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Strahovnik A, Strahovnik I, Fokter SK. Coronal Knee Alignment and Tibial Rotation in Total Knee Arthroplasty: A Prospective Cohort Study of Patients with End-Stage Osteoarthritis. Bioengineering (Basel) 2024; 11:296. [PMID: 38534570 DOI: 10.3390/bioengineering11030296] [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: 02/19/2024] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
Several studies have found a relationship between the rotational anatomy of the distal femur and the overall coronal lower limb alignment in knees with osteoarthritis (OA). Less is known about the rotation of the proximal tibia, especially in the context of total knee arthroplasty (TKA), where one of the goals of the surgery is to achieve the appropriate component-to-component rotation. The aim of this study was to investigate the relationship between the coronal alignment of the lower extremity and the relative proximal tibial rotation. A prospective cohort study of patients with an end-stage OA scheduled for TKA was conducted. All patients underwent a computed tomography (CT) scan and a standing X-ray of both lower limbs. A relative femorotibial rotation was measured separately for mechanical and kinematic alignment. A statistically significant correlation was found between the tibial varus and the external tibial rotation (p < 0.001). Out of 14 knees with high tibial varus (>5°), 13 (93%) and 7 (50%) knees had >10° of femorotibial rotation for the mechanical and kinematic alignment landmarks, respectively. In order to keep the component-to-component rotation within the 10° margin, more internal rotation of the tibial component is required in knees with higher tibial varus.
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Affiliation(s)
- Andrej Strahovnik
- Valdoltra Orthopeadic Hospital, Jadranska Cesta 31, 6280 Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Igor Strahovnik
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
| | - Samo Karel Fokter
- Faculty of Medicine, University of Ljubljana, Kongresni trg 12, 1000 Ljubljana, Slovenia
- Clinical Department of Orthopedic Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Slomškov trg 15, 2000 Maribor, Slovenia
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Tone S, Hasegawa M, Naito Y, Wakabayashi H, Sudo A. Association between pre- and postoperative rotational mismatches of the femorotibial components and bones in bi-cruciate retaining and posterior stabilized total knee arthroplasty. Sci Rep 2023; 13:14902. [PMID: 37689778 PMCID: PMC10492851 DOI: 10.1038/s41598-023-42243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Abstract
To clarify the association between pre- and postoperative rotational mismatches of the femorotibial components and bones for total knee arthroplasty (TKA) with bi-cruciate retaining (BCR) design and with fixed bearing posterior stabilized (PS) design. This retrospective cohort study included 40 BCR TKAs and 50 PS TKAs. Pre- and postoperative rotational mismatches of the femorotibial components and bones were measured by three-dimensional assessment based on computed tomography imaging. The mean value and percentage within ± 5° of pre- and postoperative rotational mismatches were compared between BCR TKA and PS TKA. Correlations between pre- and postoperative rotational mismatches of the femorotibial components and bones were investigated in BCR TKA and PS TKA. There was no significant difference in mean preoperative rotational mismatch of femorotibial components and bones between BCR TKA and PS TKA. Mean postoperative rotational mismatch of femorotibial components and bones was significantly greater in BCR TKA than in PS TKA. Postoperative rotational mismatch of the femorotibial components was within ± 5° in 21 knees (52.5%) for BCR TKA and in 43 knees (86.0%) for PS TKA. The rate of postoperative rotational mismatch of the femorotibial components and bones within ± 5° was significantly lower for BCR TKA than for PS TKA. In BCR TKA, there was a positive correlation between pre- and postoperative rotational mismatches of the femorotibial components and of bones. We consider these results can be attributed to the retention of both cruciate ligaments, which may affect the reduction of rotational permittance of the components and bones.
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Affiliation(s)
- Shine Tone
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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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.
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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
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Elkins J, Jennings JM, Johnson RM, Brady AC, Parisi TJ, Dennis DA. Component Rotation in Well-Functioning, Gap-Balanced Total Knee Arthroplasty without Navigation. J Arthroplasty 2023; 38:S204-S208. [PMID: 36963529 DOI: 10.1016/j.arth.2023.03.033] [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: 10/31/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Malalignment of total knee arthroplasty (TKA) components is a potential cause of clinical failure following TKA. Since the goal of a gap-balancing (GB) technique is equal flexion and extension gaps secondary to soft-tissue balancing, and not necessarily component alignment, variation in component placement may exist. Our purpose was (1) to evaluate precision of component alignment in well-functioning GB TKAs performed without the aid of navigation using computed tomographic (CT) evaluation and (2) to determine any relationship between femoral version and/or tibial torsion and TKA component positioning. METHODS There were 93 well-functioning TKAs performed with an extension gap first GB technique with a minimum 2-year follow-up evaluated using CT to assess component rotational alignment, as well as osseous femoral version and tibial torsion. Femoral and tibial rotational alignment was assessed by previously described methods. RESULTS The mean Knee Society Score was 185.7 ± 21.7. Mean range of motion was 128.5 ± 7.8°. Femoral postero-condylar axis (relative to the transepicondylar axis) values ranged from -8.3 to 4.1° with a mean of -0.78 ± 2.7° (internal rotation). Mean tibial rotation was 17.2 ± 7.9° internal rotation relative to the tibial tubercle. No correlation was found between native femoral version and femoral component rotational alignment (Pearson's correlation coefficient, r, 0.007). Weak correlation was found between native tibial torsion and tibial component alignment (r = 0.24). CONCLUSIONS Despite being only a secondary objective with the GB technique, most components evaluated were within the desired range of rotation. Alignment was not influenced by native osseous rotational geometry.
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Affiliation(s)
| | - Jason Michael Jennings
- Colorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
| | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA.
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Kiyohara M, Hamai S, Gondo H, Higaki H, Ikebe S, Okazaki K, Nakashima Y. Comparison of in vivo knee kinematics before and after bicruciate-stabilized total knee arthroplasty during squatting. BMC Musculoskelet Disord 2021; 22:772. [PMID: 34511113 PMCID: PMC8436441 DOI: 10.1186/s12891-021-04669-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background No studies have directly evaluated kinematic changes during squatting before and after bicruciate-stabilized total knee arthroplasty (BCS-TKA) with the dual cam-post mechanism and asymmetric surfaces. This study investigated the effect of BCS-TKA on changes to pre- and postoperative skeletal knee kinematics, to identify factors associated with postoperative skeletal kinematic parameters. Methods Seventeen knees in 17 patients were prospectively recruited before primary TKA for advanced medial knee osteoarthritis. Subjects underwent BCS-TKA and were evaluated more than 1 year postoperatively. In vivo dynamic skeletal knee kinematics were evaluated using periodic radiographic images collected during squatting to quantify the tibiofemoral functional extension/flexion angle, anteroposterior (AP) translation, and axial rotation angle using image-matching techniques. Rotational alignments of femoral and tibial components were measured postoperatively using computed tomography images. Results The pre- and postoperative tibiofemoral functional extension/flexion angles during squatting were 12.2° ± 6.7°/100.1° ± 16.8° and 9.6° ± 8.6°/109.4° ± 16.8°, respectively, with a significant difference in flexion angle (p < .05). Total AP translation was significantly larger postoperatively than preoperatively (10.8 mm ± 3.7 mm vs. 14.4 mm ± 4.2 mm, respectively; p < .05). The pre- and postoperative total rotation angles were 6.6° ± 3.0° and 6.4° ± 3.7°, respectively, indicating no significant difference. The pre- and postoperative tibiofemoral functional flexion angles were significantly associated with each other (p = .0434, r = .49). The postoperative total rotation angle was significantly smaller when the total component rotational mismatch angle between the femoral and tibial components was above 5° vs. below 5° (4.6° ± 2.7° vs. 8.3° ± 3.9°, respectively; p < .05). Conclusions BCS-TKA significantly increased the tibiofemoral functional flexion angles, with larger AP translation postoperatively. Both preoperative skeletal kinematics and surgical techniques affected the skeletal kinematics of the replaced knee. A total component rotational mismatch angle greater than 5° significantly decreased postoperative total knee rotation during squatting.
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Affiliation(s)
- Masato Kiyohara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hirotaka Gondo
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8503, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8503, Japan
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5- 20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 802-0985, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, 162-8666, Tokyo, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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