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Kokubu Y, Kawahara S, Mizu‐Uchi H, Hamai S, Akasaki Y, Sato T, Ishibashi S, Konishi T, Nakashima Y. Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty. J Exp Orthop 2024; 11:e12069. [PMID: 38957227 PMCID: PMC11217670 DOI: 10.1002/jeo2.12069] [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: 04/19/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient-reported outcome measures (PROMs). Methods Seventy-one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole-leg and supine knee radiographs using a three-dimensional-to-two-dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hideki Mizu‐Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Toshiki Konishi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Zhang Z, Zhang T, Zhang L, Chen Z, Zhao H, Kuang J, Ou L. Comparison of the coverage and rotation of asymmetrical and symmetrical tibial components: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:336. [PMID: 38671454 PMCID: PMC11046884 DOI: 10.1186/s12891-024-07466-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND An optimized fit of the tibial component to the resection platform and correct rotational alignment are critical for successful total knee arthroplasty (TKA). However, there remains controversy regarding the superiority of symmetric tibial component versus asymmetric tibial component. The objective of this systematic review and meta-analysis was to evaluate the current evidence for comparing the coverage and rotation of asymmetrical and symmetrical tibial component. METHODS We searched potentially relevant studies form PubMed, Web of science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and China National Knowledge Infrastructure (CNKI), up to 1 March 2023. Data extraction and quality assessment were performed by two independent reviewers. Meta-analysis was conducted using Review Manager 5.4. RESULTS Sixteen articles were identified. Compared to symmetric tibial component, asymmetric tibial component increased the coverage of the proximal tibial cut surface (MD, -2.87; 95%CI, -3.45 to -2.28; P < 0.00001), improved the prevalence of tibial baseplate underhang (OR, 0.16; 95%CI, 0.07 to 0.33; P < 0.00001) and malrotation (OR, 0.13; 95%CI, 0.02 to 0.90; P = 0.04), and reduced the degree of tibial component rotation (MD, -3.11; 95%CI, -5.76 to -0.47; P = 0.02). But there was no statistical significance for improving tibial baseplate overhang (OR, 0.58; 95%CI, 0.08 to 3.97; P = 0.58). Additionally, no revision had occurred for the two tibial components in the included studies. CONCLUSION The current evidence shows asymmetric tibial component offer advantages in terms of coverage and rotation compared with symmetric tibial component in TKA.
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Affiliation(s)
- Ziming Zhang
- Hunan Academy of Chinese Medicine, 58 Lushan Street, Changsha, 410006, China
- Hunan University of Chinese Medicine, Changsha, China
| | - Tiantian Zhang
- Hunan Academy of Chinese Medicine, 58 Lushan Street, Changsha, 410006, China
| | - Le Zhang
- Hunan University of Chinese Medicine, Changsha, China
| | - Zehua Chen
- Department of Orthopedics, Orthopedics Hospital of Chinese Medicine Zhuzhou City, Zhuzhou, China
| | - Haoming Zhao
- Hunan University of Chinese Medicine, Changsha, China
| | - Jianjun Kuang
- Hunan Academy of Chinese Medicine, 58 Lushan Street, Changsha, 410006, China.
| | - Liang Ou
- Hunan Academy of Chinese Medicine, 58 Lushan Street, Changsha, 410006, China.
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Dossett HG, Deckey DG, Clarke HD, Spangehl MJ. Individualizing a Total Knee Arthroplasty with Three-Dimensional Planning. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00010. [PMID: 38478756 PMCID: PMC10923344 DOI: 10.5435/jaaosglobal-d-24-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 03/17/2024]
Abstract
Total knee arthroplasty (TKA) is evolving from mechanical alignment to more individualized alignment options in an attempt to improve patient satisfaction. Thirteen-year survival of kinematically aligned prostheses has recently been shown to be similar to mechanically aligned TKA, allaying concerns of long-term failure of this newer individualized technique. There is a complex inter-relationship of three-dimensional knee and limb alignment for a TKA. This article will review planning parameters necessary to individualize each knee, along with a discussion of how these parameters are related in three dimensions. Future use of computer software and machine learning has the potential to identify the ideal surgical plan for each patient. In the meantime, the material presented here can assist surgeons as newer individual alignment planning becomes a reality.
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Affiliation(s)
- Harold Gene Dossett
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - David G. Deckey
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - Henry D. Clarke
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - Mark J. Spangehl
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
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Zhang Q, Li Z, Chen Z, Peng Y, Jin Z, Qin L. Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning. Front Bioeng Biotechnol 2024; 11:1255625. [PMID: 38260731 PMCID: PMC10800660 DOI: 10.3389/fbioe.2023.1255625] [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: 07/09/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
The precise alignment of tibiofemoral components in total knee arthroplasty is a crucial factor in enhancing the longevity and functionality of the knee. However, it is a substantial challenge to quickly predict the biomechanical response to malrotation of tibiofemoral components after total knee arthroplasty using musculoskeletal multibody dynamics models. The objective of the present study was to conduct a comparative analysis between a deep learning method and four conventional machine learning methods for predicting knee biomechanics with different tibial component malrotation during a walking gait after total knee arthroplasty. First, the knee contact forces and kinematics with different tibial component malrotation in the range of ±5° in the three directions of anterior/posterior slope, internal/external rotation, and varus/valgus rotation during a walking gait after total knee arthroplasty were calculated based on the developed musculoskeletal multibody dynamics model. Subsequently, deep learning and four conventional machine learning methods were developed using the above 343 sets of biomechanical data as the dataset. Finally, the results predicted by the deep learning method were compared to the results predicted by four conventional machine learning methods. The findings indicated that the deep learning method was more accurate than four conventional machine learning methods in predicting knee contact forces and kinematics with different tibial component malrotation during a walking gait after total knee arthroplasty. The deep learning method developed in this study enabled quickly determine the biomechanical response with different tibial component malrotation during a walking gait after total knee arthroplasty. The proposed method offered surgeons and surgical robots the ability to establish a calibration safety zone, which was essential for achieving precise alignment in both preoperative surgical planning and intraoperative robotic-assisted surgical navigation.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhuhuan Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang’an University, Xi’an, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Manon J, Pletser V, Saint-Guillain M, Vanderdonckt J, Wain C, Jacobs J, Comein A, Drouet S, Meert J, Sanchez Casla IJ, Cartiaux O, Cornu O. An Easy-To-Use External Fixator for All Hostile Environments, from Space to War Medicine: Is It Meant for Everyone's Hands? J Clin Med 2023; 12:4764. [PMID: 37510879 PMCID: PMC10381442 DOI: 10.3390/jcm12144764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Long bone fractures in hostile environments pose unique challenges due to limited resources, restricted access to healthcare facilities, and absence of surgical expertise. While external fixation has shown promise, the availability of trained surgeons is limited, and the procedure may frighten unexperienced personnel. Therefore, an easy-to-use external fixator (EZExFix) that can be performed by nonsurgeon individuals could provide timely and life-saving treatment in hostile environments; however, its efficacy and accuracy remain to be demonstrated. This study tested the learning curve and surgical performance of nonsurgeon analog astronauts (n = 6) in managing tibial shaft fractures by the EZExFix during a simulated Mars inhabited mission, at the Mars Desert Research Station (Hanksville, UT, USA). The reduction was achievable in the different 3D axis, although rotational reductions were more challenging. Astronauts reached similar bone-to-bone contact compared to the surgical control, indicating potential for successful fracture healing. The learning curve was not significant within the limited timeframe of the study (N = 4 surgeries lasting <1 h), but the performance was similar to surgical control. The results of this study could have important implications for fracture treatment in challenging or hostile conditions on Earth, such as war or natural disaster zones, developing countries, or settings with limited resources.
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Affiliation(s)
- Julie Manon
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Morphology Lab (MORF), UCLouvain-IREC, 1200 Brussels, Belgium
- Neuromusculoskeletal Lab (NMSK), UCLouvain-IREC, 1200 Brussels, Belgium
- Orthopedic Surgery Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | | | | | - Jean Vanderdonckt
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
| | - Cyril Wain
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | - Jean Jacobs
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | - Audrey Comein
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | - Sirga Drouet
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | - Julien Meert
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | - Ignacio Jose Sanchez Casla
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Crew 227-Mission Analog Research Simulation (M.A.R.S. UCLouvain), Mars Desert Research Station (MDRS), Hanksville, UT 84734, USA
| | - Olivier Cartiaux
- Department of Health Engineering, ECAM Brussels Engineering School, Haute Ecole "ICHEC-ECAM-ISFSC", 1200 Brussels, Belgium
| | - Olivier Cornu
- Université Catholique de Louvain (UCLouvain), 1348 Louvain-la-Neuve, Belgium
- Neuromusculoskeletal Lab (NMSK), UCLouvain-IREC, 1200 Brussels, Belgium
- Orthopedic Surgery Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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Luan Y, Wang H, Fang C, Zhang M, Li J, Zhang N, Liu B, Su J, Cheng CK. Mechanical alignment tolerance of a cruciate-retaining knee prosthesis under gait loading—A finite element analysis. Front Bioeng Biotechnol 2023; 11:1148914. [PMID: 37064225 PMCID: PMC10098169 DOI: 10.3389/fbioe.2023.1148914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Component alignment is one of the most crucial factors affecting total knee arthroplasty’s clinical outcome and survival. This study aimed to investigate how coronal, sagittal, and transverse malalignment affects the mechanical behavior of the tibial insert and to determine a suitable alignment tolerance on the coronal, sagittal, and transverse planes. A finite element model of a cruciate-retaining knee prosthesis was assembled with different joint alignments (−10°, −7°, −5°, −3°, 0°, 3°, 5°, 7°, 10°) to assess the effect of malalignment under gait loading. The results showed that varus or valgus, extension, internal rotation, and excessive external rotation malalignments increased the maximum Von Mises stress and contact pressure on the tibial insert. The mechanical alignment tolerance of the studied prosthesis on the coronal, sagittal, and transverse planes was 3° varus to 3° valgus, 0°–10° flexion, and 0°–5° external rotation, respectively. This study suggests that each prosthesis should include a tolerance range for the joint alignment angle on the three planes, which may be used during surgical planning.
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Affiliation(s)
- Yichao Luan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
| | - Chaohua Fang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Department of Sport Medicine, Ningbo No 6 Hospital, Ningbo, China
| | - Min Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Junwei Li
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ningze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Bolun Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jian Su
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- *Correspondence: Cheng-Kung Cheng,
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Luan Y, Wang H, Zhang M, Li J, Zhang N, Liu B, Su J, Fang C, Cheng CK. Comparison of navigation systems for total knee arthroplasty: A systematic review and meta-analysis. Front Surg 2023; 10:1112147. [PMID: 36733891 PMCID: PMC9888247 DOI: 10.3389/fsurg.2023.1112147] [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: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
Background Component alignment is a crucial factor affecting the clinical outcome of total knee arthroplasty (TKA). Accelerometer-based navigation (ABN) systems were developed to improve the accuracy of alignment during surgery. This study aimed to compare differences in component alignment, clinical outcomes, and surgical duration when using conventional instrumentation (CONI), ABN, and computer navigation (CN) systems. Methods A comprehensive literature search was carried out using the Web of Science, Embase, PubMed, and Cochrane databases. Articles that met the eligibility criteria were included in the study. Meta-analyses were performed using the Cochrane Collaboration Review Manager based on Cochrane Review Method. The variables used for the analyses were postoperative clinical outcome (PCO), surgical duration, and component alignment, including the hip-knee-ankle (HKA) angle, coronal femoral angle (CFA), coronal tibial angle (CTA), sagittal femoral angle (SFA), sagittal tibial angle (STA), and the outliers for the mentioned angles. The mean difference (MD) was calculated to determine the difference between the surgical techniques for continuous variables and the odds ratio (OR) was used for the dichotomous outcomes. Results The meta-analysis of the CONI and ABN system included 18 studies involving 2,070 TKA procedures, while the comparison of the ABN and CN systems included 5 studies involving 478 TKA procedures. The results showed that the ABN system provided more accurate component alignment for HKA, CFA, CTA, and SFA and produced fewer outliers for HKA, CFA, CTA, and STA. However, while the ABN system also required a significantly longer surgical time than the CONI approach, there was no statistical difference in PCO for the two systems. For the ABN and CN systems, there was no statistical difference in all variables except for the ABN system having a significantly shorter surgical duration. Conclusion There was no significant difference in the accuracy of component alignment between the ABN and CN systems, but the ABN approach had a shorter surgical duration and at lower cost. The ABN system also significantly improved the accuracy of component alignment when compared to the CONI approach, although the surgery was longer. However, there was no significant difference in PCO between the CONI, ABN, and CN systems.
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Affiliation(s)
- Yichao Luan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Huizhi Wang
- Engineering Research Center of Digital Medicine, Ministry of Education; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Min Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Junwei Li
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ningze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Bolun Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jian Su
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chaohua Fang
- Engineering Research Center of Digital Medicine, Ministry of Education; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Department of Joint Surgery, Ningbo No.6 Hospital, Ningbo, China,Correspondence: Chaohua Fang Cheng-Kung Cheng
| | - Cheng-Kung Cheng
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China,Engineering Research Center of Digital Medicine, Ministry of Education; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Correspondence: Chaohua Fang Cheng-Kung Cheng
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Luan Y, Zhang M, Ran T, Wang H, Fang C, Nie M, Wang M, Cheng CK. Correlation between component alignment and short-term clinical outcomes after total knee arthroplasty. Front Surg 2022; 9:991476. [PMID: 36311927 PMCID: PMC9606652 DOI: 10.3389/fsurg.2022.991476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between component alignment and short-term clinical outcomes after total knee arthroplasty (TKA). METHODS 50 TKA patients from a regional hospital were enrolled in the study. The following component alignments were measured from radiological data acquired within 1 week after surgery: hip-knee-ankle angle (HKA), medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), femoral flexion-extension angle (FEA), tibial slope angle (TSA), femoral rotational angle (FRA) and tibial rotational angle (TRA). The Hospital for Special Surgery (HSS) knee scoring system was used to assess clinical outcomes after 1 year, with patients being divided into three groups (excellent, good and not good) according to the HSS scores. Difference analysis and linear correlation analysis were used for the statistical analysis. RESULTS The results showed significant differences in MDFA (p = 0.050) and FEA (p = 0.001) among the three patient groups. It was also found that the total HSS had only a moderate correlation with FEA (r = 0.572, p < 0.001), but FEA had a positive linear correlation with pain scores (r = 0.347, p = 0.013), function scores (r = 0.535, p = 0.000), ROM scores (r = 0.368, p = 0.009), muscle scores (r = 0.354, p = 0.012) and stability scores (r = 0.312, p = 0.028). A larger MDFA was associated with lower FE deformity scores (r = -0.289, p = 0.042) and the TSA had a positive influence on the ROM (r = 0.436, p = 0.002). Also, changes in FRA produced a consequent change in the FE deformity score (r = 0.312, p = 0.027), and the muscle strength scores increased as TRA increased (r = 0.402, p = 0.004). CONCLUSION The results show that the FEA plays a significant role in clinical outcomes after TKA. Surgical techniques and tools may need to be improved to accurately adjust the FEA to improve joint functionality and patient satisfaction.
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Affiliation(s)
- Yichao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tianfei Ran
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chaohua Fang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Department of Joint Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Maodan Nie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Min Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China,Correspondence: Min Wang Cheng-Kung Cheng
| | - Cheng-Kung Cheng
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Correspondence: Min Wang Cheng-Kung Cheng
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