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Wallace SJ, Greenstein MD, Fragomen AT, Reif TJ, Rozbruch SR. Staged Extra-Articular Deformity Correction in the Setting of Total Knee Arthroplasty. Arthroplast Today 2023; 24:101247. [PMID: 38023645 PMCID: PMC10663752 DOI: 10.1016/j.artd.2023.101247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/22/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Extra-articular lower-leg deformities mandate unique considerations when planning total knee arthroplasty (TKA). Poor limb alignment may increase perioperative complications and cause early implant failure. This study reports on the safety and efficacy of staged, extra-articular deformity correction about the knee in the setting of osteoarthritis and TKA. Methods A retrospective review was conducted from December 2007 to December 2019 identifying 30 deformities in 27 patients (average age: 52.7 years; range 31-74) who underwent staged surgical correction of extra-articular deformity in preparation for TKA. Patient demographics, surgical details, clinical and radiographic measurements, severity of knee arthritis, and complications were collected. Results There were 17 femur and 12 tibia deformities. There was an average improvement of 14.7° of deformity measured in the coronal plane and 12.7° of deformity in the sagittal plane in the femur and 13.5° in the coronal plane and 10.3° in the sagittal plane in the tibia. Leg length discrepancies improved by 26 mm on average (1-100 mm). After an average 3.1-year follow-up, 12 out of 27 patients proceeded with primary or revision TKA. There were no cases of blood transfusion, nerve palsy, or compartment syndrome, and all patients achieved bony union. Conclusions Staged, extra-articular deformity correction is a safe and effective approach to improve limb alignment in the setting of knee osteoarthritis and TKA.
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Affiliation(s)
- Stephen J. Wallace
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
- Summit Orthopaedics, Lake Oswego, OR, USA
| | - Michael D. Greenstein
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Austin T. Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Taylor J. Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
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Alturki AA, Alshammari NA, Albassam AL, Aljaafri ZA, Almugren TS. Robotic-assisted total knee arthroplasty for extra-articular femur deformity correction. J Surg Case Rep 2023; 2023:rjad395. [PMID: 37434720 PMCID: PMC10331803 DOI: 10.1093/jscr/rjad395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023] Open
Abstract
Femoral shaft fracture is one of the most common injuries encountered. However, improper management can lead to significant long-term complications, of which is malunion. Patients with femoral malunion are at increased risk of developing knee osteoarthritis, and if arthroplasty is indicated, these extra-articular deformities pose a challenge as corrective osteotomy and soft tissue release are also required. In such circumstances, robotic arm-assisted total knee arthroplasty (RATKA) might be an appropriate option. In this case, we present a 66-year-old woman who had previously suffered a femur shaft fracture, which was treated conservatively, and developed a varus malunion and severe knee osteoarthritis, and who was treated with RATKA.
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Affiliation(s)
- Abdullah A Alturki
- Department of Orthopedic Surgery, Ministry of the National Guard—Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nayf A Alshammari
- Department of Orthopedic Surgery, AlHabib Hospital, Riyadh, Saudi Arabia
| | - Abdulrahman L Albassam
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ziad A Aljaafri
- Correspondence address. College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Tel: +966 55 547 6999; E-mail:
| | - Turki S Almugren
- Department of Orthopedic Surgery, Ministry of the National Guard—Health Affairs, Riyadh, Saudi Arabia
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Ikuta K, Matsumoto T, Nakano N, Mukohara S, Hayashi S, Kuroda R. Total knee arthroplasty for severe valgus deformity of the knee with extra-articular deformities of the femur and tibia using a 3-dimensional image matching software system. Int J Surg Case Rep 2022; 103:107853. [PMID: 36701901 PMCID: PMC9883240 DOI: 10.1016/j.ijscr.2022.107853] [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: 10/01/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Knee osteoarthritis with femoral and/or tibial extra-articular deformities makes total knee arthroplasty (TKA) technically difficult to perform, especially using intramedullary-based instrumentation systems. The Athena Knee 3-dimensional (3-D) image matching software is effective for TKA with an extra-articular deformity, especially in case of using a long-stem prosthesis or not available computer-assisted navigation systems. CASE PRESENTATION A 79-year-old woman presented with right knee pain secondary to a progressive valgus deformity and gait disturbance. She had experienced a supracondylar femoral fracture fifteen years ago, and a tibial shaft fracture ten years ago on the same side; both of fractures were treated surgically. She had a severe valgus knee deformity and extra-articular deformity of femur and tibia, and valgus stress test detected medial knee instability. The range of motion was 0° in extension and 75° in flexion. Severe medial knee laxity compelled us to use a constrained and long-stem prosthesis, resulting in the use of an intramedullary guided system. The 3-D software system helped us to determine the amount of bone to cut as well as the appropriate entry points for the intramedullary rods and mechanical axis restoration. At two years after surgery, knee range of motion improved to 90° in flexion, and walking ability had also advanced from the use of two crutches to that of a T cane. CONCLUSION The 3-D image matching software system for preoperative planning was useful for TKA with extra-articular deformity, especially in the case of a long-stem prosthesis without using a navigation system.
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Affiliation(s)
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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Baek JH, Lee SC, Ryu S, Ahn HS, Nam CH. Coronal Correction for Post-Traumatic Malalignment Using Robot-Assisted Total Knee Arthroplasty: A Case Series. Orthop Res Rev 2022; 14:445-451. [DOI: 10.2147/orr.s387957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
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John R, Sherman K, Sharma H. Surgical principles for complex primary total knee arthroplasty in the presence of extra-articular deformity. J Orthop 2022; 34:295-303. [PMID: 36164287 PMCID: PMC9508380 DOI: 10.1016/j.jor.2022.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background Accurate restoration of alignment is vital to the success of a total knee arthroplasty (TKA) procedure. Deformities, whether these are intra-articular and/or extra-articular AND/OR whether these are uniplanar/multiplanar/complex, can impose varying technical challenges in surgical planning and execution. Literature on performing TKA in presence of limb deformity is limited, especially for extra-articular deformities. Objectives The objectives of this narrative review are twofold. Firstly, we analyse the existing English literature for studies focussed on TKA and deformity correction and summarise the important points about deformity pathomechanics, clinical and radiological assessment, pre-operative planning and surgical techniques. The second objective is to provide the readers with a simplistic and wholistic management algorithm to assist surgeons in meticulous planning to tackle the technical challenges imposed by lower limb deformities while performing a TKA. Discussion Approach to each patient must be holistic and customised on an individual basis according to patient characteristics, deformity characteristics and surgeon experience. The three main options available are: (1) Primary TKA (symmetric cuts/asymmetric cuts with/without computer navigation assistance) (2) Single stage corrective osteotomy and TKA and (3) Two-staged deformity correction and TKA. A multi-disciplinary team approach is required and a knee surgeon well-versed in revision arthroplasty and a limb reconstruction surgeon specialising in deformity correction, should be involved from the outset. The use of computer navigation technology, particularly for deformity correction and TKA, has increased over the last couple of decades and is recommended by the authors for these challenging cases.
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Affiliation(s)
- Rakesh John
- Department of Trauma & Orthopaedics, Hull University Teaching Hospital, Hull, East Yorkshire, UK
| | - Kevin Sherman
- University of Cambridge, Human Anatomy Centre, Department of Physiology, Development and Neuroscience, UK
| | - Hemant Sharma
- Department of Trauma & Orthopaedics, Hull University Teaching Hospital, Hull, East Yorkshire, UK
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Tibial reference point in total knee arthroplasty in patient with proximal tibia vara: A case report. Int J Surg Case Rep 2022; 93:106945. [PMID: 35305425 PMCID: PMC8933577 DOI: 10.1016/j.ijscr.2022.106945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/12/2022] [Accepted: 03/13/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Center of the intercondylar eminence at the proximal tibia had been widely used as a reference point for tibial bone cut in the Total Knee Arthroplasty (TKA) procedure. However, in the presence of preexisting tibia vara, the center of intercondylar eminence as tibial bone cut reference point often leads to varus malalignment after TKA procedure. Case report 75 years old male patient complained of worsening pain on the left knee. The patient has had a history of knee osteoarthritis for the past seven years. The radiograph on the right knee revealed osteoarthritis grade 3 and left knee osteoarthritis grade 4, both with tibia vara. We planned to perform total knee arthroplasty surgery on his left knee with a preoperative planning tibial reference point of 10 mm lateral to the center. Six months after the knee replacement, there was minimal pain on activity, and full ROM was achieved on his left knee. On the radiographic X-ray evaluation, the alignment between the tibial implant surface and mechanical axis is 0.43 degrees valgus. Clinical discussion In a varus knee malignment, the mechanical axis passes through one-third of the medial side of the knee, which makes the medial side of the implant wear off faster, resulting in the collapse of the medial tibia, thus decreasing implant survival and increasing the need for revision for TKA. Conclusion In patients with preexisting tibia vara, tibial bone cut reference point planning before TKA procedure is important to provide longevity of implant survival and better quality of life. Normal coronal alignment to the mechanical axis is important for long-term implant survival The correct alignment by bone cuts will restore the neutral mechanical axis of the femur and tibia in the coronal plane In tibia vara, the center of intercondylar eminence as a tibial bone reference often leads to varus malalignment after TKA The tibial bone cut reference should be calculated according to the degree of the tibia vara deformity In patient with tibia vara the tibial cut reference point is lateral to the center of intercondylar eminence
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Scholl LY, Hampp EL, de Souza KM, Chang TC, Deren M, Yenna ZC, Sodhi N, Mont MA, Westrich GH. How Does Robotic-Arm Assisted Technology Influence Total Knee Arthroplasty Implant Placement for Surgeons in Fellowship Training? J Knee Surg 2022; 35:198-203. [PMID: 32906160 DOI: 10.1055/s-0040-1716983] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Implant malalignment during total knee arthroplasty (TKA) may lead to suboptimal postoperative outcomes. Accuracy studies are typically performed with experienced surgeons; however, it is important to study less experienced surgeons when considering teaching hospitals where younger surgeons operate. Therefore, this study assessed whether robotic-arm assisted TKA (RATKA) allowed for more accurate and precise implant position to plan when compared with manual techniques when the surgery is performed by in-training orthopaedic surgical fellows. Two surgeons, currently in their fellowship training and having minimal RATKA experience, performed a total of six manual TKA (MTKA) and six RATKAs on paired cadaver knees. Computed tomography scans were obtained for each knee pre- and postoperatively. These scans were analyzed using a custom autosegmentation and autoregistration process to compare postoperative implant position with the preoperative planned position. Mean system errors and standard deviations were compared between RATKA and MTKA for the femoral component for sagittal, coronal, and axial planes and for the tibial component in the sagittal and coronal planes. A 2-Variance testing was performed using an α = 0.05. Although not statistically significant, RATKA was found to have greater accuracy and precision to plan than MTKA for: femoral axial plane (1.1° ± 1.1° vs. 1.6° ± 1.3°), coronal plane (0.9° ± 0.7° vs. 2.2° ± 1.0°), femoral sagittal plane (1.5° ± 1.3° vs. 3.1° ± 2.1°), tibial coronal plane (0.9° ± 0.5° vs. 1.9° ± 1.3°), and tibial sagittal plane (1.7° ± 2.6° vs. 4.7° ± 4.1°). There were no statistical differences between surgical groups or between the two surgeons performing the cases. With limited RATKA experience, fellows showed increased accuracy and precision to plan for femoral and tibial implant positions. Furthermore, these results were comparable to what has been reported for an experienced surgeon performing RATKA.
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Affiliation(s)
| | - Emily L Hampp
- Department of Orthopaedics, Stryker, Mahwah, New Jersey
| | | | - Ta-Cheng Chang
- Department of Orthopaedics, Stryker, Fort Lauderdale, Florida
| | - Matthew Deren
- Department of Orthopaedic Surgery, Cleveland Clinic Ringgold Standard Institution, Cleveland, Ohio
| | - Zachary C Yenna
- Department of Orthopaedic Surgery, Cleveland Clinic Ringgold Standard Institution, Cleveland, Ohio
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center Northwell Health, New York, New York
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Northwell Health, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Pietsch M, Hochegger M, Djahani O, Mlaker G, Eder-Halbedl M, Hofstädter T. Handheld computer-navigated constrained total knee arthroplasty for complex extra-articular deformities. Arch Orthop Trauma Surg 2021; 141:2245-2254. [PMID: 34255171 DOI: 10.1007/s00402-021-04053-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The present study aimed to assess the postoperative alignment and clinical outcomes of patients with complex extra-articular deformities (EADs) undergoing computer-assisted surgery (CAS) for constrained total knee arthroplasty (TKA) with modular stem extensions. MATERIALS AND METHODS From May 2015 to July 2018, ten patients with EADs scheduled for constrained TKA were enrolled retrospectively. The preoperative average deviation from neutral (= 180°) mechanical axis was 15.3° (range of coronal alignment: 150.9° varus-202.9° valgus). Alignment was assessed using an accelerometer-based handheld CAS system. On long-leg films, the positions of the components and possible stems were analysed and templated preoperatively. The average follow-up was 3.3 years (range: 2.0-4.6 years). RESULTS The postoperative mechanical axis was within ± 3.0° from neutral in nine patients. In all patients, the Knee Society score (KSS) and range of motion improved significantly. A constrained condylar and a rotating hinge prosthesis were used in five patients each. In eight patients, the 100-mm cementless stem that was preferred by the authors was found to be unusable for the femur or the tibia in the planning stage. For the femur, a cementless 100-mm stem was used in three, and a cemented 30-mm stem in five patients; a femoral stem was not usable in two patients. For the tibia, a cementless 100-mm stem was used in six, and a cemented 30-mm stem in two patients; a monoblock rotating hinge tibia was used in two patients. CONCLUSIONS Complex EADs were excellently managed during constrained TKA implantation using the handheld CAS system. Templating allowed the possible stem lengths to be identified and prevented anatomical conflict with the CAS-configured mechanical alignment. Limb alignment and function improved significantly after surgery. No intra- or postoperative complications occurred. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- M Pietsch
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria.
| | - M Hochegger
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - O Djahani
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - G Mlaker
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - M Eder-Halbedl
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - Th Hofstädter
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Vedoya SP, Viale G, Gessara A, Del Sel H. Congenital Fibular Deficiency: Total Knee Arthroplasty with Extraarticular Deformity: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00007. [PMID: 33798125 DOI: 10.2106/jbjs.cc.20.00590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A total knee arthroplasty (TKA) was performed on a 35-year-old man with congenital fibular deficiency and a 20° varus and 28° antecurvatum tibial deformity of the left lower limb. CONCLUSION One-stage TKA and correction of the extraarticular deformity by means of intraarticular bone resections and a standard soft tissue release were performed to restore the limb's mechanical axis. Patients with congenital fibular deficiency present a wide range of limb deformities because of bone deficiencies or treatment sequels, which might require a specific surgical technique and small-sized implants to obtain good results during a TKA.
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Grzelecki D, Szneider J, Marczak D, Kowalczewski J. Total knee arthroplasty with simultaneous tibial shaft osteotomy in patient with multiple hereditary osteochondromas and multiaxial limb deformity - a case report. BMC Musculoskelet Disord 2020; 21:233. [PMID: 32284061 PMCID: PMC7155326 DOI: 10.1186/s12891-020-03245-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hereditary multiple osteochondromas (hereditary multiple exostoses, HME) is a rare genetic disease characterized by the development of benign osteocartilaginous tumors that may cause severe limb deformities and early onset osteoarthritis. Total knee arthroplasty (TKA) is the method of choice for the treatment of advanced gonarthrosis, however the surgical management with coexisting severe axial limb deformity remains unclear. CASE PRESENTATION 65-year-old man with HME and extra-articular multi-axial limb deformity was admitted to the orthopedic department due to chronic knee pain and limited range of motion caused by secondary osteoarthritis. Regarding to the clinical and radiological examinations, after preoperative planning he was qualified to a one-stage TKA combined with tibial shaft osteotomy (TSO). In a one year follow-up full bone union was confirmed with no signs of implant loosening or prosthesis displacement. Patient was very satisfied, did not report any joint pain and has sufficient range of motion without knee instability. CONCLUSION The improvement of mechanical axis during TKA is a crucial factor for achieve operative success and long implant survival. Despite the higher risk of complication rate in comparison to two-stage treatment, one-stage TKA with simultaneous TSO should be a considerable method for patients with osteoarthritis and multiaxial limb deformities. This method can give a good clinical and functional outcomes, however should be performed subsequently to careful preoperative planning and proper patient qualification.
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Affiliation(s)
- Dariusz Grzelecki
- Department of Orthopaedics and Rheumoortopaedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| | - Jan Szneider
- Department of Traumatology and Orthopaedic Surgery, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| | - Dariusz Marczak
- Department of Orthopaedics and Rheumoortopaedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics and Rheumoortopaedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland
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Matassi F, Cozzi Lepri A, Innocenti M, Zanna L, Civinini R, Innocenti M. Total Knee Arthroplasty in Patients With Extra-Articular Deformity: Restoration of Mechanical Alignment Using Accelerometer-Based Navigation System. J Arthroplasty 2019; 34:676-681. [PMID: 30685259 DOI: 10.1016/j.arth.2018.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) in patients with post-traumatic extra-articular deformity (EAD) is difficult to manage using conventional instrumentation techniques. In this study, we evaluate whether accelerometer navigation system can be a valuable option to make accurate bone resections and restore the neutral mechanical axis in complex TKA patients with EAD. METHODS From May 2015 to June 2017, 18 consecutive TKA were performed in 18 patients with knee osteoarthritis with associated EAD. An accelerometer-based navigation system was used to guide tibial and femoral resection in the coronal and sagittal plane. Postoperative lower limb alignment in coronal plane and component position in coronal and sagittal plane was measured through full-leg weight-bearing X-ray. Clinical score were recorded using the Knee Society Score at the final follow-up. RESULTS The mean hip-knee-ankle angle was 0.9° ± 1.4° varus alignment. The coronal alignment of the femoral component was 89.2° ± 1.9°, and the coronal alignment of the tibial component was 89.4° ± 2.1°. The sagittal alignment of the femoral component was 93.2°± 1.9°, and the sagittal alignment of the tibial component was 84.4° ± 3.1°. At the final follow-up, the Knee Society Score was 89 points (range, 82-100), and the functional score was 86.7 points (range, 60-100). No intraoperative and postoperative surgical complications were reported using this technology. CONCLUSION Accelerometer-based navigation is accurate in achieving neutral mechanical alignment and optimal implant position after TKA in patients with EAD. This system should be considered a valuable option to the more complex technique of computer navigation or robotic surgery.
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Affiliation(s)
| | | | | | - Luigi Zanna
- University of Florence, Orthopaedic Clinic CTO, Florence, Italy
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Nogueira JBS, Carvalho ACGDS, Barros Filho EMD, Araújo LHDC, Bezerra MJC, Leite JAD. Planning a total knee arthroplasty through an application for mobile devices: case report. Rev Bras Ortop 2018; 53:792-796. [PMID: 30377618 PMCID: PMC6204531 DOI: 10.1016/j.rboe.2018.09.001] [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: 12/28/2016] [Accepted: 05/02/2017] [Indexed: 06/08/2023] Open
Abstract
For decades, the main cause of failure in total knee arthroplasty (TKA) is still the malalignment of prosthetic components. The authors present a case of advanced knee arthrosis, treated by TKA. Preoperative planning was performed with a mobile application and the patient was submitted to primary TKA using an implant developed with inspiration from the theory of "modified GAP" with a rotated tibial tray. Neutral mechanical alignment of the lower limbs was obtained and the application proved to be viable regarding its proposed plan for this case.
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Affiliation(s)
- João Bosco Sales Nogueira
- Departamento de Pós-graduação, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | | | | | | | - José Alberto Dias Leite
- Departamento de Pós-graduação, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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Planejamento de artroplastia total do joelho através de aplicativo para dispositivos móveis: relato de caso. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Paredes-Carnero X, Escobar J, Galdo J, Babé J. Total knee arthroplasty for treatment of osteoarthritis associated with extra-articular deformity. J Clin Orthop Trauma 2018; 9:125-132. [PMID: 29896014 PMCID: PMC5995007 DOI: 10.1016/j.jcot.2017.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy). METHODS Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity. Angulation of deformity in patients was 19° in coronal plane (range 15°-25°) and 12° in sagittal plane (range 8°-5°). Knee Score (KS) and Functional Score (FS) were measured pre and post-surgery, likewise arc flexion was reported. Results in KS and FS were correlationed with extra-articular angulation. RESULTS Duration of follow-up averaged 55 months (range, 48-63 months). KS Average and FS increased from 50.5 and 38.4 points, preoperatively, to 96.5 and 84.4 points, respectively, at time of following-up. No statistically significant differences in any postoperative parameters were found between the postoperative group of extra-articular deformities and the control group were found. Positive correlation was obtained between deformity degrees and KS. Arc of motion averaged 86° preoperatively and 118° at time of following-up. No total knee arthroplasty was revised. CONCLUSION In our opinion, best management for extra-articular deformities associated to osteoarthritis is to carry out a knee replacement without corrective osteotomy on condition that planification allow to us avoid ligaments insertions, using an extensive soft-tissue balancing in conjunction with a minimally constrained TKA.
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Affiliation(s)
- X. Paredes-Carnero
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Complexo Hospitalario Universitario de Ourense, Rúa Ramón Puga 52-54, Ourense cp 32005, Spain,Corresponding author.
| | - J. Escobar
- Unidad de Cirugía de Rodilla, Hospital Nuestra Señora de Fátima, Vigo, Pontevedra, Spain
| | - J.M. Galdo
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - J.G. Babé
- Unidad de Cirugía de Rodilla, Hospital Nuestra Señora de Fátima, Vigo, Pontevedra, Spain
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15
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Denjean S, Chatain F, Tayot O. One-stage computer-assisted total knee arthroplasty and tibial osteotomy. Orthop Traumatol Surg Res 2017; 103:381-386. [PMID: 28263806 DOI: 10.1016/j.otsr.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 02/02/2023]
Abstract
Same-stage tibial osteotomy may deserve consideration in candidates to total knee arthroplasty (TKA) who have severe bone deformities, particularly at extra-articular sites. This strategy obviates the need for either a major and technically difficult ligament release procedure, which may compromise ligament balancing, or the use of a semi-constrained prosthesis. This technical note describes a one-stage, computer-assisted technique consisting in TKA, followed by corrective tibial osteotomy to obtain an overall mechanical axis close to 180° without extensive ligament balancing. This technique provided satisfactory outcomes in 8 patients followed-up for at least 3years, with no specific complications or ligament instability and with a hip-knee-ankle angle close to 180°. After planning, intra-operative computer assistance ensures accurate determination of both implant position and the degree of correction achieved by the osteotomy.
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Affiliation(s)
- S Denjean
- Polyclinique du Val-de-Saône, 44, rue Ambroise-Paré, 71000 Macon, France
| | - F Chatain
- Clinique Belledonne, pôle santé Axone, 75, avenue G.-Péri, 38400 Saint-Martin-d'Hères, France.
| | - O Tayot
- Clinique du Parc, 155 Ter, boulevard Stalingrad, 69006 Lyon, France
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16
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Fletcher MD. Single Stage Tibial Osteotomy and Long Stem Total Knee Arthroplasty to Correct Adverse Consequences of Unequal Tibial Lengthening with an Ilizarov Circular Fixator. J Orthop Case Rep 2015; 5:9-11. [PMID: 27299056 PMCID: PMC4725311 DOI: 10.13107/jocr.2250-0685.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Correction of limb alignment or length discrepancy by circular external fixation is an accepted technique which relies on the correct biomechanical application of the frame and precise corrections which are frequently delegated to the patient to perform. Errors can occur in the execution of the correction by the patient and may result in significant deformity that requires remedial intervention. Case Report: A 67 Caucasian female underwent multifocal limb reconstruction of the lower limb utilising a complex Ilizarov frame. Attendance at follow-up visits did not occur and the patient presented at 6 months with severe deformity due to incorrect execution of the correction protocol which resulted in a 45 degree varus deformity of the tibia. Subsequent correction via acute tibial osteotomy and stabilisation with a stemmed total knee replacement resulted in a good outcome. Conclusion: Patient compliance with post-operative management is paramount with distraction osteogenesis and should be ensured prior to embarking on lengthening or deformity correction.
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Affiliation(s)
- M D Fletcher
- Department of Orthopaedic, Dawson Creek Hospital, Dawson Creek BC Canada
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17
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Elhence A, Jalan D, Rathore DS, Kumar MD, Chahar H. Comment on Madelaine et al.: Results and complications of single-stage total knee arthroplasty and high tibial osteotomy. INTERNATIONAL ORTHOPAEDICS 2014; 39:589. [PMID: 25532860 DOI: 10.1007/s00264-014-2624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Abhay Elhence
- Department of Orthopaedics, All India Institute of Medical Sciences, Basni Industrial Area Phase-2, Jodhpur, 342005, Rajasthan, India
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18
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Total knee arthroplasty in the valgus knee. INTERNATIONAL ORTHOPAEDICS 2013; 38:273-83. [PMID: 24366186 DOI: 10.1007/s00264-013-2227-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 11/24/2013] [Indexed: 12/20/2022]
Abstract
Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10% of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.
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Affiliation(s)
- Anil K Jain
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India,Address for correspondence: Dr. Anil K Jain, Prof. of Orthopaedics, Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi 110 095, India. E-mail:
| | - Sudhir Kumar
- Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India
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