the sagittal plane, the mean extension-flexion angle was significantly more recurvatum in women than in men. In the coronal plane, the mean 3D hip-knee-ankle angle was more varus by several degrees in this Japanese series than that in a Caucasian series reported previously. Regarding rotational alignment, the mean angle between the anteroposterior axis of the tibia and the transepicondylar axis of the femur in this series was slightly larger (externally rotated) than that of previously reported Japanese series examined in the supine position. CONCLUSIONS These data are believed to represent important references for 3D evaluation of morbid lower extremity alignment in the weight-bearing, standing position and are important for biomechanical research (e.g., 3D analyses of knee kinematics) because the relative angles between the femur and tibia are assessed three-dimensionally.
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Sekiya H, Takatoku K, Takada H, Sasanuma H, Sugimoto N. Postoperative lateral ligamentous laxity diminishes with time after TKA in the varus knee. Clin Orthop Relat Res 2009; 467:1582-6. [PMID: 18941848 PMCID: PMC2674159 DOI: 10.1007/s11999-008-0588-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 10/03/2008] [Indexed: 01/31/2023]
Abstract
For successful TKA, good soft tissue balance is one of the most important factors; however, it is unknown whether the coronal balance immediately after surgery is maintained with time. We hypothesized, if neutral mechanical alignment was achieved at the time of TKA, some degree of lateral ligamentous laxity could be accepted and the laxity would diminish with time. To confirm this hypothesis, we posed two scientific questions: (1) Does the coronal ligament balance measured immediately after TKA change with time? (2) Does the degree of preoperative varus alignment correlate with the lateral or medial ligamentous laxity observed after TKA? We measured coronal lateral or medial ligamentous laxity in 71 knees with varus deformities immediately after surgery and at 3, 6, and 12 months thereafter. The mean mechanical axis was 15.9 degrees varus preoperatively and 0.4 degrees varus postoperatively. The mean medial ligamentous laxity was relatively constant postoperatively from immediately after surgery to 12 months. However, the mean lateral ligamentous laxity was as much as 8.6 degrees immediately after surgery and decreased to 5.1 degrees at 3 months. The lateral ligamentous laxity immediately after surgery correlated with the preoperative varus mechanical axis. Our data show residual lateral ligamentous laxity observed in preoperative varus deformity may be corrected spontaneously after TKA.
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Affiliation(s)
- Hitoshi Sekiya
- Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 3290498, Japan.
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Minoda Y, Kobayashi A, Iwaki H, Ohashi H, Takaoka K. TKA sagittal alignment with navigation systems and conventional techniques vary only a few degrees. Clin Orthop Relat Res 2009; 467:1000-6. [PMID: 18712579 PMCID: PMC2650059 DOI: 10.1007/s11999-008-0449-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 07/25/2008] [Indexed: 01/31/2023]
Abstract
Navigation systems have been developed to achieve more reliable prosthetic alignment in TKAs. However, the component alignment in the sagittal plane is reportedly less reliable than in the coronal plane even with navigation systems. We measured and compared sagittal prosthetic alignments for TKAs with the conventional technique and three navigation approaches to establish reference frames, using radiographs of the entire lower extremity while standing. The sagittal alignments simulated on the radiographs with the conventional technique and navigation systems differed by a mean of 2 degrees to 4 degrees . Use of navigation systems resulted in a mean of 1 degrees to 4 degrees hyperextension between the femoral and tibial components and use of the conventional technique resulted in a mean of 1 degrees flexion. Use of different reference points on the distal femoral condyle for the navigation systems resulted in differences of as much as 3 degrees alignment in the sagittal plane. Although optimal prosthetic alignment for TKA in the sagittal plane is unknown, surgeons and technicians using navigation systems should be aware of this difference in the sagittal plane and the risk of hyperextension between the femoral and tibial components, which might be associated with osteolysis and anterior post-cam impingement.
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Affiliation(s)
- Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585 Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585 Japan
| | - Hiroyoshi Iwaki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585 Japan
| | - Hirotsugu Ohashi
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka, 545-8585 Japan
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