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Hörlesberger N, Zinggl C, Smolle MA, Leitner L, Lohberger B, Leithner A, Sadoghi P. Mechanically aligned total knee arthroplasty with the extension-first technique does not equally restore neutral knee alignment in all preoperative knee phenotypes. Knee Surg Sports Traumatol Arthrosc 2022; 31:1405-1411. [PMID: 36087129 PMCID: PMC10049937 DOI: 10.1007/s00167-022-07147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to determine the change in the long leg axis according to the preoperative knee phenotype using the mechanically aligned extension-first technique in total knee arthroplasty. The hypothesis of this study was that the knee phenotype would have an impact on the postoperative leg axis. METHODS This was a retrospective comparative study comprising 224 whole-leg radiographs of 112 patients. The leg axes of the pre- and postoperative radiographs were measured and categorized into three preoperative limb phenotypes (based on the hip-knee-ankle angle [HKA]) according to Hirschmann et al. (varus-HKA < 178.5°, neutral-HKA 178.5°-181.5°, and valgus-HKA > 181.5°). Additionally, femoral phenotypes (based on the femoral mechanical angle [FMA], i.e., the mechanical medial distal femoral angle [mMDFA], as well as the tibial phenotypes [based on the tibial mechanical angle, i.e., the medial proximal tibial angle (MPTA)] was calculated. The change in the long leg axis was analyzed and compared with the preoperative limb phenotype. RESULTS Significantly more patients with preoperative varus alignment shifted to neutral alignment (46.3%, n = 31) than did patients with preoperative valgus alignment (38.9%; n = 14). Moreover, 43.3% of patients (n = 29) with the varus phenotype remained in a varus alignment, compared with the 58.3% of patients with preoperative valgus phenotype (n = 21) remaining in valgus alignment. These findings were similar for both females (p < 0.001) and males (p = 0.015). CONCLUSION Using an extension-first mechanically aligned surgical technique, varus phenotypes predominantly result in neutral leg axes or remain varus, neutral phenotypes remain neutral, and valgus phenotypes remain valgus or change to neutral phenotypes. This study showed that preoperative knee phenotypes in valgus knees influence this technique more strongly than estimated in previous investigations, which is in line with modern alignment philosophies for TKA. LEVEL OF EVIDENCE Level IV, retrospective comparative study.
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Affiliation(s)
- Nina Hörlesberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Carina Zinggl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Deng T, Liu T, Lei Q, Cai L, Chen S. Patient-specific instrumentation combined with a new tool for gap balancing is useful in total knee replacement: a 3-year follow-up of a retrospective study. J Orthop Surg Res 2021; 16:309. [PMID: 33980282 PMCID: PMC8114523 DOI: 10.1186/s13018-021-02467-6] [Citation(s) in RCA: 3] [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: 12/06/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The purpose of this study was to determine whether the gap-balancing technique with patient-specific instrumentation (PSI) and a new balancing device in total knee arthroplasty (TKA) can improve knee function to a greater extent than can the measured resection technique. Materials and methods Data from 150 patients who underwent TKA from August 2014 to June 2016 were studied retrospectively. The gap-balancing technique assisted by PSI and the new balancing device was used in 80 patients (82 knees), and the measured resection technique was used in 70 patients (70 knees). The surgical, imaging, and knee function data were compared. Results The gap-balancing technique assisted by PSI and the new balancing device was found to be feasible in all operated knees and reliable. In total, 150 patients (152 knees) of ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up period ranged from 35 to 52 months (mean 45 months). Only one patient, who was included in the gap-balancing group, underwent a revision surgery at 2 years postoperatively due to infection. There were no differences in the incidence of anterior knee pain between the two groups. The mean flexion angle, KSS scores, and VAS scores did not significantly differ between the measured resection group and gap-balancing group at 12 weeks or 36 weeks postoperatively. The average joint line displacement was 1.3 ± 1.1 mm (range 0–3) proximally in the GB (gap-balancing) group and 1.2 ± 1.4 mm in the MR (measured-resection) group. No outliers >5 mm in either group were recorded. The mean leg axis deviation from the neutral mechanical axis was 1.8°±1.5° varus (range 0°–3°varus) versus the neutral mechanical axis in the GB group and 1.4°±1.2°(range 0°–3°)in the MR group. No outliers with >3° deviation in either group were recorded. Conclusions The gap-balancing technique performed with the new balancing device and PSI can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years. The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI.
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Affiliation(s)
- Ting Deng
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Tangyou Liu
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Qing Lei
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China.
| | - Lihong Cai
- Department of Radiology, The Third Hospital of Changsha, Changsha, China
| | - Song Chen
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
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Moewis P, Duda GN, Trepczynski A, Krahl L, Boese CK, Hommel H. Retention of Posterior Cruciate Ligament Alone May Not Achieve Physiological Knee Joint Kinematics After Total Knee Arthroplasty: A Retrospective Study. J Bone Joint Surg Am 2021; 103:146-154. [PMID: 33060427 DOI: 10.2106/jbjs.20.00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The apparently physiological kinematics of the bicruciate-stabilized total knee arthroplasty (BCS TKA) systems have been attributed to the anterior and posterior post-cam mechanism. Although comparisons between TKA designs with either a retained or a sacrificed cruciate ligament have been conducted, we are not aware of any analyses of 2 implants with identical bearing geometry but different cruciate-ligament strategies under equal loading conditions. Knowledge about the kinematic effect of the different cruciate ligament strategies would potentially be valuable to facilitate preoperative planning and decision-making with regard to selecting the most appropriate implant for a patient. METHODS This retrospective study included 20 patients: 10 treated with a BCS and 10 treated with a cruciate retaining (CR) TKA. Fluoroscopic analyses during high-flexion activities (unloaded flexion-extension and loaded lunge) were conducted at 24 months postsurgery. All patients completed the Knee Society Score, Forgotten Joint Score, and High-Flexion Knee Score questionnaires preoperatively and postoperatively. RESULTS The BCS cohort showed greater femoral lateral rollback as well as a medial pivot in both activities. In contrast, the CR cohort showed a significant increase in anterior translation on the medial compartment as well as almost absent femoral lateral rollback. Higher clinical scores were observed in the BCS cohort. CONCLUSIONS At 24 months postsurgery, despite equal bearing geometry, retention of the posterior cruciate ligament in the CR cohort apparently was insufficient to reduce anterior shift. The BCS cohort showed expected knee joint kinematics; however, the kinematics in this cohort could eventually benefit from a smooth transition between the interchanging surfaces. Further investigation should be focused on the surgical technique and its interaction with the TKA design. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Philippe Moewis
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leonie Krahl
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph K Boese
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.,Smith & Nephew GmbH, Hamburg, Germany
| | - Hagen Hommel
- Krankenhaus Märkisch-Oderland GmBH, Wriezen, Germany.,Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Neuruppin, Germany
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Pfitzner T, Moewis P, Stein P, Boeth H, Trepczynski A, von Roth P, Duda GN. Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation. Knee Surg Sports Traumatol Arthrosc 2018; 26:1645-1655. [PMID: 28656456 DOI: 10.1007/s00167-017-4622-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/19/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE As the aims of changes in total knee arthroplasty (TKA) designs are to reinstate more natural kinematics, the current study evaluated the in vivo kinematics in patients who underwent a cruciate retaining gradually changing femoral radius ("G-CURVE") against a cruciate retaining conventional changing femoral radius ("J-CURVE") geometry TKA design. The hypothesis of the study is that the G-CURVE design would allow a substantial increase in the femoral rollback compared to the J-CURVE design. METHODS Retrospective study design. Thirty patients were included (G-CURVE, n = 20; J-CURVE, n = 10). Single-plane fluoroscopic analysis and marker-based motion capture gait analysis was performed to analyse dynamic tibiofemoral motion during weight-bearing and unloaded activities at 24 month after index surgery. RESULTS The analysis of the medial and lateral points on the tibia plateau during the unloaded flexion-extension and the weight-bearing lunge activities revealed a significant difference in femoral rollback in G-CURVE TKA above 60° (p = 0.001) and 30° (p = 0.02) of knee flexion, respectively. Moreover, the lateral condyle of the G-CURVE showed a higher extent of femoral rollback while the lateral condyle of the J-CURVE rolled forward. CONCLUSION At 2 years post-operative, the G-CURVE TKA showed significant differences in femoro-tibial translation in comparison with the J-CURVE system, in vivo. The G-CURVE resulted in an increased lateral rollback and simultaneously in an elimination of the paradoxical medial roll-forward present in the J-CURVE design. Moreover, knee kinematics analysis showed significant differences between unloaded and weight-bearing conditions revealing the impact of load and muscle force. The analysis conducted in this study contributes to further understand the principal movement characteristics in widely used older designs in comparison with recently developed concepts to get a better overview on their potential benefits on in vivo kinematics. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tilman Pfitzner
- Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Moewis
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Patrick Stein
- Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heide Boeth
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp von Roth
- Center for Muskuloskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Salzmann M, Fennema P, Becker R, Hommel H. Does Postoperative Mechanical Axis Alignment Have an Effect on Clinical Outcome of Primary Total Knee Arthroplasty? A Retrospective Cohort Study. Open Orthop J 2017; 11:1330-1336. [PMID: 29290871 PMCID: PMC5721318 DOI: 10.2174/1874325001711011330] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/22/2022] Open
Abstract
Background: There is an ongoing debate whether patients with constitutional varus should be restored to neutral mechanical alignment following total knee arthroplasty (TKA). Objective: The aim of this retrospective cohort study is to determine whether mild unintentional postoperative varus alignment (3°–6°) influences TKA outcome in patients with and without preoperative varus alignment due to medial osteoarthritis of the knee. Methods: We analyzed 172 consecutive TKA cases between April 2011 and May 2014. Patients were divided into four groups based on their preoperative and postoperative hip-knee-ankle angles (HKA): preoperative varus ≤ 3° with postoperative varus position ≤ 3° (Group 1, n = 47); preoperative varus >3° with postoperative varus ≤ 3° (Group 2, n = 104); preoperative varus ≤ 3° with postoperative varus malalignment > 3° (Group 3, n = 3); and preoperative varus > 3° with postoperative varus malalignment > 3° (Group 4, n = 18). Patients were followed up until 2 years postoperatively. Results: Knee Society Score and Western Ontario and McMaster University Osteoarthritis Index scores for all study groups increased following TKA, with no postoperative differences at any time point. Group 4 performed significantly better on the Forgotten Joint Score than Group 2 (p = 0.019). Group 4 performed significantly better on the High Flexion Knee Score than Group 2 (p = 0.004) and Group 1 (p = 0.019). All other between-group differences were not statistically significant. Conclusion: Residual postoperative varus alignment of the lower limb does not appear to adversely affect clinical outcome following TKA for varus-type osteoarthritis.
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Affiliation(s)
- Mikhail Salzmann
- Hochschulklinikum der MHB Theodor Fontane, Städtisches Klinikum Brandenburg GmbH, Center of Orthopedics and Traumatology, Hochstraße 29, 14770 Brandenburg an der Havel, Germany
| | - Peter Fennema
- AMR Advanced Medical Research GmbH, Hofenstrasse 89b, 8708 Männedorf, Switzerland
| | - Roland Becker
- Hochschulklinikum der MHB Theodor Fontane, Städtisches Klinikum Brandenburg GmbH, Center of Orthopedics and Traumatology, Hochstraße 29, 14770 Brandenburg an der Havel, Germany
| | - Hagen Hommel
- KH-MOL GmBH Sonnenburger Weg 3, 16269 Wriezen, Germany.,Medizinische Hochschule Brandenburg (MHB), Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany
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Hommel H, Kunze D, Hommel P, Fennema P. Small Improvements in Postoperative Outcome with Gap Balancing Technique Compared with Measured Resection in Total Knee Arthroplasty. Open Orthop J 2017; 11:1236-1244. [PMID: 29290862 PMCID: PMC5721317 DOI: 10.2174/1874325001711011236] [Citation(s) in RCA: 7] [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: 10/10/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 01/26/2023] Open
Abstract
Background: There is ongoing debate about how to obtain correct rotational alignment in total knee arthroplasty (TKA). Two commonly used techniques are the measured resection (MR) and the gap balancing (GB) technique. Objective: The objective of the present study was to analyze which of these two techniques confers a clinical advantage up to 10 years postoperatively. Methods: Two hundred patients were randomized to either MR or GB. The primary outcome was the Knee Society Knee Score (KS) 10 years postoperatively. Secondary outcomes were passive range of motion, the Knee Society Function Score (FS), and the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), along with implant survival. We employed a two one-sided test (TOST) and linear mixed models to assess clinical outcomes. Results: Mean KS was 82 (95% confidence interval (CI), 80 – 83) and 77 (95% CI, 76 – 79) in the GB and MR group, respectively. The TOST test and linear mixed model both revealed statistical significance (p < 0.001). In addition, GB yielded better postoperative FS and WOMAC. However, between-group differences were consistently small. Implant survival rates at 10 years, with survival for any reason as the endpoint of interest, were 93.7% (95% CI, 86.4% and 97.1%) and 89.8% (95% CI, 81.9% - 94.4%) for the GB group and the MR group, respectively (p = 0.302). Conclusion: Gap-balancing is a safe and reliable technique. KS for the two study groups at 10 years can be considered equivalent, and the small postoperative advantages may not extend beyond clinical relevance.
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Affiliation(s)
- Hagen Hommel
- KH-MOL GmBH Sonnenburger Weg 3, 16269 Wriezen, Germany.,Medizinische Hochschule Brandenburg (MHB), Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany
| | - Daniel Kunze
- KH-MOL GmBH Sonnenburger Weg 3, 16269 Wriezen, Germany
| | - Peggy Hommel
- KH-MOL GmBH Sonnenburger Weg 3, 16269 Wriezen, Germany
| | - Peter Fennema
- AMR Advanced Medical Research GmbH, Hofenstrasse 89b, 8708 Männedorf, Switzerland
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Hommel H, Wilke K. Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series. Open Orthop J 2017; 11:51-56. [PMID: 28400873 PMCID: PMC5366378 DOI: 10.2174/1874325001711010051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer. Objective: The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. Material and Methods: This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available. Results: Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes. Conclusion: When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant.
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Affiliation(s)
- Hagen Hommel
- Krankenhaus Märkisch Oderland GmbH BT Wriezen, Klinik für Orthopädie, Sportmedizin und Rehabilitation, Wriezen, Germany
| | - Kai Wilke
- Krankenhaus Märkisch Oderland GmbH BT Wriezen, Klinik für Orthopädie, Sportmedizin und Rehabilitation, Wriezen, Germany
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Peersman G, Taeymans K, Jans C, Vuylsteke P, Fennema P, Heyse T. Malrotation deformities of the lower extremity and implications on total knee arthroplasty: a narrative review. Arch Orthop Trauma Surg 2016; 136:1491-1498. [PMID: 27531495 DOI: 10.1007/s00402-016-2554-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a successful procedure for the management of osteoarthritis (OA) of the knee. Axial plane deformities are more common than suspected in patients presenting with osteoarthritis of the knee joint. Recent research has indicated that torsional deformities could play an important role in the development of anterior knee pain (AKP). METHODS In a narrative review of the literature, the aetiology of maltorsion deformity of the lower extremity in both, childhood and adulthood, as well as the development of postoperative femoral axial plane deformities are examined. This includes the numerous surgical interventions that have been described for the treatment of maltorsion syndrome, and the role of patient-specific instrumentation. Finally, correcting for maltorsion deformity during and its potential implications for the current clinical care pathway, in terms of both pre- and perioperative practices is discussed. DISCUSSION AND CONCLUSION Axial plane alignment is considered the 'third dimension' in TKA. Correct axial alignment the lower extremity and of prosthetic components is deemed an important prerequisite for a postoperatively stable and painless knee. Identification of and, where appropriate, adjustment for any pre-existing maltorsion deformities is thought to significantly reduce the proportion of patients with residual complaints following TKA. Well-designed and well-conducted clinical studies are required to support our hypotheses.
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Affiliation(s)
- Geert Peersman
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
| | - Kim Taeymans
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Christophe Jans
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Philippe Vuylsteke
- Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium
| | - Peter Fennema
- AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
| | - Thomas Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, 35043, Marburg, Germany
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Kinematic femoral alignment with gap balancing and patient-specific instrumentation in total knee arthroplasty: a randomized clinical trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:683-688. [DOI: 10.1007/s00590-016-1865-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
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Hommel H, Perka C, Pfitzner T. Preliminary results of a new surgical technique in total knee arthroplasty (TKA) using the native ligament tension for femoral implant positioning in varus osteoarthritis. Arch Orthop Trauma Surg 2016; 136:991-7. [PMID: 27271756 DOI: 10.1007/s00402-016-2480-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Individual implant alignment in total knee arthroplasty (TKA) has seen growing interest over the past years. This study therefore aimed to develop a surgical technique for implant alignment based on native ligament tension, and to present the results obtained using this technique. METHODS 25 patients were included in this prospective study. Patient-specific instrumentation (PSI) was used for the resection of the extension gap. Ligament tension was measured after the removal of all accessible osteophytes. In the event of asymmetry, the distal femur resection was adjusted up to 2.5° using an adjustable cutting block. The aim was to achieve a symmetrical extension gap without release, not a neutral leg axis. Femoral rotation was aligned on the basis of ligament tension. Patients were followed up to 3 months postoperatively. RESULTS The postoperative whole-leg axis was 2.8° ± 1.6° varus. Patients achieved a flexion of 118° ± 9°, a Knee Score of 91.5 ± 3.2 and a Function Score of 86.8 ± 8.3 points. CONCLUSION For the first time, the new surgical technique described here permits a ligament tension based femoral implant alignment together with PSI. It was shown to be safe, with encouraging clinical and radiological results. LEVEL OF EVIDENCE Therapeutic study level IV.
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Affiliation(s)
- Hagen Hommel
- Clinic of Orthopaedics, Sports Medicine and Rehabilitation, Krankenhaus Märkisch-Oderland GmbH, BT Wriezen, Wriezen, Germany
| | - Carsten Perka
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Tilman Pfitzner
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Hommel H, Perka C. Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg 2015; 135:1603-8. [PMID: 26315332 DOI: 10.1007/s00402-015-2315-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Combining patient-specific instrumentation (PSI) with a balancer device in total knee arthroplasty (TKA) to achieve functional femoral rotational alignment is a novel technique. The primary goal of this study was to introduce a new method to combine PSI with a gap-balancing technique and to determine the impact of the technique on rotation of the femoral component. MATERIALS AND METHODS Twenty-five primary TKAs (15 women, 10 men) were prospectively studied. All TKAs involved PSI with an associated gap-balancing device. Front plane alignment was performed intraoperatively with the PSI, followed by rectangular, symmetrical extension and creation of a flexion gap using the balancer device to set the femoral rotation. RESULTS Femoral component rotation was between 3° internal and 6° external rotation versus the transepicondylar axis. There were no postoperative signs of patellofemoral dysfunction. In no cases was the resulting joint line displacement >3 mm. The mean elevation was 1.2 ± 0.9 mm (range 0-3). The leg axis was straight in all cases (±3°), at a mean of 1.6° ± 1.0° varus (range 0°-3° varus). CONCLUSIONS PSI was with the gap-balancing technique was successfully used without affecting anatomical alignment. With the balancer device, PSI can be used more widely than techniques based solely on landmarks, as the soft-tissue tension can be taken into account, thus virtually eliminating flexion instabilities.
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Affiliation(s)
- Hagen Hommel
- Orthopedic Department, Hospital Märkisch Oderland, Section Wriezen, Sonnenburger Weg 3, 16269, Wriezen, Germany.
| | - Carsten Perka
- Center for Musceloskeletal Surgery, Orthopedic Department, Charité Universitätsmedizin, Berlin, Germany
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Affiliation(s)
- Heiko Graichen
- Department for Arthroplasty, Orthopaedic Hospital Lindenlohe, 92421 Schwandorf, Germany
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Rudert M, Holzapfel BM, von Rottkay E, Holzapfel DE, Noeth U. Impaction bone grafting for the reconstruction of large bone defects in revision knee arthroplasty. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 27:35-46. [PMID: 25645323 DOI: 10.1007/s00064-014-0330-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/22/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Regeneration of autologous bone stock and formation of a stable implant bed by impaction of morselized bone allograft. INDICATIONS Bone loss after septic and aseptic loosening or tumour resection. CONTRAINDICATIONS Persistent infection, one-stage septic revision, poor therapeutic compliance, extensive uncontained metaphyseal defects with cortical thinning of the diaphysis. SURGICAL TECHNIQUE Whilst the surgeon removes the loose prosthesis, the assistant prepares the graft. The medullary canal is sealed with a cement restrictor. Graft particles of different sizes are densely impacted around a trial stem. The highest level of stability is achieved by using large particles interspersed with small filler particles. Low-viscosity cement facilitates cement penetration and ensures strong interdigitation with the impacted graft mass after implantation of the prosthesis. Uncontained metaphyseal defects are treated with prosthetic augments. POSTOPERATIVE MANAGEMENT Gait training, physiotherapy with isometric quadriceps exercises, partial weight-bearing for 6 weeks, resistance training begins 8 weeks postoperatively. RESULTS Between 2010 and 2012, 28 patients with large bone defects [Anderson Orthopaedic Research Institute (AORI) grade: 21 × F3, 3 × F2, 13 × T3, 8 × T2] underwent total knee revision with impaction bone grafting. The mean follow-up was 27.7 months (range 21-47 months). On average, patients had undergone 2.5 previous revisions. Implant survival was 82.0 % (95 % CI = 62.5 %-92.1 %) for any reason of revision as the endpoint and 93.1 % (95 % CI = 74.5-98.4 %) for aseptic revision as the endpoint. The mean postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 35.4 (range 3.3-101.6, SD ± 26.2). The mean KSS was 70.6 (range 20-100, SD ± 26.8).
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Affiliation(s)
- M Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97072, Wuerzburg, Germany,
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