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Yazdi H, Nazarian A, Wu JS, Amiri A, Hafezi P, Babikian M, Mohamadi A, Pakdaman R, Ghorbanhoseini M. Different References for Valgus Cut Angle in Total Knee Arthroplasty. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:289-293. [PMID: 30175176 PMCID: PMC6110428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The valgus cut angle (VCA) of the distal femur in Total Knee Arthroplasty (TKA) is measured preoperatively on three-joint alignment radiographs. The anatomical axis of the femur can be described as the anatomical axis of the full length of the femur or as the anatomical axis of the distal half of the femur, which may result in different angles in some cases. During TKA, the anatomical axis of the femur is determined by intramedullary femoral guides, which may follow the distal half or near full anatomical axis, based on the length of the femoral guide. The aim of this study was to compare using the anatomical axis of the full length of the femur versus the anatomical axis of the distal half of the femur for measuring VCA, in normal and varus aligned femurs. We hypothesized that the VCA would be different based upon these two definitions of the anatomical axis of the femur. METHODS Full-length weight bearing radiographs were used to determine three-joint alignment in normal aligned (Lateral Distal Femoral Angle; LDFA = 87º ± 2º) and varus aligned (LDFA >89º) femurs. Full-length anatomical axis-mechanical axis angle (angle 1) and distal half anatomical axis-mechanical axis angle (angle 2) were measured in all subjects by two independent orthopedic surgeons using a DICOM viewer software (PACS). Angles 1 and 2 were compared in normal and varus aligned subjects to determine whether there was a significant difference. RESULTS Ninety-seven consecutive subjects with normally aligned femurs and 97 consecutive subjects with varus aligned femurs were included in this study. In normally aligned femurs, the mean value of angle 1 was 5.05° ± 0.76° and for angle 2 was 3.62° ± 1.19°, which were statistically different (P= 0.0001). In varus aligned femurs, the mean value of angle 1 was 5.42° ± 0.85° and for angle 2 was 4.23° ± 1.27°, which were also statistically different (P= 0.0047). CONCLUSION The two different methods of outlining the anatomical axis of the femur lead to different results in both normal and varus-aligned femurs. This should be considered in determination of the valgus cut angle on pre-operative radiographs and be adjusted according to the length of the intramedullary guide.
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Affiliation(s)
- Hamidreza Yazdi
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Ara Nazarian
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Jim S Wu
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Arash Amiri
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Poopak Hafezi
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Margaret Babikian
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Amin Mohamadi
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Reza Pakdaman
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
| | - Mohammad Ghorbanhoseini
- Department of knee Surgery, Firoozgar Hospital, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA
- BIDMC, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Tufts Medical Center, General Surgery Department, Boston, MA, USA
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Yoo JH, Park SH, Han CD, Oh HC, Park JY, Choi SJ. Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty. Yonsei Med J 2016; 57:225-31. [PMID: 26632405 PMCID: PMC4696958 DOI: 10.3349/ymj.2016.57.1.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. MATERIALS AND METHODS The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5° varus (Group 1, 351 cases), 5° to less than 10° varus (Group 2, 189 cases), 10° to less than 15° varus (Group 3, 59 cases), and 15° varus or more (Group 4, 28 cases). RESULTS On average, the alignment of the tibial implant was 0.2±1.4°, 0.1±1.3°, 0.1±1.6°, and 0.3±1.7° varus, and the tibiofemoral alignment was 5.2±1.9degrees, 4.7±1.9°, 4.9±1.9°, and 5.1±2.0° valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0±3° varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p<0.0001). There was no difference in terms of tibiofemoral alignment, with 83.9%, 82.9%, 85.4%, and 86.7% of each group, respectively, showing 6±3° valgus angulation (p>0.05). CONCLUSION Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.
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Affiliation(s)
- Ju Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Sang Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea.
| | - Chang Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Jun Young Park
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Seung Jin Choi
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
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