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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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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: 2] [Impact Index Per Article: 2.0] [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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Jose RS, Kannan V. Functional and radiological outcome of total knee replacement in osteoarthritis with varus deformity. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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András G, Németh G, Oláh CZ, Lénárt G, Drén Z, Papp M. The personalized Berger method is usable to solve the problem of tibial rotation. J Exp Orthop 2021; 8:116. [PMID: 34897564 PMCID: PMC8665959 DOI: 10.1186/s40634-021-00432-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case. Methods Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks. The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated. Results A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°). Conclusion The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component. Level of evidence Level II, Diagnostic Study (Methodological Study).
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Affiliation(s)
- Gömöri András
- Department of Traumatology, Semmelweis University - Medicine and Health Sciences, Borsod-Abaúj-Zemplén County Hospital, Üllői út 26., Budapest, 1085, Hungary.
| | - Gábor Németh
- Department of Ophthalmology, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Csaba Zsolt Oláh
- Department of Neurosurgery, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Gábor Lénárt
- Department of Radiology, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Zsanett Drén
- Department of Radiology, Borsod-Abaúj-Zemplén County Hospital, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary
| | - Miklós Papp
- TritonLife Róbert Magánkórház, Department of Orthopaedics, Miskolci Egyetem, Egészségtudományi kar, Egyetemváros, Miskolc, 3515, Hungary
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Shin KH, Kim SB, Jang KM, Lee CS, Han SB. Posterior tibial slope is a modifiable predictor of relatively large extension gaps in total knee arthroplasty for degenerative osteoarthritis. J Orthop Surg (Hong Kong) 2021; 29:23094990211002004. [PMID: 33779412 DOI: 10.1177/23094990211002004] [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] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND During total knee arthroplasty (TKA) for osteoarthritis, the sagittal gap imbalance (SGI) with a relatively large extension gap is an important surgical challenge. We determined the predictors of SGI with a relatively large extension gap and evaluated the surgical outcomes of knees with SGI. METHODS 551 consecutive cases of primary TKA for osteoarthritis were retrospectively reviewed. The cohort was divided into two groups according to the SGI and statistically matched according to baseline characteristics via the inverse probability of treatment weighting method. Multiple linear and logistic regression analyses were performed to determine the predictors of sagittal gap difference (SGD) and SGI. Intergroup differences in clinical and radiological outcomes were analyzed. RESULTS Of all the knees included, 8.5% (n = 45) presented with SGI with a relatively large extension gap and required femoral sagittal balancing to manage SGI. The hyperextension angle (HA), preoperative joint line convergence angle (JLCA), and the change in posterior tibial slope (PTS) significantly correlated to SGD and predicted SGI with a relatively large extension gap. SGI group showed significant changes in femoral posterior condylar offset and joint line height compared to those without SGI (1.48 vs -0.45, 1.37 vs -0.51, respectively). Postoperative ROM and knee society knee scores were lower in SGI group. CONCLUSION Knees requiring sagittal balancing to manage SGI with a relatively large extension gap is not uncommon in TKA for osteoarthritic knees. The change in PTS is an independent and modifiable predictor of SGI.
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Affiliation(s)
- Kyun-Ho Shin
- Joint Center, 37997Inbone Hospital, Paju-si, Gyeonggi-do, South Korea
| | - Sang-Bum Kim
- Joint Center, 37997Inbone Hospital, Paju-si, Gyeonggi-do, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, 37997Korea University College of Medicine, Seoul, South Korea
| | - Chul-Soo Lee
- Department of Orthopaedic Surgery, Anam Hospital, 37997Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, 37997Korea University College of Medicine, Seoul, South Korea
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Robertson EL, Hengherr M, Amsler F, Hirschmann MT, Mathis DT. A comparison of femoral component rotation after total knee arthroplasty in Kanekasu radiographs, axial CT slices and 3D reconstructed images. Skeletal Radiol 2021; 50:1389-1397. [PMID: 33398456 PMCID: PMC8119264 DOI: 10.1007/s00256-020-03702-7] [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: 10/22/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the posterior condylar angle measured with Kanekasu radiograph and 2D-CT with the gold standard 3D-CT following primary total knee arthroplasty (TKA). METHODS Eighty-two knees with pain following TKA were included in this retrospective study. Two independent raters measured the anatomical and surgical posterior condylar angles twice on each Kanekasu radiograph and 2D-CT. These measurements were compared against the 3D-CT measurement. The intra- and interrater reliability of the Kanekasu radiograph and 2D-CT and the correlation with 3D-CT were calculated. RESULTS The intra- and interrater reliability for measurements of the anatomical posterior condyle angle for the Kanekasu radiograph and the 2D-CT were excellent for both raters (0.85-0.92). For the less experienced rater 1, the intrarater reliability was significantly better for 2D-CT than Kanekasu radiograph for measuring both the surgical (p < 0.01) and anatomical posterior condyle angles (p < 0.05). For the experienced rater 2, the intrarater reliability was significantly better for Kanekasu radiograph than 2D-CT for measurement of the surgical posterior condyle angle (p < 0.05). The correlation with 3D-CT is higher in 2D-CT than in Kanekasu radiograph (p < 0.01). While the Kanekasu radiograph predicts the 3D-CT angle with 65.9%, 2D-CT can measure the true angle with 82.9% certainty. CONCLUSION Measurements using the anatomical transepicondylar axis are easier to replicate compared to the surgical transepicondylar axis. In comparison with the gold standard 3D-CT, 2D-CT showed a significantly higher correlation with 3D-CT than the Kanekasu measurements. If 3D-CT is available, it should be preferred over 2D-CT and Kanekasu view radiograph for femoral component rotation measurements.
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Affiliation(s)
- Emma L. Robertson
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
| | - Martin Hengherr
- Department of Radiology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland
| | | | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
| | - Dominic T. Mathis
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland ,University of Basel, 4051 Basel, Switzerland
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Popescu R, Haritinian EG, Cristea S. Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement. INTERNATIONAL ORTHOPAEDICS 2019; 44:119-128. [PMID: 31655885 DOI: 10.1007/s00264-019-04424-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
AIM OF THE STUDY To identify the most reliable anatomical landmarks and imaging techniques for assessing the rotation of the tibial component in total knee arthroplasty (TKA). METHODS An extensive literature review (from January 2016 to March 2019) was performed. We included studies about primary TKA with details concerning the anatomical landmarks used for implanting the tibial component and also imaging studies assessing tibial component rotation. The final selection comprises only thirty-five articles consistent with the inclusion criteria. RESULTS Extra-articular landmarks are not always reliable (even though the tibial tubercle is one of the most popular extra-articular landmarks used to assess the rotation of the tibial component), mainly because they vary and can lead to malrotation of the tibial component. Akagi's line (an intra-articular landmark) is considered to be the most reliable and easy to find during surgery and likewise is not affected by articular deformities. The anterior tibial cortex (intra-articular landmark) also proved to be accurate and reliable with the main advantage being that is palpable after tibial resection. Radiography provides a good and inexpensive option for imaging, but it is insufficient. Magnetic resonance imaging (MRI) is used in some cases but not routinely for assessing TKA components or their orientation. Computed tomography (CT), used together with a well-defined protocol (Berger's method being the preferred choice), remains the "gold standard" for evaluating the rotation of the tibial component after TKA. CONCLUSION Currently, the most accurate and reliable anatomical landmarks are represented by Akagi's line and the anterior cortex of the tibia. Post-operatively, through CT and well-established protocols, the rotation of the tibial component can be accurately determined.
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Affiliation(s)
- Roman Popescu
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania
| | - Emil G Haritinian
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania. .,Clinical Hospital of Orthopedics and Traumatology and Osteoarticular TB "Foișor", Ferdinand Blvd, no. 35-37, District 2, 021382, Bucharest, Romania.
| | - Stefan Cristea
- Carol Davila University of Medicine and Pharmacy, Rectorate - Dionisie Lupu Street, no. 37, District 1, 020021, Bucharest, Romania. .,Department of Orthopaedics and Traumatology, Saint Pantelimon Emergency Hospital, Pantelimon Road, no. 340-342, District 2, 021659, Bucharest, Romania.
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Computed tomography evaluation of total knee arthroplasty implants position after two different surgical methods of implantation. INTERNATIONAL ORTHOPAEDICS 2018; 43:139-149. [DOI: 10.1007/s00264-018-4180-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
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Bizzozero P, Bulaid Y, Flecher X, Ollivier M, Parratte S, Argenson JN. Morphometric Tibial Implant Decreases Posterior Overhang Rate and Improves Clinical Outcomes: Results of a Prospective, Matched Controlled Study. J Arthroplasty 2018; 33:2804-2809. [PMID: 29748070 DOI: 10.1016/j.arth.2018.04.020] [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: 12/30/2017] [Revised: 03/04/2018] [Accepted: 04/08/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tibial implant's positioning in total knee arthroplasty (TKA) requires a compromise between implant's rotation and bone coverage. We hypothesized that morphometric tibial trays (MTTs) would improve implant positioning and clinical outcomes as compared with symmetrical tibial trays. METHODS Thirty-three patients were included prospectively according to the following criteria: age from 18 to 85 years, body mass index <35 kg/m2, and posterostabilized cemented TKA performed for primary arthritis. Patients were matched for age, gender, body mass index, and preoperative international knee society (IKS) scoring system and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score, in a 1:1 fashion with patients from a prospectively collected database receiving a symmetrical tibial tray TKA. Tibial implant's rotation, bone coverage, and the percentage of patients with a posterior overhang (PO) >3 mm were assessed using computerized tomography. The IKS and the KOOS were compared at 3-year follow-up. RESULTS Bone coverage (90% vs 88%, P = .07) and rotation (mean difference 0.7 ± 3°; P = .69) were not different between the 2 groups. The percentage of patient with a PO was lower in the morphologic group (2/33 vs 14/33, P = .01, odds ratio = 10.3 [2.12-50.24]). Functional scores were superior in the morphometric group: IKS (mean difference 20 ± 21 points; P = .0005), mainly due to a difference in the IKS pain subscore (mean difference 11 ± 15 points; P = .0002). According to the multivariate analysis, an MTT had a positive, independent effect on IKS pain (P = .006) and KOOS pain subscores (P = .03) at the last follow-up. CONCLUSION The use of an MTT in TKA did not modify the tibial implant position in the axial plane; however, it decreased implant's posterior overhang and improved functional scores. The clinical improvement was mainly found on pain scores.
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Affiliation(s)
- Paul Bizzozero
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Yassine Bulaid
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Xavier Flecher
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Sébastien Parratte
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
| | - Jean-Noel Argenson
- Department of Orthopaedic Surgery, APHM, Institut du mouvement et de l'appareil locomoteur, Sainte-Marguerite Hospital, Marseille, France; Aix-Marseille University, CNRS, ISM UMR 7287, Marseille, France
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Mochizuki T, Sato T, Tanifuji O, Watanabe S, Kobayashi K, Endo N. Extrinsic Factors as Component Positions to Bone and Intrinsic Factors Affecting Postoperative Rotational Limb Alignment in Total Knee Arthroplasty. J Arthroplasty 2018; 33:2100-2110. [PMID: 29506933 DOI: 10.1016/j.arth.2018.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/15/2018] [Accepted: 02/01/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study aimed to identify the factors affecting postoperative rotational limb alignment of the tibia relative to the femur. We hypothesized that not only component positions but also several intrinsic factors were associated with postoperative rotational limb alignment. METHODS This study included 99 knees (90 women and 9 men) with a mean age of 77 ± 6 years. A three-dimensional (3D) assessment system was applied under weight-bearing conditions to biplanar long-leg radiographs using 3D-to-2D image registration technique. The evaluation parameters were (1) component position; (2) preoperative and postoperative coronal, sagittal, and rotational limb alignment; (3) preoperative bony deformity, including femoral torsion, condylar twist angle, and tibial torsion; and (4) preoperative and postoperative range of motion (ROM). RESULTS In multiple linear regression analysis using a stepwise procedure, postoperative rotational limb alignment was associated with the following: (1) rotation of the component position (tibia: β = 0.371, P < .0001; femur: β = -0.327, P < .0001), (2) preoperative rotational limb alignment (β = 0.253, P = .001), (3) postoperative flexion angle (β = 0.195, P = .007), and (4) tibial torsion (β = 0.193, P = .010). CONCLUSION In addition to component positions, the intrinsic factors, such as preoperative rotational limb alignment, ROM, and tibial torsion, affected postoperative rotational limb alignment. On a premise of correct component positions, the intrinsic factors that can be controlled by surgeons should be taken care. In particular, ROM is necessary to be improved within the possible range to acquire better postoperative rotational limb alignment.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Osamu Tanifuji
- Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Koichi Kobayashi
- Department of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Naoto Endo
- Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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12
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Planckaert C, Larose G, Ranger P, Lacelle M, Fuentes A, Hagemeister N. Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 2018; 138:553-561. [PMID: 29322318 DOI: 10.1007/s00402-018-2873-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Up to 20% of total knee arthroplasty patients remain unsatisfied post-surgery, and a large proportion of them report anterior knee pain. This study aims to verify whether patients who experience anterior knee pain after total knee arthroplasty (TKA) will exhibit kinematic characteristics similar to those associated with patellofemoral syndrome, including in the frontal and transverse planes. MATERIALS AND METHODS Using four different assessment methods [radiological, patient-reported outcome, musculoskeletal assessment with functional performance testing, and a 3D kinematic assessment during gait], the clinical and 3D knee kinematic profiles of three groups were compared: a painful and an asymptomatic TKA group and a healthy control group. All three groups underwent a three-dimensional kinematic knee assessment while walking on a treadmill. Prosthetic component rotation was assessed through a CT scan measurement performed by one experienced radiologist. Flexion/extension, ab/adduction, and tibial internal rotation curves were compared, and significant differences were highlighted through ANCOVA analysis performed on SPSS. RESULTS A total of 62 knees were evaluated, 24 asymptomatic, 21 painful, and 17 control. A dynamic flexion contracture during gait was observed in the painful group, which was associated with a lack of flexibility of the thigh muscles. Moreover, painful TKA cases exhibited a valgus alignment (- 1.5°) during stance, which increases the Q angle and lateralizes the patella. Finally, CT scan evaluation of painful total knee arthroplasty patients revealed that their combined components rotation was in slight internal rotation (- 1.4°, SD 7.0°). CONCLUSIONS Painful TKA patients presented three well-known characteristics that tend to increase patellofemoral forces and that could be the cause of the unexplained pain: a stiff knee gait, a valgus alignment when walking, and combined TKA components slightly internally rotated.
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Affiliation(s)
- Célia Planckaert
- École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada.,Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Gabriel Larose
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.,Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Pierre Ranger
- Hôpital Jean-Talon, 1385 Rue Jean-Talon E, Montreal, QC, H2E 1S6, Canada.,Hôpital Sacré-Coeur, Canada, 5400 Boul Gouin O, Montreal, QC, H4J 1C5, Canada
| | - Marc Lacelle
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Alexandre Fuentes
- Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada
| | - Nicola Hagemeister
- École de technologie supérieure, 1100 Rue Notre-Dame Ouest, Montreal, QC, H3C 1K3, Canada. .,Laboratoire de recherche en imagerie et orthopédie (LIO), École de techonologie supérieure, Centre de recherche du CHUM, Tour Viger, 900 Rue Saint-Denis, Local R11.322, Montreal, QC, H2X 0A9, Canada.
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13
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Amanatullah DF, Ollivier MP, Pallante GD, Abdel MP, Clarke HD, Mabry TM, Taunton MJ. Reproducibility and Precision of CT Scans to Evaluate Tibial Component Rotation. J Arthroplasty 2017; 32:2552-2555. [PMID: 28434699 DOI: 10.1016/j.arth.2017.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Component rotation likely plays a greater role on the survivorship and outcomes of total knee arthroplasties than is currently known. Our goal was to evaluate the precision, interobserver reliability, and intrarater reliability of tibial component rotation as measured by computed tomography (CT) scan, regardless of measurement technique. METHODS Three fellowship-trained, academic arthroplasty surgeons independently measured tibial component rotation on CT scans of 62 total knee arthroplasties using their methods of choice. Measurements were repeated at least 2 weeks after the initial measurement. The precision of the measurements was assessed using a formal 8-step protocol as the gold standard. Intraclass correlation coefficients (ICCs) were calculated to evaluate precision, interobserver agreement, and intrarater reliability RESULTS: The interobserver agreement between the 3 surgeons for tibial component rotation was also moderate (ICC = 0.52). The intrarater reliability of tibial rotation was excellent (ICC = 0.81). Comparison of surgeons' measurement to a validated gold standard revealed only moderate precision for tibial component rotation (ICC = 0.64). CONCLUSION Practicing surgeons measuring tibial rotation were internally consistent, but failed to demonstrate satisfactory precision and interobserver agreement. We support the adoption of standardized criteria for the measurement of tibial component rotation on CT scans.
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Affiliation(s)
- Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, California; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Graham D Pallante
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Tad M Mabry
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
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14
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Nardi C, Buzzi R, Molteni R, Cossi C, Lorini C, Calistri L, Colagrande S. The role of cone beam CT in the study of symptomatic total knee arthroplasty (TKA): a 20 cases report. Br J Radiol 2017; 90:20160925. [PMID: 28467105 DOI: 10.1259/bjr.20160925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aims of this study were to evaluate the efficacy of cone beam CT (CBCT) in the study of the patellar tilt angle and rotational alignment of the femoral/tibial component after total knee arthroplasty and to estimate how metallic artefacts impaired detection of periprosthetic bone structures and bordering tendon-muscle structures. METHODS 20 symptomatic total knee arthroplasties were examined using CBCT by three independent observers. The patellar tilt angle and rotational alignment of femoral and tibial components were measured in relation to the femoral flange, transepicondylar axis and tibial tuberosity, respectively. A four-score scale, ranging from "many metallic artefacts" (the structure cannot be identified) to "no metallic artefacts" (the structure can be perfectly identified), was used to judge every structure. RESULTS The patellar tilt angle and rotational alignment of the prosthetic components showed very high intra- and interobserver agreements (intraclass correlation coefficient values 0.895-0.975 and 0.891-0.948, respectively). Bone and tendon-muscle structures cannot be identified in the distal part of the femoral component, whereas they can be well identified in the proximal part of the femoral component and in the proximal/middle third of the tibial stem. CONCLUSION CBCT was an effective tool, providing reproducible measurements of the patellar tilt angle and the rotational alignment of the femoral/tibial component. Furthermore, it allowed bone and tendon-muscle structures analysis with little impediments from metal artefacts. Advances in knowledge: CBCT allows easy and accurate measurements on the rotational axial plane, unburdened by image quality impairment due to metal artefacts.
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Affiliation(s)
- Cosimo Nardi
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Roberto Buzzi
- 2 Department of Surgery and Translation Medicine, University of Florence-Azienda Ospedaliero, Universitaria Careggi, Florence, Italy
| | | | | | - Chiara Lorini
- 5 Department of Health Science, University of Florence, Florence, Italy
| | - Linda Calistri
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Colagrande
- 1 Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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15
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Kim JI, Chun SH, Han HS, Lee S, Lee MC. Femoral component rotations in different gap tensions in total knee arthroplasty: A prospective randomized controlled trial. Knee 2017; 24:439-446. [PMID: 28185775 DOI: 10.1016/j.knee.2017.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total knee arthroplasty (TKA), femoral component rotation is an important factor in the flexion stability and biomechanics of the patellofemoral joint. However, it remains unclear how much tension is appropriate when performing TKA using the gap technique. METHODS One hundred fifty TKAs that used the gap technique were randomized into one of the three groups. Gravity group (n=50) included patients who underwent TKA using only the weight of the patient's lower leg. In 20-lbf group (n=50) and 30-lbf group (n=50), a gap-tensioning device was set at 20lbf and 30lbf respectively. The femoral component rotation was measured based on the clinical transepicondylar axis (cTEA) on postoperative CT and any outliers (a femoral component rotation diverging from the cTEA over 3°) were evaluated. RESULTS The mean femoral component rotation was -0.82°±2.44° (95% confidence interval [CI], -1.52° to -0.13°) in gravity group, -0.40°±2.22° (95% CI, -1.03° to 0.23°) in 20-lbf group, and 1.37°±2.70° (95% CI, 0.61° to 2.14°) in 30-lbf group. The mean femoral component rotation in 30-lbf group was significantly different from that in gravity group (p<0.001) and 20-lbf group (p<0.001). There were more outliers in 30-lbf group (18% in gravity group, 18% in 20-lbf group, and 36% in 30-lbf group; p=0.043). CONCLUSIONS The use of a tensioning device set at 30lbf resulted in an externally rotated femoral component and frequent outliers.
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Affiliation(s)
- Joong Il Kim
- Department of Orthopaedic Surgery, CM Hospital, 13 Yeongdeungpo-ro 36-gil, Yeongdeungpo-gu, Seoul, 07031, Republic of Korea.
| | - Sae Hyung Chun
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Hyuk Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
| | - Sahnghoon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
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16
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De Valk EJ, Noorduyn JCA, Mutsaerts ELAR. How to assess femoral and tibial component rotation after total knee arthroplasty with computed tomography: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:3517-3528. [PMID: 27655141 DOI: 10.1007/s00167-016-4325-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/07/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE One of the most important factors leading to revision of total knee arthroplasties (TKA) is malrotation of femoral and/or tibial component. Rotation measurements performed on radiographs are limited and less reliable compared to 2D computed tomography (CT). Nowadays, 2D-CT and 3D-CT can be distinguished in measuring rotation of the TKA components. The aim of this systematic review is to determine the most reliable CT techniques in measuring rotation of the TKA components and to investigate possible cut-off points that can be used in the clinician's decision for a possible revision of the TKA. METHODS A search of PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science was performed up to April 2015. Final selections of 12 articles were used in this systematic review. RESULTS 3D-CT, compared to 2D-CT, is more reliable and shows a high level of intra- and interobserver reliability. Femoral component rotation is measured using the component's posterior condylar line or inner pegs in relation to the epicondylar axis. Five different techniques were used to measure tibial component rotation. The posterior border of the tibial component in relationship to the geometric centre and tibial tubercle was most frequently used. CONCLUSION This systematic review shows a strong preference for 3D-CT to determine the component's rotation following a TKA. The literature shows consensus on the reference points of the femoral component. In measurements of the tibial component, various techniques are used with similar results. No clear cut-off point for revision of malrotated TKA components can be stated because of limited evidence. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Eduard J De Valk
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
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17
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Everhart JS, Flanigan DC, Chaudhari AMW, Siston RA. Tibiofemoral joint subchondral surface conformity: Individual variability with race and sex-specific trends. Knee 2016; 23:770-6. [PMID: 27288067 DOI: 10.1016/j.knee.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/05/2016] [Accepted: 05/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral and tibial subchondral surface morphology has been extensively studied to aid in anatomically correct total knee arthroplasty (TKA) implant design. Emphasis has been placed on shape variations in individual bones, and person-to-person variability in joint conformity has been overlooked. The purpose of this study is to 1) determine individual variability in key measures of tibiofemoral joint conformity, and 2) determine whether variability differs by sex or race. METHODS Laser-scanner-generated surface models of tibiofemoral joints were obtained from 165 archival skeletons (at death: age 28.8±7.6years; 85 African-American, 80 Caucasian, 86 men, 79 women). Ratios and correlations were determined among related femoral and tibial subchondral surface areas (SA), alignment, curvatures, and linear dimensions between opposing surfaces with stratification by race and sex. RESULTS Anterior-posterior length (R=0.80, p<0.001) and medial-lateral width (R=0.93, p<0.001) were the only linear measures that were highly correlated between the femur and tibia. Tibial and femoral surface areas were correlated among Caucasian men only (R=0.58, p<0.001; R<0.20), with a wide range of surface area ratios regardless of sex or race (SA ratio total sample: 2.32±0.39, range 1.36 to 3.62). CONCLUSIONS There is high individual variability in tibiofemoral joint conformity at the subchondral surface, and for some measures this variability is sex-or-race specific. Key measures of joint conformity including surface area, curvature, width, and depth covary weakly or not at all, and a wide range of TKA component sizes and shapes would be required to accurately replicate native joint conformity in most people.
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Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
| | - Ajit M W Chaudhari
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States; Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, United States
| | - Robert A Siston
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States; Department of Mechanical and Aerospace Engineering, The Ohio State University, United States
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18
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Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate the potential of MRI to determine rotational alignment after TKA in comparison to the gold standard, CT. METHODS Rotational alignment was measured in the transverse plane on CT and MR-images in 14 patients prior to TKA revision. Differences between CT and MRI measurements were analysed. RESULTS There was a strong correlation between CT and MRI measurements for both the tibial (r = 0.929) and femoral (r = 0.942) components with a mean difference of 0.47 ± 1.3 and 0.13 ± 3.2 degrees, respectively. INTERPRETATION Despite artefact formation, it can be concluded that the rotational alignment of metallic TKA components can be measured by MRI as accurately as by CT.
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19
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Figueroa J, Guarachi JP, Matas J, Arnander M, Orrego M. Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation? INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2917-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Nakamura S, Ito H, Yoshitomi H, Kuriyama S, Komistek RD, Matsuda S. Analysis of the Flexion Gap on In Vivo Knee Kinematics Using Fluoroscopy. J Arthroplasty 2015; 30:1237-42. [PMID: 25680453 DOI: 10.1016/j.arth.2015.01.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/16/2015] [Accepted: 01/29/2015] [Indexed: 02/01/2023] Open
Abstract
There is a paucity of information on the relationships between postoperative knee laxity and in vivo knee kinematics. The correlations were analyzed in 22 knees with axial radiographs and fluoroscopy based 3D model fitting approach after a tri-condylar total knee arthroplasty. During deep knee bend activities, the medial flexion gap had significant correlations with the medial contact point (r=0.529, P=0.011) and axial rotation at full extension. During kneeling activities, a greater medial flexion gap caused larger anterior translation at complete contact (r=0.568, P=0.011). Meanwhile, the lateral flexion gap had less effect. In conclusion, laxity of the medial collateral ligament should be avoided because the magnitude of medial flexion stability was crucial for postoperative knee kinematics.
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Affiliation(s)
- Shinichiro Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Hiroyuki Yoshitomi
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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Abstract
There are many reasons why a total knee replacement (TKR) may fail and qualify for revision. Successful revision surgery depends as much on accurate assessment of the problem TKR as it does on revision implant design and surgical technique. Specific modes of failure require specific surgical solutions. Causes of failure are often presented as a list or catalogue, without a system or process for making a decision. In addition, strict definitions and consensus on modes of failure are lacking in published series and registry data. How we approach the problem TKR is an essential but neglected aspect of understanding knee replacement surgery. It must be carried out systematically, comprehensively and efficiently. Eight modes of failure are described: 1) sepsis; 2) extensor discontinuity; 3) stiffness; 4) tibial- femoral instability; 5) patellar tracking; 6) aseptic loosening and osteolysis; 7) periprosthetic fracture and 8) component breakage. A ninth 'category', unexplained pain is an indication for further investigation but not surgery.
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Affiliation(s)
- K G Vince
- Northland District Health Board, Department of Orthopaedic Surgery, Whangarei, New Zealand
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22
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Martin S, Saurez A, Ismaily S, Ashfaq K, Noble P, Incavo SJ. Maximizing tibial coverage is detrimental to proper rotational alignment. Clin Orthop Relat Res 2014; 472:121-5. [PMID: 23653101 PMCID: PMC3889435 DOI: 10.1007/s11999-013-3047-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traditionally, the placement of the tibial component in total knee arthroplasty (TKA) has focused on maximizing coverage of the tibial surface. However, the degree to which maximal coverage affects correct rotational placement of symmetric and asymmetric tibial components has not been well defined and might represent an implant design issue worthy of further inquiry. QUESTIONS/PURPOSES Using four commercially available tibial components (two symmetric, two asymmetric), we sought to determine (1) the overall amount of malrotation that would occur if components were placed for maximal tibial coverage; and (2) whether the asymmetric designs would result in less malrotation than the symmetric designs when placed for maximal coverage in a computer model using CT reconstructions. METHODS CT reconstructions of 30 tibial specimens were used to generate three-dimensional tibia reconstructions with attention to the tibial anatomic axis, the tibial tubercle, and the resected tibial surface. Using strict criteria, four commercially available tibial designs (two symmetric, two asymmetric) were placed on the resected tibial surface. The resulting component rotation was examined. RESULTS Among all four designs, 70% of all tibial components placed in orientation maximizing fit to resection surface were internally malrotated (average 9°). The asymmetric designs had fewer cases of malrotation (28% and 52% for the two asymmetric designs, 100% and 96% for the two symmetric designs; p < 0.001) and less malrotation on average (2° and 5° for the asymmetric designs, 14° for both symmetric designs; p < 0.001). CONCLUSIONS Maximizing tibial coverage resulted in implant malrotation in a large percentage of cases. Given similar amounts of tibial coverage, correct rotational positioning was more likely to occur with the asymmetric designs. CLINICAL RELEVANCE Malrotation of components is an important cause of failure in TKA. Priority should be given to correct tibial rotational positioning. This study suggested that it is easier to balance rotation and coverage with asymmetric tibial baseplates; clinical research will need to determine whether the observed difference affects patellar tracking, loosening rates, or the likelihood of revisions after TKA.
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Affiliation(s)
- Stacey Martin
- />Methodist Center for Orthopaedic Surgery, 6550 Fannin, Suite 2600, Houston, TX 77030 USA
| | - Alex Saurez
- />Institute of Orthopaedic Research and Education, Houston, TX USA
| | - Sabir Ismaily
- />Institute of Orthopaedic Research and Education, Houston, TX USA
| | - Kashif Ashfaq
- />Methodist Center for Orthopaedic Surgery, 6550 Fannin, Suite 2600, Houston, TX 77030 USA
| | - Philip Noble
- />Institute of Orthopaedic Research and Education, Houston, TX USA
| | - Stephen J. Incavo
- />Methodist Center for Orthopaedic Surgery, 6550 Fannin, Suite 2600, Houston, TX 77030 USA
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Aligning the tibial component with medial border of the tibial tubercle--is it always right? Knee 2014; 21:295-8. [PMID: 22789681 DOI: 10.1016/j.knee.2012.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Correct rotational alignment of the tibial component is crucial for total knee arthroplasty (TKA). Several studies have indicated that the best rotational orientation of the tibial component is close to the medial border of the tibial tubercle. However, it remains obscure whether it is always right. Thus, the objective of current study was to quantify tibial rotational alignment in 120 primary rotating platform TKAs using the medial border of tibial tubercle as a landmark between July 2008 and June 2010. METHODS The femoral component was positioned parallel to the transepicondlylar axis, and a rotating platform trial insert was used to determine tibial insert rotational alignment relative to the most medial aspect of the tibial tubercle with the knee in full extension. Rotational alignment of the components was detected based on radiograph and CT scan. This investigation is based on the premise that all neutral points would lie within 10° of the mean. RESULTS The mean divergence external to the medial border of the tubercle was 2.3°±3.5°. However, six of the knees (5%) had neutral points≥10° from the mean, including two valgus knees measured 10° of internal rotation and four varus knees measured 10° of external rotation. CONCLUSION Using the medial border of tibial tubercle as a landmark does not always result in a good femoro-tibial rotational alignment. Surgeons using fixed bearings component should be aware of this effect to avoid suboptimal outcomes resulting from tibiofemoral rotational malalignment in full extension. LEVEL OF EVIDENCE Diagnostic study, Level II-3.
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Konigsberg B, Hess R, Hartman C, Smith L, Garvin KL. Inter- and intraobserver reliability of two-dimensional CT scan for total knee arthroplasty component malrotation. Clin Orthop Relat Res 2014; 472:212-7. [PMID: 23813180 PMCID: PMC3889411 DOI: 10.1007/s11999-013-3111-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotational malalignment of total knee arthroplasty (TKA) has been correlated with patellofemoral maltracking, knee instability, and stiffness. CT is the most accurate method to assess rotational alignment of prosthetic components after TKA, but inter- and intraobserver reliability of CT scans for this use has not been well documented. QUESTIONS/PURPOSES The objective of this study was to determine the inter- and intraobserver reliability and the repeatability of the measurement of TKA component rotation using two-dimensional CT scans. METHODS Fifty-two CT scans of TKAs being evaluated for revision surgery were measured by three different physicians. An orthopaedic resident and attending measured the same scans twice (more than 2 weeks apart) and a musculoskeletal radiologist measured them once. To assess interobserver reliability, intraclass correlation coefficients (ICCs) with two-way mixed-effects analysis of variance models as well as 95% confidence intervals for each were done. The repeatability coefficient was calculated as well, which is defined as the difference in measurements that include 95% of the values. This indicates the magnitude of variability among measurements in the same scale, which in this study is degrees. RESULTS The interobserver ICC measurement for the femoral component was 0.386 (poor), and it was 0.670 (good) for the tibial component. The interobserver ICC for the combined rotation measurements was 0.617 (good). The intraobserver ICC for the femoral component was 0.606 (good), and it was 0.809 (very good) for the tibial component. The intraobserver ICC for combined rotation was 0.751 (good). The intraobserver repeatability coefficient for the femoral component was 0.49°, 10.64° for the tibial component, and 12.29° for combined rotation. CONCLUSIONS In this study, the inter- and intraobserver reliability, and the repeatability, of TKA component rotation were variable. This raises concern about whether CT scan is diagnostic in the assessment of component malrotation after TKA.
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Affiliation(s)
- Beau Konigsberg
- University of Nebraska Medical Center, Omaha, NE 68198-1080 USA
| | - Ryan Hess
- University of Nebraska Medical Center, Omaha, NE 68198-1080 USA
| | - Curtis Hartman
- University of Nebraska Medical Center, Omaha, NE 68198-1080 USA
| | - Lynette Smith
- University of Nebraska Medical Center, Omaha, NE 68198-1080 USA
| | - Kevin L. Garvin
- University of Nebraska Medical Center, Omaha, NE 68198-1080 USA
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Abstract
PURPOSE The aim of the present study was to assess the changes in rotational alignment introduced by total knee arthroplasty (TKA) and the reproducibility of pre- and postoperative CT measurements of rotational limb alignment. METHODS For this purpose we analyzed data from 196 consecutive cruciate-retaining, fixed bearing Columbus TKA procedures. Both pre- and postoperative scans torsion difference CT scans were available for measurements in 89 cases. Using these CT scans the neck-malleolar angle (NMA), the femoral posterior condylar angle (fPCA), the tibial posterior condylar axis (tPCA) and the tibial torsion angle (TTA) were independently assessed by three raters. CT scans were re-evaluated 8 weeks later by the most experienced rater for assessment of intraobserver agreement. RESULTS Measurements of all angles were prone to high standard deviations reflecting interindividual variability. Mean fPCA changed from 1.3° to 2.7° internal rotation preoperatively to 0.1°-1.9° internal rotation postoperatively. Based on a relative external rotation of the tibial base plate as compared to the preoperative situation, we found a relative internal rotation of the postoperative NMA and tibial torsion of 3°-5.4° and 6°-7.5°, respectively. Intra- and interobserver agreement was strong for all angles assessed (ICCs 0.7-1.0) except for fPCA (ICC 0.2-0.6). However, mean absolute measurement differences for fPCA were clinically acceptable (1.2°-2.6°). CONCLUSIONS Reproducibility of CT rotational limb alignment measurements was found to be clinically acceptable. Rotational alignment of the femoral and even more so of the tibial component will ultimately affect the rotational alignment of the entire limb-at least when fixed bearings are used. LEVEL OF EVIDENCE Diagnostic study, Level III.
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Sarmah SS, Patel S, Hossain FS, Haddad FS. The radiological assessment of total and unicompartmental knee replacements. ACTA ACUST UNITED AC 2012; 94:1321-9. [PMID: 23015555 DOI: 10.1302/0301-620x.94b10.29411] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.
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Affiliation(s)
- S S Sarmah
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK.
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Murakami AM, Hash TW, Hepinstall MS, Lyman S, Nestor BJ, Potter HG. MRI evaluation of rotational alignment and synovitis in patients with pain after total knee replacement. ACTA ACUST UNITED AC 2012; 94:1209-15. [PMID: 22933492 DOI: 10.1302/0301-620x.94b9.28489] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Component malalignment can be associated with pain following total knee replacement (TKR). Using MRI, we reviewed 50 patients with painful TKRs and compared them with a group of 16 asymptomatic controls to determine the feasibility of using MRI in evaluating the rotational alignment of the components. Using the additional soft-tissue detail provided by this modality, we also evaluated the extent of synovitis within these two groups. Angular measurements were based on the femoral transepicondylar axis and tibial tubercle. Between two observers, there was very high interobserver agreement in the measurements of all values. Patients with painful TKRs demonstrated statistically significant relative internal rotation of the femoral component (p = 0.030). There was relative internal rotation of the tibial to femoral component and combined excessive internal rotation of the components in symptomatic knees, although these results were significant only with one of the observers (p = 0.031). There was a statistically significant association between the presence and severity of synovitis and painful TKR (p < 0.001). MRI is an effective modality in evaluating component rotational alignment.
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Affiliation(s)
- A M Murakami
- Boston University School of Medicine, Department of Radiology, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, Massachusetts 02118, USA.
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Lozano LM, López V, Ríos J, Popescu D, Torner P, Castillo F, Maculé F. Better outcomes in severe and morbid obese patients (BMI > 35 kg/m2) in primary Endo-Model rotating-hinge total knee arthroplasty. ScientificWorldJournal 2012; 2012:249391. [PMID: 22623889 PMCID: PMC3353285 DOI: 10.1100/2012/249391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 01/09/2012] [Indexed: 12/15/2022] Open
Abstract
The Endo-Model rotating-hinge prosthesis is preferably indicated as a primary implant in patients with advanced axial deviation of the lower limbs or unstable knees with severe bone defects. Outcomes were studied in 111 knees, operated in a three-year period; the mean followup was 28 months. Joint balance enhancement and limbs mechanical axis correction were achieved after surgery. There were 6 deep infections and 16 patients referred postoperative anterior knee pain. WOMAC index scores disaggregated by gender and BMI showed better outcomes in obese patients (specifically, those with a BMI of 35-40 kg/m(2)) and in men. Although the lack of a control group did not allow definite conclusions and despite a nonnegligible complication rate, our results reveal that the Endo-Model total knee arthroplasty can be a useful tool to deal with severe and morbid obese patients affected of severe gonarthrosis associated with marked axial deviations, ligament instability, or bone defects.
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Affiliation(s)
- Luis M Lozano
- Knee Surgery Unit, Orthopaedic Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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29
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Herrmann S, Kaehler M, Souffrant R, Rachholz R, Zierath J, Kluess D, Mittelmeier W, Woernle C, Bader R. HiL simulation in biomechanics: a new approach for testing total joint replacements. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2012; 105:109-119. [PMID: 21852016 DOI: 10.1016/j.cmpb.2011.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 06/24/2011] [Accepted: 07/21/2011] [Indexed: 05/31/2023]
Abstract
Instability of artificial joints is still one of the most prevalent reasons for revision surgery caused by various influencing factors. In order to investigate instability mechanisms such as dislocation under reproducible, physiologically realistic boundary conditions, a novel test approach is introduced by means of a hardware-in-the-loop (HiL) simulation involving a highly flexible mechatronic test system. In this work, the underlying concept and implementation of all required units is presented enabling comparable investigations of different total hip and knee replacements, respectively. The HiL joint simulator consists of two units: a physical setup composed of a six-axes industrial robot and a numerical multibody model running in real-time. Within the multibody model, the anatomical environment of the considered joint is represented such that the soft tissue response is accounted for during an instability event. Hence, the robot loads and moves the real implant components according to the information provided by the multibody model while transferring back the position and resisting moment recorded. Functionality of the simulator is proved by testing the underlying control principles, and verified by reproducing the dislocation process of a standard total hip replacement. HiL simulations provide a new biomechanical testing tool for analyzing different joint replacement systems with respect to their instability behavior under realistic movements and physiological load conditions.
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Affiliation(s)
- Sven Herrmann
- Department of Orthopaedics, University of Rostock, Germany.
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30
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Lawrie CM, Noble PC, Ismaily SK, Stal D, Incavo SJ. The flexion-extension axis of the knee and its relationship to the rotational orientation of the tibial plateau. J Arthroplasty 2011; 26:53-58.e1. [PMID: 21723702 DOI: 10.1016/j.arth.2011.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 04/18/2011] [Indexed: 02/01/2023] Open
Abstract
We measured the optimal rotational alignment of the tibial component with respect to anatomic landmarks. Kinematic data were collected from functional maneuvers simulated in 20 cadaveric knees mounted in a joint simulator. The axis of knee motion was calculated for squatting and lunging activities over the interval of 30° to 90° of knee flexion. We then examined the accuracy and variability of 5 different anatomic axes in predicting the direction of knee motion. No one landmark guaranteed correct alignment of the tibial component and most predictors were highly variable (range, 6°-21°). The most accurate indicators were the medial third of the tibial tubercle (average error: squatting: 3.5° external rotation; lunging: 9.5°), and the medial-lateral axis of the resected tibial surface (6.7° and 1.1° internal rotation). The correct alignment of the tibial component can be best achieved by splitting the difference between these landmarks to eliminate placement of the component in excessive external and excessive internal rotation.
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31
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Stumpe KDM, Romero J, Ziegler O, Kamel EM, von Schulthess GK, Strobel K, Hodler J. The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med Mol Imaging 2006; 33:1218-25. [PMID: 16721569 DOI: 10.1007/s00259-006-0127-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 03/16/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate 18F-fluorodeoxyglucose (FDG) uptake in patients with painful total knee arthroplasty and to relate FDG uptake to the location of soft tissue pain. METHODS Twenty-eight patients with painful total knee arthroplasty had a clinical examination, standard radiographs, CT measurement of rotation of the femoral component and FDG-PET (18 PET/CT, 10 PET). The diagnosis of infection was based on microbiological examinations of surgical specimens (n=12) or clinical follow-up for at least 6 months (n=16), 99mTc-labelled monoclonal antibody scintigraphy and joint aspiration. RESULTS Twenty-seven of 28 patients presented with diffuse synovial FDG uptake. Additional focal extrasynovial FDG uptake was observed in 19 knees. Twenty-four of the 28 patients had a diagnosis of internal femoral malrotation. The remaining four patients showed no rotation (0 degrees) and 3 degrees, 4 degrees and 7 degrees of external rotation, respectively. Three patients presented with the additional diagnosis of an infected total knee replacement. Pain was described as diffuse (n=10) or focal (n=18). In two knees a relationship between pain location and FDG uptake was observed. Of ten patients with a severe internal femoral component rotation (>6 degrees), seven had focal uptake, four in the femoral periosteum and three in the tibial periosteum. The difference between knees with severe malrotation and the remaining knees was not significant (p=1.000, Fisher's Exact Test). CONCLUSION Diffuse synovial and focal extrasynovial FDG-PET uptake is commonly found in patients with malrotation of the femoral component and is not related to pain location. The information provided by FDG-PET does not contribute to the diagnosis and management of individual patients with persistent pain after total knee replacement.
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Affiliation(s)
- Katrin D M Stumpe
- Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland
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Abstract
The knee is a frequently injured joint and, thus, a common focus of operative intervention. As operative techniques and imaging modalities evolve, radiologists must be aware of the expected postoperative appearance after knee surgeries that are performed commonly and also must be comfortable recognizing complications encountered commonly in the immediate and delayed postoperative period. Drawing on the large amount of attention this subject has received of late in the radiologic and orthopedic literature, this article reviews the knee surgeries performed most commonly and the expected normal and most frequently encountered abnormal postoperative imaging findings with an emphasis on MR imaging.
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Affiliation(s)
- Matthew A Frick
- Department of Radiology, Division of Musculoskeletal Radiology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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Huddleston JI, Scott RD, Wimberley DW. Determination of neutral tibial rotational alignment in rotating platform TKA. Clin Orthop Relat Res 2005; 440:101-6. [PMID: 16239791 DOI: 10.1097/01.blo.0000185448.43622.77] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Use of a fixed anatomic landmark to set rotation of the tibial component may lead to rotational malalignment. Post wear in stabilized components, backside wear in any conforming modular system, and patellar maltracking may result from tibiofemoral rotational incongruence. We aimed to quantify tibial rotational alignment in 109 primary rotating platform TKAs. After trial components were inserted with the knee properly balanced, we recorded the neutral point of the rotating tibial insert, in extension, relative to the most medial aspect of the tibial tubercle. We hypothesized that all neutral points would lie within 10 degrees of the mean. Divergence of the neutral point was recorded as being internal or external to the medial border of the tibial tubercle to the nearest 5 degrees increment. Our results showed a mean divergence of 5 degrees +/- 5 degrees external to the medial border of the tubercle. Five percent of knees, however, had neutral points > or = 10 degrees from the mean. Surgeons who use fixed-bearing modular components with any rotational constraint must be cautious in choosing a fixed anatomic tibial landmark to determine the rotational alignment of the tibial component. Doing so may create tibiofemoral rotational malalignment in full extension that may lead to suboptimal outcomes. LEVEL OF EVIDENCE Diagnostic study, Level II-3. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- James I Huddleston
- Orthopaedic Biomechanics and Biomaterials Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA.
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Franceschini R, Franceschini M, Romano P, Bussi P, Caruso EM, De Amici S. Joint replacement in osteoarthritis: state of the art. Semin Arthritis Rheum 2005; 34:73-7. [PMID: 16206963 DOI: 10.1016/j.semarthrit.2004.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Miller TT. Imaging of knee arthroplasty. Eur J Radiol 2005; 54:164-77. [PMID: 15837396 DOI: 10.1016/j.ejrad.2005.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 01/24/2005] [Accepted: 01/28/2005] [Indexed: 12/19/2022]
Abstract
Knee replacement surgery, either with unicompartmental or total systems, is common. The purpose of this manuscript is to review the appearance of normal knee arthroplasty and the appearances of complications such as infection, polyethylene wear, aseptic loosening and particle-induced osteolysis, patellofemoral abnormalities, axial instability, and periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help the radiologist in the diagnostic evaluation of the patient with a painful knee arthroplasty.
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Affiliation(s)
- Theodore T Miller
- Department of Radiology, North Shore University Hospital, 825 Northern Blvd., Great Neck, NY 11021, USA.
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36
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Rosenberg AG, Jacobs JJ, Saleh KJ, Kassim RA, Christie MJ, Lewallen DG, Rand JA, Rubash HE. The patella in revision total knee arthroplasty. J Bone Joint Surg Am 2003; 85-A Suppl 1:S63-70. [PMID: 12540672 DOI: 10.2106/00004623-200300001-00012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Aaron G Rosenberg
- Department of Orthopaedic Surgery, Rush Medical College, Chicago, IL 60612-3828, USA
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