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O'Neill A, McAuliffe M, Pillay T, Garg G, Whitehouse S, Crawford R. What Is the Correlation between Coronal Plane Alignment Measured on Pre- and Postoperative Weight-bearing Radiographs and Intraoperative Navigation When Stress Is Applied to the Knee? J Knee Surg 2024; 37:702-709. [PMID: 38336109 DOI: 10.1055/a-2265-9896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR)-derived hip-knee-ankle angle (HKAA) and intraoperative supine computer-assisted surgery (CAS)-derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if WB alignment could be mimicked or inferred based on intraoperative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single center by a single surgeon. The HKAA was recorded using the CAS navigation system immediately postregistration of navigation data and after implantation of the prosthesis. The intraoperative HKAA was recorded in both the supine "resting" position of the knee and also while the knee was manipulated in an effort to replicate the patient's WB alignment. These measurements were compared with the HKAA recorded on pre- and postoperative WB LLRs. There was a strong correlation between the preoperative WB LLR HKAA and the intraoperative preimplant CAS-derived stressed HKAA (R = 0.946). However, there was no correlation between the postoperative WB LLR HKAA and the postimplant insertion HKAA as measured intraoperatively via CAS for either a "resting" or "stressed" position of the operated knee (R = 0.165 and R = 0.041, respectively). Thus, the interpretation of intraoperative alignment data is potentially problematic. Despite technological advances in the development and utilization of computer navigation and robotics in arthroplasty to help obtain the optimal alignment, it would seem apparent from our study that this alignment does not correlate to upright stance postoperatively. Surgeons should apply caution to the strength of assumptions they place on intraoperative coronal plane alignment findings.
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Affiliation(s)
- Anthony O'Neill
- Mater Public and Private Hospital, South Brisbane, Queensland, Australia
- Brisbane Private Hospital, Brisbane City, Queensland, Australia
| | - Michael McAuliffe
- Ipswich General Hospital, Queensland Health, Ipswich, Queensland, Australia
- CJM Centre, Ipswich, Queensland, Australia
- Mater Private Hospital, Springfield Lakes, Queensland, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
| | - Tristan Pillay
- CJM Centre, Ipswich, Queensland, Australia
- Mater Private Hospital, Springfield Lakes, Queensland, Australia
- St Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
| | - Gautam Garg
- Ipswich General Hospital, Queensland Health, Ipswich, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Whitehouse
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ross Crawford
- Orthopaedic Research Unit, Queensland University of Technology, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
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Kikuchi N, Kanamori A, Okuno K, Yamazaki M. Weight-bearing line at the ankle joint level shifted laterally after total knee arthroplasty for varus knee osteoarthritis: Evaluation of the hip-to-calcaneus line. Orthop Traumatol Surg Res 2024; 110:103690. [PMID: 37741441 DOI: 10.1016/j.otsr.2023.103690] [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: 04/24/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Few studies have comprehensively examined how alignment beyond the ankle joint changes after Total knee arthroplasty (TKA). This retrospective study aimed to answer the questions: (1) do the radiological parameters beyond the ankle joint, including the weight-bearing line at the ankle joint level, change after TKA in varus knee osteoarthritis? (2) Does the lower extremity alignment correlate with alignment beyond the ankle joint? HYPOTHESIS Our hypothesis was that TKA altered the radiological parameters beyond the ankle, which correlated with the lower extremity alignment. PATIENTS AND METHODS This retrospective study included 67 patients who underwent mechanically aligned TKA for varus knee osteoarthritis. The hip-knee-ankle angle (HKA), tibial plafond inclination angle (TPIA), hindfoot alignment angle (HA), talar tilt (TT), and weight-bearing line at the ankle joint level (mechanical ankle joint axis point [MAJAP]) were measured using radiographs taken before and 6 months after TKA; each parameter was compared between the two time points. The correlations between HKA and other parameters were examined preoperatively and postoperatively. RESULTS The mean HKA, TPIA, HA, TT, and MAJAP changed significantly after TKA from 15.0±6.1̊ to 2.6̊±3.5̊, from 10.8̊±5.7̊ to 4.7̊±3.9̊, from 2.3̊±5.5̊ to -2.5̊±4.5̊, from 0.2̊±1.3̊ to -0.5̊±1.4̊, and from 29.3±23.3 to 54.3±20.6, respectively. Correlations were noted between the preoperative HKA and the preoperative TPIA (r=0.58), HA (r=0.36), and MAJAP (r=-0.59), and between the postoperative HKA and the postoperative TPIA (r=0.54) and MAJAP (r=-0.38). DISCUSSION TKA for varus knee osteoarthritis altered radiological parameters beyond the ankle, with the weight-bearing line at the ankle joint level passing more laterally. The weight-bearing line at the ankle joint level was correlated with lower extremity alignment both preoperatively and postoperatively. LEVEL OF EVIDENCE IV; single-centre retrospective observational study.
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Affiliation(s)
- Naoya Kikuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan.
| | - Akihiro Kanamori
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan
| | - Kosuke Okuno
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575 Ibaraki, Japan
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Schranz C, Sperl M, Kraus T, Guggenberger B, Kruse A, Habersack A, Svehlik M. Different gait pattern in adolescence with patellofemoral instability. Clin Biomech (Bristol, Avon) 2023; 108:106067. [PMID: 37633176 DOI: 10.1016/j.clinbiomech.2023.106067] [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: 04/01/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Patellofemoral instability influences the gait pattern and activity level in adolescents. However, gait biomechanics to cope with recurrent patella instability and its relation to radiological findings has hardly been studied. METHODS We retrospectively analyzed kinematic and kinetic gait analysis data, magnetic resonance images and X-ray of 32 adolescents with unilateral recurrent patellofemoral instability aged 12 to 18 years. Subjects were assigned to 3 groups based on their sagittal knee moment in the loading response and mid stance phase. Kinematic and kinetic differences among the groups were analyzed using a one-way ANOVA. A multinomial logistic regression model provided a further analysis of the relationship between gait biomechanics and MRI as well as X-ray parameters. FINDINGS All three groups showed different characteristics of the knee kinematics during loading response and single stance: while the patella-norm-loading group showed a slightly reduced knee flexion (p 〈0,01), the patella-unloading group kept the knee nearly extended (p < 0,01) and patella-overloading group showed an increased knee flexion (p = 0,01) compared to the other groups. In single stance the patella-overloading group maintained increased knee flexion (p < 0,01) compared to patella-unloading group and patella-norm-loading group. None of the radiological parameters proved to be related to gait patterns. INTERPRETATION The paper describes different gait coping strategies and their clinical relevance in subjects with patellofemoral instability. However, we did not find any relation of gait biomechanics to skeletal morphology.
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Affiliation(s)
- Christian Schranz
- Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
| | - Matthias Sperl
- Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Tanja Kraus
- Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Bernhard Guggenberger
- Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; Institute of Physiotherapy, JOANNEUM University of Applied Sciences, Alte Poststraße 154, 8020 Graz, Austria
| | - Annika Kruse
- Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria
| | - Andreas Habersack
- Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria; Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria
| | - Martin Svehlik
- Paediatric Orthopaedic Unit, Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Cheng L, Ren P, Zheng Q, Ni M, Geng L, Wang Y, Zhang G. Implication of Changes in the Imaging Measurements after Mechanically Aligned Total Knee Arthroplasty. Orthop Surg 2022; 14:3322-3329. [PMID: 36324288 PMCID: PMC9732610 DOI: 10.1111/os.13456] [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: 02/11/2022] [Revised: 07/02/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Imaging measurements allow assessment of the mechanical alignment before and after total knee arthroplasty (TKA). The changes in radiographic parameters in each period of time within 1 year after TKA has been poorly understood. The purpose of this study was to examine the timing and causes of imaging changes in lower extremity force lines after total knee arthroplasty with mechanical alignment. METHODS A total of 93 mechanically-aligned TKA were radiographically examined before, 3 days, 3 months, and 1 year after surgery. Radiographic parameters included hip-knee angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), knee joint line orientation (KJLO), ankle joint line orientation (AJLO), the knee joint line relative to ankle joint line angle (KJLTA) and midpoints of the ankle distance (MAD). Paired t-test were used to analyze the changes of these imaging parameters, By establishing a simple tibial model, the time points of changes in the imaging parameters after TKA was determined, with an attempt to understand the post-TKA changes in these imaging parameters. RESULTS Statistically significant differences were found between the preoperative data and the data measured 3 days after surgery in HKA, LDFA, MPTA, MAD, KJLTA, AJLO (P < 0.05) while KJLO exhibited no significant difference (P = 0.089). There existed significant differences between the data measured 3 days and the measurements taken 3 months after operation in HKA, MPTA, KJLTA, KJLO, AJLO (P < 0.05), whereas LDFA and MAD showed no significant difference (P > 0.05). Significant differences were revealed between the data measured 3 months and those collected 1 year after surgery in LDFA, MPTA, AJLO, KJLTA (P < 0.05) but HKA, KJLO, AJLO showed no significant differences (P > 0.05). The tibial model was made to look into the changes in postoperative imaging parameters. ΔMAD and postoperative AJLO were calculated to verify the model and hypothesis. CONCLUSIONS Postoperative changes in radiographic parameters and tibial models showed that the lower extremities were in an unnatural state within 1 year after TKA. The changes in the lower extremities force line were the results of the gradual adaptation of the lower extremities to TKA and the lateral swing of the extremities (3°) after surgery. Imaging data 1 year after surgery should be taken into account in the explanation of post-TKA changes in lower limb force lines.
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Affiliation(s)
- Long Cheng
- Medical School of Chinese People's Liberation Army General HospitalBeijingChina,Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina
| | - Peng Ren
- Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina
| | - Qingyuan Zheng
- Medical School of Chinese People's Liberation Army General HospitalBeijingChina,Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina
| | - Ming Ni
- Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina,Department of Orthopaedics, the Fourth Medical CenterChinese People's Liberation Army General HospitalBeijingChina
| | - Lei Geng
- Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina,Department of Orthopaedics, the Fourth Medical CenterChinese People's Liberation Army General HospitalBeijingChina
| | - Yi‐Ming Wang
- Medical School of Chinese People's Liberation Army General HospitalBeijingChina,Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina
| | - Guo‐Qiang Zhang
- Department of Orthopaedics, the First Medical CenterChinese People's Liberation Army General HospitalBeijingChina,Department of Orthopaedics, the Fourth Medical CenterChinese People's Liberation Army General HospitalBeijingChina
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Effects of lower limb rotation on the measurement accuracy of coronal alignment in long-leg radiographs after total knee arthroplasty. Chin Med J (Engl) 2022; 135:619-621. [PMID: 35102048 PMCID: PMC8920418 DOI: 10.1097/cm9.0000000000001982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sezer HB, Bohu Y, Hardy A, Lefevre N. Knee Prosthesis in the Computer Era. Orthop Surg 2021; 13:395-401. [PMID: 33506615 PMCID: PMC7957434 DOI: 10.1111/os.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Over the past two decades, computer assistance has revolutionalized surgery and has enabled enormous advancements in knee prosthesis surgery. Total knee arthroplasty (TKA) is a hot topic of orthopaedic research. Reflecting population dynamics, its use continues to increase, especially in high demand populations. Therefore, efforts to achieve the best fit and precise alignment in TKA continue. Computer assistance is valuable for knee prosthesis surgeons in this regard. This manuscript investigated the use of computer assistance in knee prosthesis surgery. The effects of computer use on important facets of knee prosthesis surgery, such as precision, clinical aspects, and costs, were examined. Moreover, an overall review of the recent literature on the navigation and personalized cutting guides was conducted.
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Affiliation(s)
| | - Yoann Bohu
- Clinique du Sport Paris VParisFrance
- Institut de L'Appareil Locomoteur NolletParisFrance
| | - Alexandre Hardy
- Clinique du Sport Paris VParisFrance
- Institut de L'Appareil Locomoteur NolletParisFrance
| | - Nicolas Lefevre
- Clinique du Sport Paris VParisFrance
- Institut de L'Appareil Locomoteur NolletParisFrance
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Zahn RK, Graef F, Conrad JL, Renner L, Perka C, Hommel H. Accuracy of tibial positioning in the frontal plane: a prospective study comparing conventional and innovative techniques in total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:793-800. [PMID: 32124032 PMCID: PMC7244465 DOI: 10.1007/s00402-020-03389-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 12/05/2022]
Abstract
BACKGROUND Coronal alignment of the tibial component determines functional outcome and survival in total knee arthroplasty (TKA). Innovative techniques for tibial instrumentation have been developed to improve accuracy and reduce the rate of outliers. METHODS In a prospective study, 300 patients were allocated to four different groups using a randomization process (two innovative and two conventional) techniques of tibial instrumentation (conventional: extramedullary, intramedullary; innovative: navigation and patient-specific instrumentation (PSI); n = 75 for each group). The aims were to reconstruct the medial proximal tibial angle (MPTA) to 90° and the mechanical tibio-femoral axis (mTFA) to 0°. Both angles were evaluated and compared between all groups three months after the surgery. Patients who presented with a postoperative mTFA > 3° were classified as outliers. RESULTS The navigation and intramedullary technique both demonstrated that they were significantly more precise in reconstructing a neutral mTFA and MPTA compared to the other two techniques. The odd's ratio (OR) for producing outliers was highest for the PSI method (PSI OR = 5.5, p < 0.05; extramedullary positioning OR = 3.7, p > 0.05; intramedullary positioning OR = 1.7, p > 0.05; navigation OR = 0.04, p < 0.05). We could only observe significant differences between pre- and postoperative MPTA in the navigation and intramedullary group. The MPTA showed a significant negative correlation with the mTFA in all groups preoperatively and in the extramedullary, intramedullary and PSI postoperatively. CONCLUSION The navigation and intramedullary instrumentation provided the precise positioning of the tibial component. Outliers were most common within the PSI and extramedullary technique. Optimal alignment is dependent on the technique of tibial instrumentation and tibial component positioning determines the accuracy in TKA since mTFA correlated with MPTA pre- and postoperatively.
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Affiliation(s)
- R. K. Zahn
- Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Charitéplatz 1, 10115 Berlin, Germany
| | - F. Graef
- Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Charitéplatz 1, 10115 Berlin, Germany ,Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - J. L. Conrad
- Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Charitéplatz 1, 10115 Berlin, Germany
| | - L. Renner
- Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Charitéplatz 1, 10115 Berlin, Germany
| | - C. Perka
- Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Charitéplatz 1, 10115 Berlin, Germany
| | - H. Hommel
- Center for Musculoskeletal Surgery, Charité–University Medicine Berlin, Charitéplatz 1, 10115 Berlin, Germany ,Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
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Perka N, Kopf S, Hommel H. A whole leg radiograph is not necessary for postoperative determination of the mechanical leg axis after total knee arthroplasty. Arch Orthop Trauma Surg 2019; 139:1455-1460. [PMID: 31414170 DOI: 10.1007/s00402-019-03256-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Anteroposterior (AP) whole leg radiographs (WLR) in the standing position for assessment of the mechanical leg axis are generally performed preoperatively for the planning of total knee replacement (TKR) and postoperatively to assess the leg axis. The objective of the present study was to investigate whether, if preoperative WLR are available, postoperative AP standard knee radiographs in the standing position are sufficient for calculating the mechanical leg axis. METHODS In the present prospective study, the mechanical and the anatomical leg axes were determined on the basis of WLR from 104 patients prior to implantation of a TKR and the difference was calculated. Twelve weeks postoperatively, standing long AP radiographs and WLR were prepared. In addition, the mechanical axis was calculated by adding the preoperative difference between the anatomical and mechanical axis to the anatomical axis from the postoperative AP radiographs. Accuracy, bias and level of agreement for calculated relative to measured mechanical alignment were determined. RESULTS Mean accuracy of calculated mechanical alignment was 0.5° ± 0.4°, and mean bias was 0.0° ± 0.6° (p = 1.00). Bland-Altman analysis revealed a 95% upper and lower level of agreement of - 1.3° and 1.3°, respectively. CONCLUSION A preoperative WLR and a postoperative long AP knee standard radiograph are sufficient to determine the mechanical leg axis after TKR. If these are available, it is possible to do without WLR after TKR, particularly since they involve higher radiation exposure, are time-consuming, and are also prone to errors in the first postoperative weeks. LEVEL OF EVIDENCE II diagnostic study.
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Affiliation(s)
- Nina Perka
- Medical School, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
| | - Sebastian Kopf
- Center of Orthopaedics and Traumatology, Medical School Theodor Fontane, Hospital Brandenburg an der Havel, 14770, Brandenburg, Germany
| | - Hagen Hommel
- Clinic for Orthopaedics, Sports Medicine and Rehabilitation, Hospital Märkisch-Oderland GmbH, 16269, Wriezen, Germany.,Medical School Theodor Fontane, 16816, Neuruppin, Germany
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Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty. Adv Orthop 2019; 2019:4096306. [PMID: 31057974 PMCID: PMC6463624 DOI: 10.1155/2019/4096306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/22/2018] [Accepted: 03/14/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient's pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.
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Zahn RK, Renner L, Perka C, Hommel H. Weight-bearing radiography depends on limb loading. Knee Surg Sports Traumatol Arthrosc 2019; 27:1470-1476. [PMID: 29992465 DOI: 10.1007/s00167-018-5056-6] [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: 03/12/2018] [Accepted: 07/06/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE The mechanical axis of the lower limb has shown to vary between different weight-bearing conditions and change after total knee arthroplasty (TKA). The purpose of this study was to investigate the correlation between mechanical axis alignment in standing long-leg radiographs and limb loading after TKA. METHODS Mechanical axis of the lower limb and limb loading have been prospectively evaluated in 115 patients 10 days and 3 months after TKA. By the moment of standing long-leg radiography for analysis of the mechanical leg axis, two digital scales separately captured the load of each limb. RESULTS Mechanical axis changed from an initial - 1° ± 2° valgus alignment to a varus axis of + 1° ± 2° (p < 0.01). This change in alignment was associated with an increase of limb loading from 89.9 ± 10.7 to 93.0 ± 7.0% (p < 0.01). The mechanical axis strongly correlated with relative limb loading at the first and second measurements (r = 0.804, p < 0.001, respectively, r = 0.562, p < 0.001). A significant change in the rate of outliers was registered within the observation period. These alterations and distinctions were much more pronounced in patients with postoperative incomplete extension (n = 15). CONCLUSIONS The postoperative mechanical axis correlates with limb loading. A clinical relevant change in frontal alignment of the lower limb is associated with increased limb loading after TKA. The actual mechanical axis can only be assessed at physiological limb loading in long-leg radiographs with complete extension at full weight bearing. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Robert Karl Zahn
- Center for Musculoskeletal Surgery, Charité, University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Musculoskeletal Surgery, Charité, University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Lisa Renner
- Center for Musculoskeletal Surgery, Charité, University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité, University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Hagen Hommel
- Clinic for Orthopaedics, Sports Medicine, and Rehabilitation, KH-MOL GmBH, Sonnenburger Weg 3, 16269, Wriezen, Germany.,Academic Teaching Hospital of the Medical School of Brandenburg Theodor Fontane, Fehrbelliner Strase 38, 16816, Neuruppin, Germany
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Jenny JY, Dillmann G, Gisonni V, Favreau H. Noninvasive navigated assessment of the lower limb axis prior to knee arthroplasty: a feasibility study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:855-860. [PMID: 30631945 DOI: 10.1007/s00590-019-02380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
The purpose of the study was to assess accuracy and repeatability of a noninvasive navigated (NIN) measurement of the lower limb axes by comparison with the conventional, invasive navigated (IN) technique. The tested hypothesis was that NIN measure will significantly differ from IN measure when performed on a supine patient under general anesthesia just prior to knee arthroplasty. The accuracy study involved 20 cases. The following measures were performed with both systems: maximal extension angle, coronal mechanical femoro-tibial angle at the previously assessed maximal extension angle, coronal mechanical femoro-tibial angle at 30° of knee flexion. NIN and IN measures were compared with the appropriate statistical tests. The repeatability study involved 14 cases. The same measures were performed with the NIN system twice by two independent observers. The intra- and inter-observer variability was assessed by the calculation of the intra-class correlation coefficient. After correction for the systematic biases, the differences between the two systems were not significant. A good correlation, a good coherence and an excellent agreement between NIN and IN measures of maximal extension angle and coronal femoro-tibial mechanical angle at maximal extension. But measures at 30° of flexion were inconsistent. The NIN system can be considered as an accurate and precise tool for the assessment of the knee extension angle and the coronal deformation at maximal extension prior to knee arthroplasty. But this system is less accurate and less repeatable when measuring coronal femoro-tibial mechanical angle at 30° of flexion and should not be used for this purpose.
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Affiliation(s)
- Jean-Yves Jenny
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France. .,Université de Strasbourg, Strasbourg, France.
| | - Gauthier Dillmann
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
| | - Vincent Gisonni
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
| | - Henri Favreau
- Centre de Chirurgie Orthopédique et de la Main, Hôpitaux Universitaires de Strasbourg, 10 Avenue Baumann, 67400, Illkirch-Graffenstaden, France
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Parisi TJ, Levy DL, Dennis DA, Harscher CA, Kim RH, Jennings JM. Radiographic Changes in Nonoperative Contralateral Knee After Unilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:S116-S120. [PMID: 29548619 DOI: 10.1016/j.arth.2018.02.018] [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: 12/04/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Some patients perceive symptomatic improvement in the contralateral knee after unilateral total knee arthroplasty (TKA). This so-called "splinting effect" has been observed but has not been radiographically evaluated. METHODS A retrospective review of patients with bilateral knee osteoarthritis treated with unilateral TKA was performed. Patients were subcategorized into 2 groups based on whether contralateral TKA was performed within the 2-year period. Contralateral radiographic measurements were performed. RESULTS Forty-four of 203 patients had contralateral TKA performed within 2 years. Preoperative parameters were significantly worse in the bilateral group. By 6 weeks postoperatively, mechanical axis plumbline improved approximately 1°, with more change in those patients with preoperative varus alignment. Larger delta changes were also present in bilateral group preoperative to 1-year radiographs for tibiofemoral angle and joint space widening. CONCLUSION In patients with bilateral knee osteoarthritis who undergo unilateral TKA, a splinting effect may be present and measurable radiographically with improvement of contralateral mechanical axis plumbline. Further research is necessary to determine whether this improvement may delay contralateral TKA implantation.
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Affiliation(s)
| | - Daniel L Levy
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Mechanical and Materials Engineering, Denver University, Denver, CO; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO
| | - Cole A Harscher
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO
| | | | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Mechanical and Materials Engineering, Denver University, Denver, CO
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