1
|
Innocenti M, Secci G, Zanna L, Sani G, Stimolo D, Matassi F, Carulli C, Civinini R. Following the Anatomy of the Proximal Tibia With a Standard Anatomic Technique and the Use of an Asymmetrical Tibial Base Plate can Lead to a Mismatched Internal Components' Rotation in Mechanically Aligned Total Knee Arthroplasty. Arthroplast Today 2024; 28:101464. [PMID: 39100416 PMCID: PMC11295626 DOI: 10.1016/j.artd.2024.101464] [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: 11/11/2023] [Revised: 05/01/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Tibiofemoral components rotational congruency affects the total knee arthroplasty (TKA) success. The smart insert sensor (I-S) helps to establish tibial component rotation reciprocally to a fixed femoral rotation. We aimed (1) to validate the use of I-S as a possible tool to reach reproducible reciprocal femorotibial rotation (RftR) in TKA independently from anatomic landmarks, reducing outliers in combined and mismatched femorotibial rotation (CftR and MMftR, respectively) positioning and (2) to validate the "curve-on-curve" method for a specific type of asymmetrical tibial component. Methods From February 2018, we conducted a prospective case-control study including 106 patients undergoing TKA. Patients were divided into 2 groups based on the method used to establish tibial component rotation: with the I-S use (group A, n = 53) and with the standard "curve-on-curve" technique (group B, n = 53). Rotational alignment was calculated using the Berger protocol with postoperative computed tomography scanning. Alignment parameters measured were tibial and femoral component rotations (tR, fR), the CftR, the MMftR, and the RftR. Results Intraoperative rotation measured by I-S correlated the best with RftR (r = 0.84; P < .001) at the post-operative CT scanning. No significant differences were found between groups A and B regarding all types of rotation (fR: P = .774; tR: P = .467; CftR: P = .847) except for MMftR (P = .036) and RftR (P = .023). There were no outliers in group A but 27 and 12 outliers in group B for MMftR and CftR respectively (P < .001; P = .032). Conclusions The TKA components' rotation established using a smart I-S intraoperatively is ascribable to the RftR at postoperative computed tomography scan. The I-S helps reduce outliers in the CftR and MMftR. An asymmetrical tibial base plate implanted using the curve-on-curve technique does not create a neutral reciprocal femorotibial rotation significantly increasing the number of cases with mismatched femorotibial internal rotation.
Collapse
Affiliation(s)
| | - Gregorio Secci
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Luigi Zanna
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Giacomo Sani
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Davide Stimolo
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | | | | | | |
Collapse
|
2
|
Woelfle CA, Weiner TR, Sculco PK, Sarpong NO, Shah RP, Cooper HJ. Surgeon-Applied Stress and a Ligament Tensor Instrument Provide a Similar Assessment of Preresection Flexion Laxity During Robotic Total Knee Arthroplasty. Arthroplast Today 2024; 28:101450. [PMID: 39071093 PMCID: PMC11283011 DOI: 10.1016/j.artd.2024.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 06/03/2024] [Indexed: 07/30/2024] Open
Abstract
Background Robotic-assisted total knee arthroplasty (RA-TKA) allows surgeons to perform intraoperative soft tissue laxity assessments prior to bone resections and is used to alter resections to achieve gap balance. This study compared 2 techniques for flexion gap laxity assessment during RA-TKA. Methods A prospective study of 50 primary RA-TKAs performed by a single surgeon was conducted between February and October 2023. Following full exposure, anterior tibial dislocation, and osteophyte removal, maximal medial and lateral compartment flexion laxity was quantified to the nearest 0.5 mm by the robotic system using a dynamic, surgeon-applied stress (SURGEON). This data was used to plan a balanced flexion gap by adjusting the femoral component size, rotation, and anterior-posterior translation. Flexion laxity was quantified again after distal femoral and proximal tibial resections using a ligament tensor instrument (TENSOR). These new data were used to plan for the same desired flexion gap using the same variables. Paired-samples t-tests and a simple linear regression were used for analysis. Results Both methods produced near-identical recommendations for femoral component sizing (mean deviation 0.06 sizes, range -1 to +1 size; P = .569), rotation (deviation mean 1.0°, range -3.0° to +3.0°; P = .741), and anterior-posterior translation (deviation mean 0.13 mm, range -0.5 to +0.5 mm, P = .785). SURGEON femoral component rotation predicted TENSOR rotation (R2 = 0.157; 95% confidence interval = 0.124, 0.633; P = .004). Conclusions Assessing flexion laxity with a surgeon-applied stress vs a ligament tensor produced near-identical laxity data in RA-TKA, suggesting surgeons may comfortably choose either technique as a reliable method. Level of Evidence Level III.
Collapse
Affiliation(s)
- Catelyn A. Woelfle
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - Travis R. Weiner
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - Peter K. Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Nana O. Sarpong
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P. Shah
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - H. John Cooper
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
3
|
Basavaraj CM, Raju KP, Madhuchandra P, Dixith S. Computer-Assisted Surgery in Total Knee Arthroplasty: Our Experience. Indian J Orthop 2024; 58:503-509. [PMID: 38694697 PMCID: PMC11058145 DOI: 10.1007/s43465-024-01118-2] [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: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 05/04/2024]
Abstract
Background Total knee arthroplasty (TKA) is a reliable orthopedic procedure for knee osteoarthritis with long-term success rates of 90% after 15 years. Computer-assisted surgery (CAS) has been developed to improve the accuracy of the alignment and orientation of the components in TKA. Methods A prospective study involving 103 subjects who underwent CAS-TKA was conducted over a 3-year period. Subjects were assessed for pre- and post-operative varus and valgus deformity, BMI, comorbidities, and Knee Society Score (KSS). Outcome measures of post-operative KSS, post-operative alignment, and hospital stay were examined by Spearman correlation coefficients. Categorical outcomes of complication and secondary procedures were compared by chi-squared test and odds ratio. Results The study considered 103 TKA patients with a mean ± SD age of 63.7 ± 8.4 years (33-88 years). Unilateral knee replacement was performed on 56 patients (54.3%) and remaining 47 (45.6%) had simultaneous bilateral TKA. Forty (34.8%) patients were obese, and severe pre-operative deformity (> 15°) was observed in 47 (31.3%) patients. Mean coronal alignment of the knee joint was 91.33° (SD: 90.69° valgus-88.92° varus). The mean post-operative KSS noted in obese and non-obese subjects were 93.43 (84-98) and 94.76 (85-98) respectively. Post-operative KSS for knees with severe deformity was 94.08 (80-98), while it was 95.76 (83-98) in those with mild to moderate deformities. Conclusion The study confirms that navigation in CAS-TKA consistently achieved coronal alignment of the knee joint within ± 3°, irrespective of the patient BMI and degree of deformity.
Collapse
Affiliation(s)
- C. M. Basavaraj
- Department of Orthopaedics, BGS GLENAGLES Hospital, Bengaluru, India
| | - K. P. Raju
- Department of Orthopaedics, BGS Global Institute of Medical Sciences, Bengaluru, India
| | - P. Madhuchandra
- Department of Orthopaedics, BGS Global Institute of Medical Sciences, Bengaluru, India
| | - Sandeep Dixith
- Department of Orthopaedics, BGS GLENAGLES Hospital, Bengaluru, India
| |
Collapse
|
4
|
Laddha MS, Gowtam SV, Jain P. Accuracy of Femoral Component External Rotation with all Burr Robotic Assisted Total Knee Arthroplasty. Malays Orthop J 2024; 18:19-25. [PMID: 38638660 PMCID: PMC11023343 DOI: 10.5704/moj.2403.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/14/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction External rotation of femoral component is controversial in Total knee arthroplasty (TKA). The aim of our study is to assess the precision of femoral component external rotation in Robotic Assisted All Burr TKA. Materials and methods This is a prospective study of 30 cases who underwent All Burr Robotic Assisted TKA at our institute, RNH hospital. Inclusion criteria were primary and secondary osteoarthritis of the knee and exclusion criteria were revision and partial knee replacement. On Navio robotic system femoral external rotation was planned as per medio-lateral flexion gap balancing and executed with burr. Post-operative CT scan was done in all patients to assess intra-operative planned femoral external rotation. Results Out of 30 cases, 20 were female and 10 were male. Mean age was 66.06±7.43 years. On Navio the planned external rotation of femoral component was 2.86±1.16. Average of femoral component external rotation on postoperative CT scan was 3.11±1.16. The mean deviation of achieved femoral component external rotation from planned external rotation was -0.24 to ±0.28. Only 37% patients required 3° external rotation. Correlation between planned and achieved femoral component external rotation was significant, positive and very strong as indicated by r=0.97 and p=0.0001. Conclusion All Burr Robotic Assisted TKA provides near accurate femoral component external rotation as planned on Navio with deviation of less than 0.3° between planned and achieved external rotation.
Collapse
Affiliation(s)
- M S Laddha
- Department of Orthopaedics, RNH Hospital, Nagpur, India
| | - S V Gowtam
- Department of Arthroplasty and Arthroscocpy, RNH Hospital, Nagpur, India
| | - P Jain
- Department of Arthroplasty and Arthroscocpy, RNH Hospital, Nagpur, India
| |
Collapse
|
5
|
Ertan MB, Kose O, Tasatan E, Cakar A, Asoglu MM, Dikmen İ. Is the Akagi Line a Reliable Landmark for Adjusting the Rotational Axis of the Tibial Component in Patients with Patellofemoral Instability? Indian J Orthop 2023; 57:838-846. [PMID: 37214361 PMCID: PMC10192469 DOI: 10.1007/s43465-023-00868-9] [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: 05/19/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Purpose This study aimed to investigate whether the Akagi line is a reliable anatomic landmark for adjusting the rotational axis of the tibial component in patients with patellofemoral (PF) malalignment. Materials and methods This retrospective case-control study included 86 patients with PF instability and 129 controls. On the superimposed axial CT images, TT-TG, TT-PCL, nTT-TG, nTT-PCL, knee joint rotation, and the angle between the Akagi line and surgical transepicondylar axis (Akagi/sTEA angle) were measured. In addition, a modified Akagi line, drawn 1 cm medial to the patellar tendon attachment, was defined, and the angle between the new Akagi line and sTEA (mAkagi/sTEA angle) was also measured and compared between groups. Results There were 86 patients (47 females, 39 males) in the case group and 129 patients (56 females, 73 males) in the control group with a mean age of 35.7 ± 17.9 years and 41.1 ± 18.8 years, respectively (p < 0.001). Radiologic variables of PF alignment (TT-TG, TT-PCL, nTT-TG, nTT-PCL, and knee joint rotation) were significantly abnormal in the case group (p < 0.001 for all variables). The Akagi/sTEA angle was significantly higher in the case group, resulting in 89.5% external malrotation of the tibial component (> 10°). However, the tibial component was 96.5% aligned correctly (between 10° external and 3° internal rotation) in the control group. Using the modified Akagi line significantly improved the rotational alignment, and normal tibial rotation increased to 93.3% of the case group. The Akagi/sTEA angle strongly correlated with the knee rotation (rho: 0.735, p: 0.001), TT-TG (rho: 0.715, p: 0.001) and nTT-TG (rho: 0.783, p: 0.001). But the TT-PCL (rho: 0.459, p: 0.001) and nTT-PCL (rho: 0.589, p: 0.001) had a medium correlation. Conclusions The Akagi line might cause unacceptable external rotation of the tibial component in patients with PF malalignment. The use of the modified Akagi line described in this study may be a solution for the rotational mismatch between femoral and tibial components in TKA. Level of evidence Level III, retrospective case-control study.
Collapse
Affiliation(s)
- Mehmet Barıs Ertan
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Kazım Karabekir Cd, Muratpasa, 07100 Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Kazım Karabekir Cd, Muratpasa, 07100 Antalya, Turkey
| | - Ersin Tasatan
- Department of Orthopedics and Traumatology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Albert Cakar
- Department. of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Melih Asoglu
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Kazım Karabekir Cd, Muratpasa, 07100 Antalya, Turkey
| | - İsmail Dikmen
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Kazım Karabekir Cd, Muratpasa, 07100 Antalya, Turkey
| |
Collapse
|
6
|
Kreuzer S, Brar A, Campanelli V. Dimensional accuracy of TKA cut surfaces with an active robotic system. Comput Assist Surg (Abingdon) 2022; 27:41-49. [DOI: 10.1080/24699322.2022.2080116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
7
|
Dalyan S, Ozan F, Altun İ, Kahraman M, Günay AE, Özdemir K. The Influence of Component Rotational Malalignment on Early Clinical Outcomes in Total Knee Arthroplasty. Cureus 2022; 14:e22444. [PMID: 35345680 PMCID: PMC8942043 DOI: 10.7759/cureus.22444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
|
8
|
Clarke C, Pomeroy V, Clark A, Creelman G, Hancock N, Horton S, Killett A, Mann C, Payerne E, Toms A, Roberts G, Smith T, Swart AM, McNamara I. CAPAbility: comparison of the JOURNEY II Bi-Cruciate Stabilised and GENESIS II total knee arthroplasty in performance and functional ability: protocol of a randomised controlled trial. Trials 2020; 21:222. [PMID: 32093769 PMCID: PMC7041243 DOI: 10.1186/s13063-020-4143-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Osteoarthritis of the knee is a common condition that is expected to rise in the next two decades leading to an associated increase in total knee replacement (TKR) surgery. Although there is little debate regarding the safety and efficacy of modern TKR, up to 20% of patients report poor functional outcomes following surgery. This study will investigate the functional outcome of two TKRs; the JOURNEY II Bi-Cruciate Stabilised knee arthroplasty, a newer knee prosthesis designed to provide guided motion and improve knee kinematics by more closely approximating a normal knee, and the GENESIS II, a proven existing design. Aim To compare the change in Patient-reported Outcome Measures (PROMs) scores of the JOURNEY II BCS and the GENESIS II from pre-operation to 6 months post operation. Methods CAPAbility is a pragmatic, blinded, two-arm parallel, randomised controlled trial recruiting patients with primary osteoarthritis due to have unilateral TKR surgery across two UK hospitals. Eligible participants (n = 80) will be randomly allocated to receive either the JOURNEY II or the GENESIS II BCS knee prosthesis. Baseline measures will be taken prior to surgery. Patients will be followed at 1 week, 6 to 8 weeks and 6 months post-operatively. The primary outcome is the Oxford Knee Score (OKS) at 6 months post-operatively. Secondary outcomes include: other PROMs, biomechanical, radiological (computerised tomography, (CT)), clinical efficacy and safety outcomes. An embedded qualitative study will also investigate patients’ perspectives via interview pre and post surgery on variables known to affect the outcome of TKR surgery. A sub-sample (n = 30) will have additional in-depth interviews to explore the themes identified. The surgeons’ perspectives on the operation will be investigated by a group interview after all participants have undergone surgery. Discussion This trial will evaluate two generations of TKR using PROMS, kinematic and radiological analyses and qualitative outcomes from the patient perspective. Trial registration International Standard Randomised Controlled Trials Number Registration, ID: ISRCTN32315753. Registered on 12 December 2017.
Collapse
Affiliation(s)
- Celia Clarke
- School of Health Sciences, University of East Anglia, Norwich, UK.
| | - Valerie Pomeroy
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Nicola Hancock
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Simon Horton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Charles Mann
- Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Andoni Toms
- Norwich Medical School, University of East Anglia, Norwich, UK.,Norwich Radiology Academy, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Toby Smith
- School of Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ann Marie Swart
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Iain McNamara
- Norwich Medical School, University of East Anglia, Norwich, UK.,Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK
| |
Collapse
|
9
|
Twiggs JG, Dickison DM, Kolos EC, Wilcox CE, Roe JP, Fritsch BA, McMahon SJ, Miles BP, Ruys AJ. Patient Variation Limits Use of Fixed References for Femoral Rotation Component Alignment in Total Knee Arthroplasty. J Arthroplasty 2018; 33:67-74. [PMID: 28927560 DOI: 10.1016/j.arth.2017.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/24/2017] [Accepted: 08/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Optimal rotational alignment of the femoral component is a common goal during total knee arthroplasty. The posterior condylar axis (PCA) is thought to be the most reproducible reference in surgery, while the transepicondylar axis (TEA) seems to better approximate the native kinematic flexion axis. This study sought to determine if rules based on patient gender or coronal alignment could allow reliable reproduction of the TEA from the PCA. METHODS Three-dimensional models based on preoperative computed tomography were made representing a patient's arthritic knee joint. The landmarks were defined and angular relationships determined. RESULTS The population group of 726 patients contained large anatomic variation. When applying the standard reference rule of 3° external rotation from the PCA, 36.9% of patients would have a rotational target greater than ±2° from their TEA. When applying the mean external rotation of the TEA from the PCA (1.85°) from this population, this proportion dropped to 26.0% of patients. The use of statistically significant gender and coronal alignment relationships to define the femoral rotation did not reduce the proportion of patients in ±2° error. CONCLUSION This study shows that gender and coronal alignment relationships to the TEA to PCA angle are not clinically significant as a quarter of patients would still have a target for rotation greater than ±2° from the TEA using these relationships. Superior tools for orienting rotational cuts directly to the TEA in surgery or preoperative identification of relevant patient-specific angles might capture the proportion of patients for whom standard reference angles are not appropriate.
Collapse
Affiliation(s)
- Joshua G Twiggs
- Department of Biomedical Engineering, AMME, University of Sydney, Sydney, New South Wales, Australia; 360 Knee Systems Pty Ltd, Pymble, New South Wales, Australia
| | | | | | | | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia
| | - Brett A Fritsch
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia
| | | | - Brad P Miles
- 360 Knee Systems Pty Ltd, Pymble, New South Wales, Australia
| | - Andrew J Ruys
- Department of Biomedical Engineering, AMME, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|