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Hernández-Hermoso JA, Nescolarde L, Yañez-Siller F, Calle-García J, Garcia-Perdomo D, Pérez-Andres R. Combined femoral and tibial component total knee arthroplasty device rotation measurement is reliable and predicts clinical outcome. J Orthop Traumatol 2023; 24:40. [PMID: 37535276 PMCID: PMC10400495 DOI: 10.1186/s10195-023-00718-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The optimal total knee arthroplasty (TKA) rotational alignment and how best to obtain and measure it are debatable. The aim was to analyse the reliability of the Berger femoral, three different tibial and four different combined two-dimensional computer tomography (2D-CT) TKA component rotation measurements, and to ascertain which rotational values best predict a successful clinical outcome. METHODS The 2D-CT scans were obtained post-operatively on 60 patients who had TKA. We determined one femoral [Berger's femoral angle (BFA)], three tibial [Berger's tibial angle (BTA), anatomical tibial angle (ATA) and bimalleolar posterior tibial component angle (BM_PTCA)] and four combined [transepicondylar posterior tibial component angle (TE_PTCA), bicondylar posterior tibial component angle (BC_PTCA, transepicondylar bimalleolar angle (TE_BM) and bicondylar bimalleolar angle (BC_BM)] TKA rotation angles. We made all measures in 23 patients twice by three observers and determined inter- and intra-observer agreement using the Bland-Altman plot method. We analysed measures of 55 patients using the area under the ROC curve (AUC) analysis to ascertain the discriminative capacity of BFA, ATA, TE_PTCA and BC_PTCA for predicting a successful clinical outcome according to the Knee Society Score (KSS) threshold. RESULTS ATA showed the smaller inter- and intra-observer average of differences (-0.1° and 1.6°, respectively) of the studied methods followed by BFA (-0.9° and 1.4°), TE_PTCA (-2.1° and 2.7°) and BC_PTCA (-0.5° and 1.8°). BFA (-4° to 2.1° and -6.1° to 8.8°) and BC_PTCA (-4.4° to 3.4° and -7.9° to 4.4°) showed the narrower inter- and intra-observer limits of agreement. A TKA device rotation (BC_PTCA) < 0.8° of external rotation (ER) predicted a KSS and KSS knee successful outcome, and < 3.8° ER for KSS functional (AUC = 0.889; 0.907 and 0.764, respectively). BFA and ATA < 0.9° ER and < 3.9° internal rotation (IR) predicted a successful KSS knee outcome (AUC = 0.796 and 0.889, respectively). CONCLUSION The ATA tibial component rotation measurement was the most reliable of those studied. BFA, TE_PTCA and BC_PTCA were reliable measures for TKA femoral and combined rotation. The presence of a minimal rotation between the TKA components (BC_PTCA) and a small femoral ER or tibial IR predicted a successful KSS outcome. LEVEL OF EVIDENCE II
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Affiliation(s)
- José A Hernández-Hermoso
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain.
- Department of Surgery, Faculty of medicine, Universitat Autònoma de Barcelona, Campus UAB, 08913, Bellaterra, Spain.
| | - Lexa Nescolarde
- Biomedical Engineering, Department of Electronic Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Federico Yañez-Siller
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Juan Calle-García
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Damian Garcia-Perdomo
- Department of Radiology, Hospital, Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
| | - Ricard Pérez-Andres
- Department of Radiology, Hospital, Universitari Germans Trias i Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Campus UAB, 08913, Bellaterra, Spain
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Elkins J, Jennings JM, Johnson RM, Brady AC, Parisi TJ, Dennis DA. Component Rotation in Well-Functioning, Gap-Balanced Total Knee Arthroplasty without Navigation. J Arthroplasty 2023; 38:S204-S208. [PMID: 36963529 DOI: 10.1016/j.arth.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Malalignment of total knee arthroplasty (TKA) components is a potential cause of clinical failure following TKA. Since the goal of a gap-balancing (GB) technique is equal flexion and extension gaps secondary to soft-tissue balancing, and not necessarily component alignment, variation in component placement may exist. Our purpose was (1) to evaluate precision of component alignment in well-functioning GB TKAs performed without the aid of navigation using computed tomographic (CT) evaluation and (2) to determine any relationship between femoral version and/or tibial torsion and TKA component positioning. METHODS There were 93 well-functioning TKAs performed with an extension gap first GB technique with a minimum 2-year follow-up evaluated using CT to assess component rotational alignment, as well as osseous femoral version and tibial torsion. Femoral and tibial rotational alignment was assessed by previously described methods. RESULTS The mean Knee Society Score was 185.7 ± 21.7. Mean range of motion was 128.5 ± 7.8°. Femoral postero-condylar axis (relative to the transepicondylar axis) values ranged from -8.3 to 4.1° with a mean of -0.78 ± 2.7° (internal rotation). Mean tibial rotation was 17.2 ± 7.9° internal rotation relative to the tibial tubercle. No correlation was found between native femoral version and femoral component rotational alignment (Pearson's correlation coefficient, r, 0.007). Weak correlation was found between native tibial torsion and tibial component alignment (r = 0.24). CONCLUSIONS Despite being only a secondary objective with the GB technique, most components evaluated were within the desired range of rotation. Alignment was not influenced by native osseous rotational geometry.
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Affiliation(s)
| | - Jason Michael Jennings
- Colorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
| | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, CO, USA; Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA; Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA.
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Coronal and axial alignment relationship in Caucasian patients with osteoarthritis of the knee. Sci Rep 2021; 11:7836. [PMID: 33837279 PMCID: PMC8035173 DOI: 10.1038/s41598-021-87483-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/30/2021] [Indexed: 01/26/2023] Open
Abstract
Individualized pre-operative assessment of the patterns of the lower extremity anatomy and deformities in patients undergoing total knee arthroplasty seems essential for a successful surgery. In the present study, we investigated the relationship among the coronal alignment and the rotational profile of the lower extremities in the Caucasian population with end-stage knee osteoarthritis. We conducted a prospective study of 385 knees that underwent a pre-operative three-dimensional computed tomography-based model. The lower extremity alignment was determined (mechanical tibiofemoral or hip-knee-ankle angle, supplementary angle of the femoral lateral distal angle, and proximal medial tibial angle). For each case, the femoral distal rotation (condylar twist angle), the femoral proximal version, and the tibial torsion were determined. As the coronal alignment changed from varus to valgus, the femoral external rotation increased (r = 0.217; p < 0.0005). As the coronal alignment changed from varus to valgus, the external tibial torsion increased (r = 0.248; p < 0.0005). No correlation was found between the global coronal alignment and the femoral version. The present study demonstrates a linear relationship between the coronal alignment and the rotational geometry of the distal femur. This correlation also occurs with the tibial torsion. Perhaps outcomes of total knee arthroplasty surgery might be improved by addressing these deformities as well.
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Sun M, Yang L, He R, Chen G, Guo L, Duan X, Zhang Y, Sun J, Fan H. [Gait analysis after total knee arthroplasty assisted by three-dimensional printing navigation template]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:953-959. [PMID: 31407552 PMCID: PMC8337902 DOI: 10.7507/1002-1892.201902068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/19/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the gait trajectory characteristics of patients after total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing navigation template. METHODS Twenty female patients (20 knees) with knee osteoarthritis who were treated with TKA assisted by 3D printing navigation template between February 2017 and February 2018 were selected as the 3D printing group. The patients were 50-69 years old, with an average age of 57.2 years. The disease duration was 4-7 years, with an average of 5.6 years. The osteoarthritis was classified as Kellgren-Lawrence Ⅲ level in 5 cases and Ⅳ level in 15 cases. The preoperative hip-knee-ankle angle (HKA) was (170.8±5.6)°. All patients were varus deformity. According to age and affected side, 20 healthy female volunteers were selected as the control group. The volunteers were 51-70 years old, with an average age of 56.7 years. Preoperative HKA was (178.8±0.6)°. There was significant difference in HKA between the two groups ( P>0.05). The HKA, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analogue scale (VAS) scores of the 3D printing group before and after operation were compared. At 6 months after operation, the gait trajectory characteristics of 3D printing group and control group were analyzed by Vicon gait capture system. The kinematics parameters included velocity, cadence, stride length, maximum knee flexion angle (stance), minimum knee flexion angle (stance), maximum knee flexion angle (swing), mean hip rotation angle (stance), mean ankle rotation angle (stance). RESULTS The incisions of 3D printing group healed by first intention, with no complications. All patients were followed up 7-12 months (mean, 9.0 months). The WOMAC and VAS scores at 6 months after operation were significant lower than those before operation ( P<0.05). The HKA was (178.8±0.8)° at 4 weeks after operation and the difference was significant when compared with that before operation ( t=39.203, P=0.000). The position of the prosthesis was good. The femoral posterior condyle osteotomy line, surgical transepicondylar axis, and patella transverse line were parallel, varus deformity was corrected, and lower limb alignment was restored to neutral position. Gait analysis at 6 months after operation showed that the differences in all kinematics parameters between the two groups were significant ( P<0.05). CONCLUSION Assisted by 3D printing navigation template, TKA can alleviate pain symptoms and correct deformity, with satisfactory early effectiveness. Compared with healthy people, the early postoperative gait of the patients were characterized by decreasing velocity, cadence, stride length, knee flexion range, and increasing compensatory hip and ankle rotation range.
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Affiliation(s)
- Maolin Sun
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Liu Yang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038,
| | - Rui He
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Guangxing Chen
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Lin Guo
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Xiaojun Duan
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Ying Zhang
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Jiawei Sun
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
| | - Huaquan Fan
- Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China
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