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Singh D, Patel KC, Singh RD. Achieving coronal plane alignment in total knee arthroplasty through modified preoperative planning based on long-leg radiographs: a prospective study. J Exp Orthop 2021; 8:100. [PMID: 34729656 PMCID: PMC8563908 DOI: 10.1186/s40634-021-00418-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose This prospective study was undertaken to examine whether the desired coronal plane alignment of limb and prosthetic components in total knee arthroplasty (TKA) could be achieved precisely using conventional jig-based methods by modifying the preoperative planning of bone resection utilizing long-leg radiographs (LLRs). Methods The study included consecutive 245 TKA procedures. Pre- and postoperative radiological variables, i.e., the mechanical axis (hip-knee-ankle [HKA] axis), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA), and their outliers were evaluated. Statistical analysis was performed using SPSS version 21.0. Results The mean postoperative HKA axis, mLDFA and MPTA was 179.80 ± 1.81° (p < 0.01; 95% CI: 8.09–9.67), 90.35 ± 1.54° (p < 0.01; 95% CI: 1.33–2.02), and 90.26 ± 1.25° (p < 0.01; 95% CI: 4.41–5.20), respectively. The postoperative HKA axis on the coronal plane was 180 ± 3° in 235 knees (95.92%, 4.08% outliers). Femoral and tibial components were implanted in an acceptable position, withing 90 ± 3° of the mechanical axis of the femur and tibia on the coronal plane in 238 (97.14%, 2.86% outliers) and 243 (99.18%, 0.8% outliers) knees, respectively. Conclusion Modified preoperative planning for TKA on LLRs is a reliable and consistent method to achieve the desired limb and component alignment on the coronal plane without adding financial or logistical costs. Level of evidence II
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Affiliation(s)
- Daria Singh
- Zydus Hospitals, Ahmedabad, Gujarat, 380059, India.
| | | | - Ragini D Singh
- Zydus Hospitals, Ahmedabad, Gujarat, 380059, India.,Department of Biochemistry, All India Institute of Medical Sciences, Khanderi, Rajkot, Gujarat, India
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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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Shah SM, Sciberras NC, Allen DJ, Picard F. Technical and surgical causes of outliers after computer navigated total knee arthroplasty. J Orthop 2019; 18:171-176. [PMID: 32042221 DOI: 10.1016/j.jor.2019.10.016] [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: 08/10/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022] Open
Abstract
Background Navigated total knee arthroplasty (TKA) improves implant and limb alignment but outliers continue to exist. This study aimed to determine the technical and surgical causes of outliers. Methods This retrospective cohort study included 208 patients who had undergone navigated TKA. Limb and implant alignment indices were measured on post-operative CT scans: mechanical femoro-tibial angle (MFTA); coronal femoral angle (CFA); coronal tibial angle (CTA); sagittal femoral angle (SFA); and sagittal tibial angle (STA). Values outside 0°±3° for MFTA and SFA, 90°±3° for CFA, CTA and STA were considered outliers. Intra-operative navigation data and CT scans were evaluated to categorize the causes of sagittal and coronal plane outliers into hip centre error; ankle centre error; heterogeneous tibial cement mantle; malalignment accepted by surgeon; suboptimal knee balance; and no obvious explanation. Results Of the 1040 measurements (five per TKA), the overall incidence of outliers was 10.4% (n = 108). Femoral component outliers (CFA + SFA, n = 51) were all attributable to hip centre error. Tibial component outliers (CTA + STA, n = 43) were attributable to ankle centre error (n = 6), heterogeneous cement mantle (n = 20), malalignment accepted by the surgeon (n = 6) and no obvious cause (n = 11). MFTA outliers were attributable to hip centre error (n = 4) or suboptimal knee balance (n = 10). Conclusions Surgeon related errors can be minimized by a meticulous operative technique. These results indicate scope for additional technical improvement, especially in hip centre acquisition, which may further reduce the incidence of outliers.
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Affiliation(s)
- Siddharth M Shah
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Nadia C Sciberras
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - David J Allen
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Frederic Picard
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK.,Biomedical Engineering Department, Strathclyde University, Glasgow, UK
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Park JK, Seon JK, Cho KJ, Lee NH, Song EK. Is Immediate Postoperative Mechanical Axis Associated with the Revision Rate of Primary Total Knee Arthroplasty? A 10-Year Follow-up Study. Clin Orthop Surg 2018; 10:167-173. [PMID: 29854339 PMCID: PMC5964264 DOI: 10.4055/cios.2018.10.2.167] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background Achieving neutral limb alignment during total knee arthroplasty (TKA) has been considered an important determinant in the long-term prosthesis survival. The purpose of this study was to evaluate the association between the immediate postoperative mechanical alignment of the lower limb and the rate of revision TKA by comparing an acceptable mechanical axis group (within ± 3° from neutral alignment) and an outlier group (> 3° deviation from neutral alignment). Methods Between 2000 and 2006, clinical and radiographic data of 334 primary TKAs were retrospectively reviewed to determine the 10-year Kaplan-Meier survival rate. Patients were divided into acceptable and outlier groups according to the mechanical axis checked postoperatively within a month. Clinical outcomes were assessed using Hospital for Special Surgery, Knee Society Score, and Western Ontario and McMaster Universities Osteoarthritis Index score preoperatively and at the final follow-up. Postoperative complications and revision rates were also evaluated. Results The mean change in mechanical axis between the immediate postoperative examination and the last follow-up was greater in the outlier group (1.6 ± 2.7) than in the acceptable group (0.8 ± 2.4). The revision rates were significantly different between the two groups (p = 0.04). At the last follow-up, clinical scores were all improved in both groups compared to each preoperative condition. There were no significant differences in clinical scores between the two groups at the last follow-up. The 10-year Kaplan-Meier survival analysis showed a tendency towards better survival with restoration of neutral mechanical axis. However, the difference was not statistically significant (p = 0.25). Conclusions Restoration of neutral limb alignment is a factor that can result in a lower revision rate and higher longevity in TKA. However, there were no significant differences in clinical outcomes between the two groups.
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Affiliation(s)
- Ju-Kwon Park
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jong-Keun Seon
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyu-Jin Cho
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Nam-Hoon Lee
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Eun-Kyoo Song
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Sciberras NC, Almustafa M, Smith BRK, Allen DJ, Picard F, Deakin AH. A randomized controlled trial to compare component placement in navigated total knee arthroplasty using original and streamlined registration processes. Arthroplast Today 2017; 3:111-117. [PMID: 28695183 PMCID: PMC5484974 DOI: 10.1016/j.artd.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/14/2016] [Accepted: 07/20/2016] [Indexed: 01/26/2023] Open
Abstract
Background This randomized controlled trial validated a redesigned version of navigated total knee arthroplasty software with a streamlined registration (Smart) against the previous version (Classic). The objectives were to determine if Smart software had the same accuracy of component positioning and whether registration and operative time were reduced. Methods A total of 220 patients were recruited and had a navigated total knee arthroplasty performed. With the exception of the software, all patients had the same perioperative care. At 6-week follow-up with an independent arthroplasty service, all patients had a computerized tomography scan. This was assessed by an independent radiologist to measure the mechanical alignment of the components. Results The mean postoperative mechanical femorotibial angles were equivalent between groups (mean difference −0.2°, 95% confidence interval −0.7° to 0.3°, P = .407). Component positions were similar in both groups. Mean registration time was significantly shorter for the Smart group (2 minutes 30 seconds ± 54 seconds) than the Classic group (3 minutes 23 seconds ± 39 seconds), P < .001. The mean operative time was 72 ± 12 minutes in both groups (P = .855). At 6-week follow-up, both groups had similar clinical outcomes with 96.5% of patients being satisfied or very satisfied. Conclusions The study verified that a reduced registration time did not alter the accuracy of component placement. However, despite a shorter registration time, the overall surgical time was not reduced.
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Affiliation(s)
- Nadia C Sciberras
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland, UK
| | - Mohammed Almustafa
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland, UK
| | - Benjamin R K Smith
- Department of Radiology, Gartnavel General Hospital, Glasgow, Scotland, UK
| | - David J Allen
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland, UK
| | - Frederic Picard
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland, UK
| | - Angela H Deakin
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland, UK
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