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Hanada M, Hotta K, Matsuyama Y. Impact of implant positions in total knee arthroplasty on the postoperative knee kinematics of tibial rotation. J Orthop 2024; 58:24-28. [PMID: 39045510 PMCID: PMC11262114 DOI: 10.1016/j.jor.2024.06.025] [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: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction In total knee arthroplasty (TKA), the implant positions and knee kinematics, as well as the manifestation of medial pivot motion, play pivotal roles in determining postoperative clinical outcomes. The purpose of the current study was to analyze the correlation between knee kinematics, which was measured during TKA and implant positions derived using computed tomography (CT) examination after TKA. Methods This study comprised 64 patients (76 knees) who underwent primary TKA between 2015 and 2022. A navigation system was used in TKA procedures, and intraoperative knee kinematics were automatically calculated with it. Utilizing three-dimensional evaluation software, positioning of implants was quantified with CT images taken pre- and post-operatively. Multiple regression analyses were employed to explore the impact of femoral component position (FP) and tibial component position (TP) on knee kinematics, focusing on the extent of tibial rotational motion (TRM) during passive knee motion. Results FP affected TRM between knee extension and 90° flexion (p = 0.003, 95 % confidence interval [CI]: 0.315-1.384) and between knee extension and full flexion (p = 0.0002, 95 % CI: 0.654-1.844) after TKA. FP in internal rotation positively affected internal TRM after TKA. TP was not associated with TRM. Conclusions Findings of the current study suggest that FP in internal rotation positively impacts knee kinematics after TKA.
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Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
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Innocenti M, Secci G, Zanna L, Sani G, Stimolo D, Matassi F, Carulli C, Civinini R. Following the Anatomy of the Proximal Tibia With a Standard Anatomic Technique and the Use of an Asymmetrical Tibial Base Plate can Lead to a Mismatched Internal Components' Rotation in Mechanically Aligned Total Knee Arthroplasty. Arthroplast Today 2024; 28:101464. [PMID: 39100416 PMCID: PMC11295626 DOI: 10.1016/j.artd.2024.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/01/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Tibiofemoral components rotational congruency affects the total knee arthroplasty (TKA) success. The smart insert sensor (I-S) helps to establish tibial component rotation reciprocally to a fixed femoral rotation. We aimed (1) to validate the use of I-S as a possible tool to reach reproducible reciprocal femorotibial rotation (RftR) in TKA independently from anatomic landmarks, reducing outliers in combined and mismatched femorotibial rotation (CftR and MMftR, respectively) positioning and (2) to validate the "curve-on-curve" method for a specific type of asymmetrical tibial component. Methods From February 2018, we conducted a prospective case-control study including 106 patients undergoing TKA. Patients were divided into 2 groups based on the method used to establish tibial component rotation: with the I-S use (group A, n = 53) and with the standard "curve-on-curve" technique (group B, n = 53). Rotational alignment was calculated using the Berger protocol with postoperative computed tomography scanning. Alignment parameters measured were tibial and femoral component rotations (tR, fR), the CftR, the MMftR, and the RftR. Results Intraoperative rotation measured by I-S correlated the best with RftR (r = 0.84; P < .001) at the post-operative CT scanning. No significant differences were found between groups A and B regarding all types of rotation (fR: P = .774; tR: P = .467; CftR: P = .847) except for MMftR (P = .036) and RftR (P = .023). There were no outliers in group A but 27 and 12 outliers in group B for MMftR and CftR respectively (P < .001; P = .032). Conclusions The TKA components' rotation established using a smart I-S intraoperatively is ascribable to the RftR at postoperative computed tomography scan. The I-S helps reduce outliers in the CftR and MMftR. An asymmetrical tibial base plate implanted using the curve-on-curve technique does not create a neutral reciprocal femorotibial rotation significantly increasing the number of cases with mismatched femorotibial internal rotation.
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Affiliation(s)
| | - Gregorio Secci
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Luigi Zanna
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Giacomo Sani
- Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Davide Stimolo
- Orthopaedic Clinic, University of Florence, Florence, Italy
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Anjiki K, Nakano N, Ishida K, Takayama K, Fujita M, Kamenaga T, Tsubosaka M, Kuroda Y, Hayashi S, Kuroda R, Matsumoto T. Comparison of short-term clinical results between modified kinematically-aligned and guided motion bicruciate stabilized total knee arthroplasty. ARTHROPLASTY 2024; 6:40. [PMID: 38961515 PMCID: PMC11223350 DOI: 10.1186/s42836-024-00257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/22/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Both kinematically-aligned (KA) total knee arthroplasty (TKA) and bicruciate stabilized (BCS) TKA aim to reproduce the physiological knee kinematics. In this study, we compared the femoro-tibial component rotational mismatch between patients who underwent modified KA-TKA and those who received guided-motion BCS-TKA, and its influence on the clinical outcomes. METHODS In this retrospective study, 77 consecutive patients were included and divided into two groups: subjects who underwent modified KA-TKA with Persona (KA Group; n = 42) and those who received BCS-TKA with JOURNEY II (BCS group; n = 35). Range of motion, the 2011 Knee Society Score (KSS), the rotational alignment of the femoral and tibial components, and the correlations between the rotational mismatch and the 2011 KSS subscales were examined. RESULTS The postoperative objective knee indicators (P = 0.0157), patient satisfaction (P = 0.0039) and functional activity scores (P = 0.0013) in the KA group were significantly superior to those in the BCS group 1 year postoperatively. There was no significant difference between the two groups observed in the rotational mismatch. In the BCS group, significant negative correlations were identified between the rotational mismatch and objective indicators, patient satisfaction, and functional activity scores but not in the KA group. CONCLUSIONS The short-term clinical results following KA-TKA showed superior objective knee indicators, patient satisfaction and functional activity scores. A negative correlation was observed between component rotational mismatch and the 2011 KSS subscales in the BCS group, compared to no relationship found between the two in the KA group. These findings suggested that KA-TKA has a relatively higher tolerance for rotational mismatch than BCS-TKA.
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Affiliation(s)
- Kensuke Anjiki
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, 657-0068, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Takayama Orthopedic Clinic, Kobe, 654-0049, Japan
| | - Masahiro Fujita
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, 657-0068, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.
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Kokubu Y, Kawahara S, Mizu‐Uchi H, Hamai S, Akasaki Y, Sato T, Ishibashi S, Konishi T, Nakashima Y. Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty. J Exp Orthop 2024; 11:e12069. [PMID: 38957227 PMCID: PMC11217670 DOI: 10.1002/jeo2.12069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient-reported outcome measures (PROMs). Methods Seventy-one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole-leg and supine knee radiographs using a three-dimensional-to-two-dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hideki Mizu‐Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Toshiki Konishi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Dubin J, Hameed D, Moore MC, Bains SS, Patel S, Nace J, Mont MA, Delanois RE. Methodological Assessment of the 100 Most-Cited Articles in Total Knee Arthroplasty in the Last Decade Compared to the All-Time List. J Arthroplasty 2024; 39:1434-1443.e5. [PMID: 38135168 DOI: 10.1016/j.arth.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent advances in total knee arthroplasty (TKA) have been driven by a growing focus on evidence-based medicine. This transition is reflected in the critical appraisal of both, the quality of work and the potential impact on the orthopedic community. The purpose of our study was to (1) identify the top 100 most-cited articles in TKA in the last decade and from all-time, and (2) compare methodological rigor of the most-cited articles in TKA in the last decade to articles all-time by level of evidence. METHODS The top 100 cited articles were recorded for manuscripts from the last decade, January 1, 2012 to December 31, 2022, and manuscripts from all-time for TKA. We collected authors, year of publication, journal of the article, country of origin of authors, article type (basic science article, clinical research article), level of evidence, methodological index for non-randomized studies score, physiotherapy evidence database scale, and citation density (total citations/years published). RESULTS The largest number of studies for all-time TKA (53.0%) and decade TKA (42.0%) were Level III. The average methodological index for non-randomized studies score for comparative studies was 18.7 for all-time TKA and 20.7 for decade TKA (P < .001). The average physiotherapy evidence database score was 6.1 for all-time TKA and 8.1 for decade TKA (P > .05). The highest citation density for all-time TKA was 111 and for past decade was 63. The number of level II studies in TKA increased from 19.0% from all time to 38.0% from the last decade (P < .05). CONCLUSIONS Our findings of improved methodologies over time reflect positive steps toward evidence-based practice in TKA. A continued focus on producing methodologically sound studies may guide evidence-based clinical decision-making.
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Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mallory C Moore
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Saarang Patel
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Maciąg BM, Wilk B, Nawrocki M, Łapiński M, Świercz M, Maciąg G, Żarnovsky K, Adamska O, Stolarczyk A. Establishing femoral component rotation using a dynamic tensioner does not improve patellar position after total knee replacement with use of anatomic implants: A case-control study. Knee 2024; 48:217-225. [PMID: 38733872 DOI: 10.1016/j.knee.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/06/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Anterior knee pain (AKP) is one of the reasons for dissatisfaction after total knee replacement (TKR). It may result from patellofemoral joint dysfunction, caused by improper rotation of implant components. The aim of this study was to analyze patella positioning in patients after standard measured resection TKR and TKR with a use of a dynamic tensioner, and to assess the frequency of AKP, range of motion (ROM), and patient-reported outcome measures 6 weeks and 3 months postoperatively. METHODS The study consisted of 127 patients who underwent TKR. Eighty-nine of them treated with use of the dynamic tensioner FUZION formed the study group; the remainder formed the control group. All participants received cemented PERSONA MC without patella resurfacing. All patients had a standard anteroposterior, lateral weight-bearing, long-leg view X-ray and computed tomography examination in 30° of knee flexion following the procedure. RESULTS There were no significant differences between the study and the control groups regarding: posterior condylar axis (PCA)-patella angle, surgical transepicondylar axis (sTEA)-patella angle, PCA-sTEA angle, deviation from 90° in PCA-patella, sTEA-patella and PCA-sTEA angles. No significant difference was found in a ratio of obtaining PCA-patella angle deviation of more than 3°. Regarding clinical parameters, statistically and questionablly clinically significant difference in favor of the Study Group was found in Forgotten Joint Score 6 weeks and 3 months post-operativley and ROM 6 weeks post-operatively. However, such difference was not found by analyzing ROM 3 months post-operatively, AKP and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. CONCLUSION Compared with the standard 3° of femoral component external rotation, use of a dynamic tensioner does not allow for more accurate restoration of the patellar facet position with reference to the PCA.
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Affiliation(s)
- Bartosz M Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Bartłomiej Wilk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Nawrocki
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland.
| | - Maciej Świercz
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Maciąg
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Warsaw, Poland
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Grillo G, Pelfort X, Balaguer-Castro M, Amillo JR, Carbó N, Peñalver JM, Yela-Verdú C. Study of femoral component malrotation as a cause of pain after total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:231-238. [PMID: 36868373 DOI: 10.1016/j.recot.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS The total was 133 patients that was divided in two groups. A control group and pain group. The control group was made up of 70 patients with a mean age of 69.59years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48years (13 men and 50 women). We did not found difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. The analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.
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Affiliation(s)
- G Grillo
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - X Pelfort
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - M Balaguer-Castro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, España
| | - J R Amillo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Viladecans, Viladecans, Barcelona, España
| | - N Carbó
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - J M Peñalver
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - C Yela-Verdú
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
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Grillo G, Pelfort X, Balaguer-Castro M, Amillo JR, Carbó N, Peñalver JM, Yela-Verdú C. [Translated article] Study of femoral component malrotation as a cause of pain after total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T231-T238. [PMID: 38253237 DOI: 10.1016/j.recot.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1 year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS The total was 133 patients that was divided in two groups. A control group and pain group. The Control group was made up of 70 patients with a mean age of 69.59 years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48 years (13 men and 50 women). We didn't find difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. And, the analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.
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Affiliation(s)
- G Grillo
- University Cattolica del Sacro Cuore, Roma, Italy
| | - X Pelfort
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Spain; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
| | - M Balaguer-Castro
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - J R Amillo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Viladecans, Barcelona, Spain
| | - N Carbó
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Spain; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J M Peñalver
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Spain; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
| | - C Yela-Verdú
- Unidad de Cirugía de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Parc Taulí, Sabadell, Spain; Insitut d'Investigació i Innovació I3PT, Hospital Universitario Parc Taulí, Sabadell, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain.
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Laddha MS, Gowtam SV, Jain P. Accuracy of Femoral Component External Rotation with all Burr Robotic Assisted Total Knee Arthroplasty. Malays Orthop J 2024; 18:19-25. [PMID: 38638660 PMCID: PMC11023343 DOI: 10.5704/moj.2403.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/14/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction External rotation of femoral component is controversial in Total knee arthroplasty (TKA). The aim of our study is to assess the precision of femoral component external rotation in Robotic Assisted All Burr TKA. Materials and methods This is a prospective study of 30 cases who underwent All Burr Robotic Assisted TKA at our institute, RNH hospital. Inclusion criteria were primary and secondary osteoarthritis of the knee and exclusion criteria were revision and partial knee replacement. On Navio robotic system femoral external rotation was planned as per medio-lateral flexion gap balancing and executed with burr. Post-operative CT scan was done in all patients to assess intra-operative planned femoral external rotation. Results Out of 30 cases, 20 were female and 10 were male. Mean age was 66.06±7.43 years. On Navio the planned external rotation of femoral component was 2.86±1.16. Average of femoral component external rotation on postoperative CT scan was 3.11±1.16. The mean deviation of achieved femoral component external rotation from planned external rotation was -0.24 to ±0.28. Only 37% patients required 3° external rotation. Correlation between planned and achieved femoral component external rotation was significant, positive and very strong as indicated by r=0.97 and p=0.0001. Conclusion All Burr Robotic Assisted TKA provides near accurate femoral component external rotation as planned on Navio with deviation of less than 0.3° between planned and achieved external rotation.
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Affiliation(s)
- M S Laddha
- Department of Orthopaedics, RNH Hospital, Nagpur, India
| | - S V Gowtam
- Department of Arthroplasty and Arthroscocpy, RNH Hospital, Nagpur, India
| | - P Jain
- Department of Arthroplasty and Arthroscocpy, RNH Hospital, Nagpur, India
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10
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Zhang Q, Li Z, Chen Z, Peng Y, Jin Z, Qin L. Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning. Front Bioeng Biotechnol 2024; 11:1255625. [PMID: 38260731 PMCID: PMC10800660 DOI: 10.3389/fbioe.2023.1255625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
The precise alignment of tibiofemoral components in total knee arthroplasty is a crucial factor in enhancing the longevity and functionality of the knee. However, it is a substantial challenge to quickly predict the biomechanical response to malrotation of tibiofemoral components after total knee arthroplasty using musculoskeletal multibody dynamics models. The objective of the present study was to conduct a comparative analysis between a deep learning method and four conventional machine learning methods for predicting knee biomechanics with different tibial component malrotation during a walking gait after total knee arthroplasty. First, the knee contact forces and kinematics with different tibial component malrotation in the range of ±5° in the three directions of anterior/posterior slope, internal/external rotation, and varus/valgus rotation during a walking gait after total knee arthroplasty were calculated based on the developed musculoskeletal multibody dynamics model. Subsequently, deep learning and four conventional machine learning methods were developed using the above 343 sets of biomechanical data as the dataset. Finally, the results predicted by the deep learning method were compared to the results predicted by four conventional machine learning methods. The findings indicated that the deep learning method was more accurate than four conventional machine learning methods in predicting knee contact forces and kinematics with different tibial component malrotation during a walking gait after total knee arthroplasty. The deep learning method developed in this study enabled quickly determine the biomechanical response with different tibial component malrotation during a walking gait after total knee arthroplasty. The proposed method offered surgeons and surgical robots the ability to establish a calibration safety zone, which was essential for achieving precise alignment in both preoperative surgical planning and intraoperative robotic-assisted surgical navigation.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhuhuan Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang’an University, Xi’an, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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11
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Hull ML, Simileysky A, Howell SM. Differences in Trochlear Morphology of a New Femoral Component Designed for Kinematic Alignment from a Mechanical Alignment Design. Bioengineering (Basel) 2024; 11:62. [PMID: 38247939 PMCID: PMC10812931 DOI: 10.3390/bioengineering11010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Because kinematic alignment (KA) aligns femoral components in greater valgus and with less external rotation than mechanical alignment (MA), the trochlear groove of an MA design used in KA is medialized, which can lead to complications. Hence, a KA design has emerged. In this study, our primary objective was to quantify differences in trochlear morphology between the KA design and the MA design from which the KA design evolved. The KA and MA designs were aligned in KA on ten 3D femur-cartilage models. Dependent variables describing the morphology of the trochlea along the anterior flange, which extends proximal to the native trochlea, and along the arc length of the native trochlea, were determined, as was flange coverage. Along the anterior flange, the KA groove was significantly lateral proximally by 10 mm and was significantly wider proximally by 5 mm compared to the MA design (p < 0.0001). Along the arc length of the native trochlea, the KA groove was significantly lateral to the MA design by 4.3 mm proximally (p ≤ 0.0001) and was significantly wider proximally by 19 mm than the MA design. The KA design reduced lateral under-coverage of the flange from 4 mm to 2 mm (p < 0.0001). The KA design potentially mitigates risk of patellofemoral complications by lateralizing and widening the groove to avoid medializing the patella for wide variations in the lateral distal femoral angle, and by widening the flange laterally to reduce under-coverage. This information enables clinicians to make informed decisions regarding use of the KA design.
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Affiliation(s)
- Maury L. Hull
- Department of Biomedical Engineering, Department of Mechanical Engineering, Department of Orthopaedic Surgery, University of California Davis, Davis, CA 95616, USA
| | - Alexander Simileysky
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
| | - Stephen M. Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
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12
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Lakhotia D, Agrawal U, Singh SP. A Prospective Randomized Study on Whether Computer Navigation Is Better Than Conventional Total Knee Replacement in Terms of Short-Term Functional and Clinical Outcomes. Cureus 2024; 16:e53226. [PMID: 38425621 PMCID: PMC10902750 DOI: 10.7759/cureus.53226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Computer navigation results in better radiological alignment in total knee replacement (TKR). However, functional and clinical outcomes are equally good in conventional TKR. This study aims to compare the functional and clinical outcomes in patients undergoing navigated and conventional TKR. METHODS A prospective randomized study between navigated TKR (NKR/Group I) and conventional TKR (CKR/Group II) was carried out. Functional outcome was analyzed using the Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Clinical outcome was evaluated as knee range of motion. RESULTS Thirty-nine patients (68 knees) were randomized into two groups: I and II. The mean follow-up was 26 months. There was no statistically significant difference between the two groups with respect to knee range of motion, OKS, and WOMAC score at the final follow-up. CONCLUSION We concluded that there is no difference in clinical and functional outcomes between navigated and conventional TKR.
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Affiliation(s)
- Devendra Lakhotia
- Department of Orthopaedics, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, IND
| | - Utkarsh Agrawal
- Department of Orthopaedics, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, IND
| | - Shankar P Singh
- Department of Orthopaedics, Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, IND
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13
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Kersten RFMR, de Vries AJ, van Raaij JJAM, Brouwer RW. 12-Year clinical and radiological results of a double-blind randomized controlled trial comparing posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty. Knee 2023; 45:110-116. [PMID: 37925801 DOI: 10.1016/j.knee.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/10/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A subject of ongoing debate among orthopedic surgeons is the importance of preserving the posterior cruciate ligament in total knee arthroplasty (TKA), but long-term survival studies are scarce. The aim of this study was to compare long-term survival rates, and clinical and radiological follow up of a double-blind randomized controlled trial comparing posterior cruciate-retaining (PCR) versus posterior-stabilizing (PS) implant design of an AGC TKA. METHODS A total of 114 patients were included in the survival analysis (PCR n = 61; PS n = 53). Forty-five patients (PCR n = 25; PS n = 20) participated in the long-term follow up using patient-reported outcome measures (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form Health Survey (SF-36) and Kujala score (measuring anterior knee pain)). Thirty-one patients were assessed with a physical test (Knee Society Score (KSS)) and radiographs. RESULTS Overall survival rate was 95.6% (PCR 98.4% vs. PS 92.5%), with five patients having a major revision (PCR n = 1 vs. PS n = 4, respectively). Satisfying outcome scores for both groups were described at on average 12-year follow up with no significant differences in KSS knee and function scores, WOMAC, SF-36, or Kujala scores between groups. Radiographically, there were no findings of femoral or tibial loosening or polyethylene wear in either group. CONCLUSIONS Good long-term survival rates were described for the PCR and the PS design of an AGC TKA. There were no significant differences in clinical and radiological outcomes between a PCR and a PS design 12 years postoperatively.
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Affiliation(s)
- R F M R Kersten
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands.
| | - A J de Vries
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - J J A M van Raaij
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - R W Brouwer
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
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14
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Mukartihal R, Bhat V, Das R, Chandan S, Patil SS, Rathnakar V, Gurava Reddy A, Annapareddy A. Relationship between femoral component placement and patient-specific anatomical rotational landmarks in robotic arm assisted total knee Arthroplasty- a multicentric study. J Orthop 2023; 45:87-90. [PMID: 37869414 PMCID: PMC10585283 DOI: 10.1016/j.jor.2023.10.010] [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: 07/06/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Osteoarthritis of the knee is a common problem in the elderly, leading to severe morbidity. Total Knee Arthroplasty (TKA) is a widely validated surgery to provide a remarkable extent of knee function and simultaneously alleviates pain for knee osteoarthritis (OA). It is clearly understood that precision of the rotational alignment and accuracy of the technique in the placement of the femoral component is a prerequisite for excellent and successful outcomes of TKA. Advanced technology has now allowed surgeons to understand patient-specific variabilities in anatomical reference landmarks and the relationship of component positioning in relation to the reference landmarks to achieve accurate gap balancing with minimal soft tissue release.14 Robotic Arm Assisted-Total Knee Arthroplasty (RAA-TKA) is a semi-automated system that enables us in replicating the same. Using this technology, the bony resections, component positions, probable component sizing and gap balancing can be tentatively planned preoperatively with CT Scan Analysis and executed intraoperatively. Hence this study was undertaken to estimate the relationship between femoral component placement to normal rotational landmarks such as the Posterior Condylar Axis (PCA) and to quantitatively evaluate coronal and sagittal plane correction obtained. Also, we aimed to use the data to detect any anatomical variations in the study population and evaluate the accuracy of predicted component sizing, including gender-based evaluation. Materials and methods A Prospective Observational Study of 1073 knees of patients of either sex above 50 years of age with Kellgren Lawrence Grade 4 Osteoarthritis of the knee which were confirmed with X-Ray undergoing RAA-TKA using MAKO Robotic System using Stryker Triathlon (Cruciate Substituting) CS Knee was conducted during the period between 2022 and 2023 in two South Indian hospitals specializing in joint replacement surgeries. Results We found a statistically significant difference between the native Posterior Condylar Axis (PCA) (4.82 ± 2.15°) and final femoral component external rotation (3.24 ± 1.29°) with a p-value of <0.001 at 95% confidence interval. The accuracy of component size prediction was 99.8%. Also, analysis in our study has shown the most common implant sizes to be 4 in males and 2 in females. We also found no statistically significant difference based on age, size, laterality, or primary varus deformity. Conclusions RAA-TKA provides patient-specific alignment/restricted kinematic alignment which might further enhance the outcome for the patient. Reliable deformity correction in coronal and sagittal planes can be achieved. Accurate flexion and extension gap balancing can be done through component placement and with minimal soft tissue dissection. Irrespective of all the advantages noted in RAA-TKA, further follow-up and long-term outcome studies are required to properly gauge and analyze this new technology.
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Affiliation(s)
| | | | | | - S. Chandan
- SPARSH Group of Hospitals, Bangalore, India
| | | | - V. Rathnakar
- Department of Orthopaedics, Sunshine Hospitals, Hyderabad, India
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15
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Hanada M, Hotta K, Koyama H, Matsuyama Y. Relationship between the Femoral and Tibial Component Positions and Postoperative Knee Range of Motion after Posterior-Stabilized Total Knee Arthroplasty in Varus-Aligned Knees. J Knee Surg 2023; 36:1302-1307. [PMID: 36075230 DOI: 10.1055/s-0042-1755357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aimed to evaluate the relationship between the femoral and tibial component positions and postoperative knee range of motion after posterior-stabilized total knee arthroplasty (TKA). Forty-four patients (48 knees in total: 9 men, 9 knees; 35 women, 39 knees) who underwent posterior-stabilized TKA using a navigation system were included. The femoral and tibial component positions were measured from the preoperative and postoperative computed tomography data with three-dimensional evaluation software. We investigated the relationship between the knee range of motion, including extension restriction and maximum flexion angles at 2 years postoperatively, and the femoral and tibial component positions. Patients with knee extension restriction of 10° or more at 2 years postoperatively showed greater posterior flexion position of the tibial component than those with knee extension restriction less than 10° (6.2° and 3.9°, respectively, p=0.018). The postoperative knee flexion angle was positively associated with the internal rotational position of the femoral component (p=0.032, 95% confidence interval: 0.105-2.178). Patients with a knee flexion angle more than 120° at 2 years postoperatively had greater internal rotational position of the femoral component than those with 120° or less (5.2° and 1.5°, respectively, p=0.002). In conclusions, after posterior-stabilized TKA, the postoperative knee extension restriction angle was associated with the posterior flexion position of the tibial component, and the knee flexion angle was positively related to the internal rotational position of the femoral component.
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Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Koyama
- Department of Orthopaedic Surgery, Juzen Memorial Hospital, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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16
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Tone S, Hasegawa M, Naito Y, Wakabayashi H, Sudo A. Association between pre- and postoperative rotational mismatches of the femorotibial components and bones in bi-cruciate retaining and posterior stabilized total knee arthroplasty. Sci Rep 2023; 13:14902. [PMID: 37689778 PMCID: PMC10492851 DOI: 10.1038/s41598-023-42243-6] [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: 05/07/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Abstract
To clarify the association between pre- and postoperative rotational mismatches of the femorotibial components and bones for total knee arthroplasty (TKA) with bi-cruciate retaining (BCR) design and with fixed bearing posterior stabilized (PS) design. This retrospective cohort study included 40 BCR TKAs and 50 PS TKAs. Pre- and postoperative rotational mismatches of the femorotibial components and bones were measured by three-dimensional assessment based on computed tomography imaging. The mean value and percentage within ± 5° of pre- and postoperative rotational mismatches were compared between BCR TKA and PS TKA. Correlations between pre- and postoperative rotational mismatches of the femorotibial components and bones were investigated in BCR TKA and PS TKA. There was no significant difference in mean preoperative rotational mismatch of femorotibial components and bones between BCR TKA and PS TKA. Mean postoperative rotational mismatch of femorotibial components and bones was significantly greater in BCR TKA than in PS TKA. Postoperative rotational mismatch of the femorotibial components was within ± 5° in 21 knees (52.5%) for BCR TKA and in 43 knees (86.0%) for PS TKA. The rate of postoperative rotational mismatch of the femorotibial components and bones within ± 5° was significantly lower for BCR TKA than for PS TKA. In BCR TKA, there was a positive correlation between pre- and postoperative rotational mismatches of the femorotibial components and of bones. We consider these results can be attributed to the retention of both cruciate ligaments, which may affect the reduction of rotational permittance of the components and bones.
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Affiliation(s)
- Shine Tone
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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17
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Spencer SJ, Jamal B, Abram SGF, Kane N, Mohammed A. Patella Denervation With Circumferential Electrocautery in Primary Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2023; 38:1057-1062. [PMID: 36858129 DOI: 10.1016/j.arth.2023.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical effectiveness of patella rim electrocautery "denervation" versus no denervation in patients undergoing total knee arthroplasty (TKA). METHODS We conducted a single-center, double-blind randomized controlled trial. Patients aged 40 years or older, due to undergo a TKA who did not have patella resurfacing (usual care) were randomized with or without circumferential patella electrocautery. This was undertaken according to a randomly generated sequence of treatment allocation that was placed into numbered, sealed opaque envelopes. Participants were blinded to treatment allocation. There was no crossover. The primary outcome was Oxford Knee Score at 1 year postoperatively. Secondary outcomes were Bartlett Patella Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and 12-Item Short Form Survey. Linear regression analyses were performed with adjustments by age, sex, and baseline (preoperative) scores. There were 142 participants recruited, of which 49 (35%) were allocated to the denervation intervention. Recruitment was stopped early when interim statistical analyses confirmed adequate numbers in both groups despite an imbalance in early treatment allocation rates due to the randomization method. The mean patient age was 71 years (range, 50 to 85) and 51% (n = 74) were women. RESULTS No difference in Oxford Knee Score was detected at 1 year (mean difference [MD] 1.87; 95% confidence interval [CI] -1.28 to 5.03). No difference was detected in Bartlett Patella Score (MD 0.490; 95% CI -1.61 to 2.59) or 12-Item Short Form Survey (MD 0.196; 95% CI -2.54 to 2.93). A statistically significant difference in WOMAC was detected, but at a level less than the minimal clinically important difference for WOMAC (MD 4.79; 95% CI 1.05 to 8.52). CONCLUSION No clinically relevant benefit was detected from patella rim electrocautery in patients undergoing TKA who did not have patella resurfacing (including no benefit in terms of anterior knee pain). This treatment is therefore not recommended for clinical practice. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Simon J Spencer
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Bilal Jamal
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Simon G F Abram
- Queen Elizabeth University Hospital, Glasgow, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Nicholas Kane
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Aslam Mohammed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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18
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Gelderman SJ, van Jonbergen HP, van Steenbergen L, Landman E, Kleinlugtenbelt YV. Patients undergoing revisions for total knee replacement malposition are younger and more often female: An analysis of data from the Dutch Arthroplasty register. J Orthop 2023; 40:70-73. [PMID: 37252322 PMCID: PMC10214277 DOI: 10.1016/j.jor.2023.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Background The proportion of patients who are dissatisfied with the outcome following total knee replacement (TKR) is high. Malalignment is considered a probable cause for persistent pain, but whether this reason for revision could be the result of specific patient characteristics remains unclear. Therefore, we aim to assess whether specific patient characteristics are associated with revision for symptomatic TKR malalignment. Methods Data was obtained from the Dutch Arthroplasty Register (LROI), which contains data from all Dutch hospitals. All patients who underwent TKR revision surgery between 2008 and 2019 were included in this study. The (primary) reason for revision as well as patient characteristics (age, gender, ASA classification, and pre-operative patient-reported outcome measures) were abstracted. The Chi-square test for categorical variables, and ANOVA or Kruskal-Wallis for continuous variables were used to determine differences in patient characteristics between the subgroups based on reason for revision. Results A total of 11,044 TKR revisions were registered in The Netherlands between 2008 and 2019. Malalignment was registered as the primary reason for revision in 13% of the patients. Subgroup analyses showed that patients who underwent TKR revisions for malalignment where younger (63.8 year, SD ± 9.3) and more often female (70%) compared to other major reasons for TKR revisions. Conclusion Patients who had a TKR revision for malalignment were younger and more often female. This suggests that patient characteristics may play a role when reasons to perform revision surgery are considered. Surgeons should invest in the expectation management in (young) patients and inform patients of these potential risk factors as part of shared decision-making.
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Affiliation(s)
| | | | | | - Ellie Landman
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, the Netherlands
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19
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Zhang Q, Peng Y, Chen Z, Jin Z, Qin L. Conformity design can change the effect of tibial component malrotation on knee biomechanics after total knee arthroplasty. Clin Biomech (Bristol, Avon) 2023; 105:105985. [PMID: 37182435 DOI: 10.1016/j.clinbiomech.2023.105985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Component alignment is essential to improve knee function and survival in total knee arthroplasty. However, it is still unclear whether the conformity design of tibiofemoral component can mitigate abnormal knee biomechanics caused by component malrotation. The purpose of this study was to investigate whether the sagittal/coronal conformity design of the tibial component could change the effect of the tibial component malrotation on knee biomechanics in total knee arthroplasty. METHODS A developed patient-specific musculoskeletal multi-body dynamics model of total knee arthroplasty was used to investigate the effects of the sagittal/coronal conformity of the tibial component on knee contact forces and kinematics caused by tibial component malrotation during the walking gait. FINDINGS Medial and lateral contact forces, internal-external rotation, and anterior-posterior translation were significantly affected by tibial component malrotation after total knee arthroplasty during the walking gait. The lower sagittal conformity of the tibial component can mitigate the abnormal internal-external rotation caused by tibial component malrotation in total knee arthroplasty, the higher coronal conformity of the tibial component can mitigate the abnormal medial-lateral translation caused by tibial component malrotation in total knee arthroplasty. INTERPRETATION This study highlights the importance of the tibiofemoral conformity designs on knee biomechanics caused by component malrotation in total knee arthroplasty. The optimization of the tibiofemoral conformity designs should be thoroughly considered in the design of new implants and in the planning of surgical procedures.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China; Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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20
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Jung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in asian patients: a prospective study. BMC Musculoskelet Disord 2023; 24:332. [PMID: 37106353 PMCID: PMC10134614 DOI: 10.1186/s12891-023-06422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (r-TKA) can reportedly achieve more accurate implant positioning than conventional total knee arthroplasty (c-TKA), although its learning curve is controversial. Moreover, few studies have investigated r-TKA in Asians, who have different anatomical characteristics. This study aimed to determine the learning curve for r-TKA and compare implant positions between r-TKA and c-TKA according to the learning curve in Asian patients. METHODS This prospective study included 50 consecutive c-TKAs (group C), followed by 50 consecutive r-TKAs conducted using the MAKO robotic system (Stryker, USA). Cumulative summation analyses were performed to assess the learning curve for operative time in r-TKA. Accordingly, the r-TKA cases were divided into the initial (group I) and proficiency cases (group P). The femoral and tibial component positions in the coronal, sagittal, and axial planes and lower limb alignment were compared among the three groups. RESULTS r-TKA was associated with a learning curve for operative time in 18 cases. The operative time was significantly shorter in groups C and P than that in group I, with no significant difference between groups C and P. Groups I and P demonstrated fewer outliers with respect to lower limb alignment, femoral component coronal position, axial position, and tibial component sagittal position than those in group C, with no significant difference between groups I and P. CONCLUSION The operative time did not differ significantly between r-TKA and c-TKA after the learning curve. Surgeons could expect more accurate and reproducible lower limb alignment and implant positioning with r-TKA in Asian patients, irrespective of the learning curve.
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Affiliation(s)
- Ho Jung Jung
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min Wook Kang
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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21
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Is mid-sulcus line a predictive guide for tibial mechanical axis during total knee arthroplasty? Knee 2023; 41:373-379. [PMID: 36848706 DOI: 10.1016/j.knee.2023.02.003] [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: 06/03/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Achieving appropriate alignment of components in total knee arthroplasty (TKA) is essential for optimal functional outcomes as well as implant longevity. Performing TKA in the absence of a computer-assisted navigation system (CANS) mandates the use of accurate anatomical landmarks for achieving appropriate alignment. In this study, we have evaluated the reliability of 'mid-sulcus line' as an anatomical landmark to guide tibial resection, with the intra-operative help of CANS. METHOD A total of 322 patients undergoing primary TKA (excluding previously operated limbs and limbs with extra-articular deformities of tibia or femur) using CANS were included in the study. After resecting ACL, the mid-suclus line was drawn with a cautery tip. We hypothesized that if tibial cut was made perpendicular to the mid-sulcus line, coronal alignment of the tibial component would be along the neutral mechanical axis. This was evaluated intra-operatively with the help of CANS. RESULTS Of 322 knees, identification of the 'mid-sulcus line' was possible in 312 knees. The mean angle between the tibial alignment defined by mid-sulcus line and the neutral mechanical axis was found to be 0.45° (range, 0-1.5°) (P < 0.05). In all of the 312 knees, the tibial alignment defined by mid-sulcus line was found to be within 3° of the neutral mechanical axis (confidence interval: 0.410°, 0.491°). CONCLUSION Mid-sulcus line can be used as an additional anatomical landmark to guide the tibial resection and thereby achieve appropriate coronal alignment in primary TKAs without any extra-articular deformity.
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Vermue H, Stroobant L, Pringels L, Chevalier A, Victor J. The Definition of the Tibial Sagittal Plane and the Paradox of Imageless Navigation and Robotics: A Cadaveric Study. J Arthroplasty 2023; 38:S374-S378. [PMID: 36828051 DOI: 10.1016/j.arth.2023.02.039] [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: 10/20/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The accuracy, precision, and repeatability by which the tibial sagittal plane can be found with imageless technology is currently unknown. The purpose of this study was to identify any differences between imageless and image-based technology to define the sagittal plane of the tibia. METHODS A computed tomography (CT) was obtained of 18 cadavers with the knee fully extended. The surgical trans-epicondylar axis and several tibial rotation references were acquired on the CT scan. After a medial parapatellar approach, the same anatomical landmarks were acquired in vivo. In the horizontal plane, the angle between the surgical trans-epicondylar axis and the tibial rotational axes was assessed. RESULTS Highest accuracy was found for posterior cruciate ligament (PCL)-anterior cruciate ligament (ACL, -1.48°, standard deviation [SD] 13.64; imageless), tibial medial condyle (TMC)-tibial lateral condyle (TLC, 1.72°, SD 4.24; image-based), the ACL-medial border of tibial tuberosity (MTT, -2.89°, SD 18.86; image-based). Highest precision was acquired with image-based technology: TMC-TLC (SD 4.24), PCL-ACL (SD 5.86), and PCL-medial third of tibial tuberosity (M3TT, SD 7.10). Excellent intraobserver and interobserver correlation coefficients were observed with image-based technology: PCL-MTT, anterior medial condyle (AMC)-anterior lateral condyle (ALC), and TMC-TLC (Intraobserver and interobserver correlation coefficients 0.90-0.98). CONCLUSION The tibial sagittal plane could be defined with highest accuracy, precision, and repeatability on a preoperative CT. Imageless methodology lacked the precision and repeatability of image-based technology. With the current pursuit of high accuracy and precision in total knee arthroplasty, the reference frame used to quantify implant position should be highly accurate and precise as well. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- Hannes Vermue
- Department of Orthopedic Surgery, University Hospital Ghent, Gent, Belgium
| | - Lenka Stroobant
- Department of Orthopedic Surgery, University Hospital Ghent, Gent, Belgium
| | - Lauren Pringels
- Department of Physical Medicine and Rehabilitation, University Hospital Ghent, Gent, Belgium
| | - Amélie Chevalier
- Department of Electromechanical, Systems and Metal Engineering, Ghent University, Gent, Belgium
| | - Jan Victor
- Department of Orthopedic Surgery, University Hospital Ghent, Gent, Belgium
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Lee OS, Lee J, Lee MC, Han HS. Changes in the femoral varus and rotational profiles are correlated in women with varus osteoarthritic lower limbs. Arch Orthop Trauma Surg 2023; 143:583-590. [PMID: 34341853 DOI: 10.1007/s00402-021-04094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Previous studies have reported the relationship between coronal alignment of the lower limbs and the rotational profile of the femur and tibia. However, the relationship between coronal alignment of the femur and tibia and their rotational profiles in patients with varus osteoarthritic knees is unclear. METHODS One hundred women with varus osteoarthritic knees (varus OA group) and 50 women with neutrally aligned lower limbs without osteoarthritis (non-OA group) were evaluated retrospectively. The coronal alignment and rotational profile of the femur and tibia were evaluated, and the correlation between coronal alignment and rotational profile was analyzed, respectively. RESULTS The femoral anteversion, posterior condylar angle of the distal femur, and tibial torsion were significantly smaller in the varus OA group than in the non-OA group. In the varus OA group, the femoral anteversion and rotational profile of the distal femur had significantly negative correlations with the degree of femoral varus, while tibial torsion was not related to the degree of tibial varus. In the non-OA group, there was no relationship between coronal alignment and rotational profiles of the femur and tibia in both the varus OA and non-OA groups. CONCLUSION Femoral anteversion and the rotational profile of the distal femur were negatively correlated with the degree of femoral varus in Asian women with varus osteoarthritic knees. This study enhanced the understanding of the relationship between changes in coronal alignment of the femur and tibia and their rotational profiles in patients with varus osteoarthritic lower limbs, although this study was limited by the small sample sizes and methodological quality.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea
| | - Jangyun Lee
- Department of Orthopedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
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Panicker J, Thilak J. A computed tomographic evaluation of femoral and tibial rotational reference axes in total knee arthroplasty. SICOT J 2023; 9:4. [PMID: 36705527 PMCID: PMC9878997 DOI: 10.1051/sicotj/2023002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The surgical trans epicondylar axis (sTEA) is considered the gold standard for optimum rotation of the femoral component; however, no consensus exists on tibial component positioning. The objectives of this study were to determine the relationship of sTEA to various femoral and tibial reference axes in varus osteoarthritis (OA) knees and (ii) to study the intra-observer and inter-observer variability of the axis relationships. MATERIALS AND METHODS The study was done on preoperative computerised tomogram (CT) scans of 110 varus knees to assess the rotational relationships respectively of femoral side sTEA with whitesides line (WSL), posterior condylar axis (PCA), clinical trans epicondylar axis (cTEA) and on the tibial side sTEA with posterior tibial margin (PTM), anterior condylar axis (ACA), Akagi's line and line from the geometric centre of the tibial plateau to 1/3rd tibial tubercle (line GC 1/3rd TT). RESULTS On the femoral side the mean angles of sTEA with WSL, PCA, cTEA were 95.64° ± 2.85°, 1.77° ± 1.88°, 4.19° ± 0.99° respectively. On the tibial side, the mean angles of sTEA with, PTM, ACA, Akagi's line, and line GC 1/3rd TT were 1.10° ± 4.69°, 11.98° ± 4.51°, 2.43° ± 4.35°, 16.04° ± 5.93° respectively. CONCLUSION Contrary to the generalization, TEA has variable relationships. The surgical trans epicondylar axis was not at the assumed 3° of external rotation to PCA in 85% of knees, nor perpendicular to WSL in >95% of knees. Of the four tibial axes, Akagi's line was the least variable with sTEA. Furthermore, surgeons should also be aware of the multiple reference axes and the range of deviation from sTEA to optimize the rotational alignment of components.
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Affiliation(s)
- Johncy Panicker
- Amrita Institute of Medical Sciences Kochi Kerala 682041 India
| | - Jai Thilak
- Clinical Professor in Orthpaedics, Amrita Institute of Medical Sciences Kochi Kerala 682041 India,Corresponding author:
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Muacevic A, Adler JR, MacDessi SJ. Interobserver Agreement of Post-operative Perth Computed Tomography Protocol Data in Total Knee Arthroplasty. Cureus 2023; 15:e34349. [PMID: 36865978 PMCID: PMC9974266 DOI: 10.7759/cureus.34349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) has become the treatment of choice for advanced osteoarthritis. Identifying malalignment is central to improving TKA outcomes and providing optimal management of TKA patients with post-operative pain and dissatisfaction. Computed tomography (CT) imaging has become increasingly popular as a more precise way of analysing post-TKA component alignment and the Perth CT protocol remains the current predominant assessment tool. This study aimed to analyse and compare inter- and intra-observer agreement of a post-operative multi-parameter quantitative CT assessment (Perth CT protocol) in TKA patients. METHODS Post-operative CT images of 27 patients who underwent TKA were analysed retrospectively. Images were analysed by an experienced radiographer and a final-year medical student at least two weeks apart. Measurements for nine angles were collected: modified hip-knee-ankle (mHKA) angle, lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA), femoral flexion and tibial slope, femoral rotation angle, femoral-tibial match rotational angle, tibial tubercle lateralisation distance, and Berger's tibial rotation. Intra-observer and inter-observer intraclass correlation coefficients (ICCs) were calculated. RESULTS Inter-observer reliability for the measurements of all variables varied from poor to excellent (ICC: -0.003 to 0.981). Five out of the nine angles demonstrated good to excellent reliability. Inter-observer reliability was highest for mHKA in the coronal plane and the poorest for the tibial slope angle in the sagittal plane. The intra-observer reliability for both reviewers was excellent (0.999 vs. 0.989). CONCLUSION This study demonstrates that the Perth CT protocol has excellent intra-observer reliability and good to excellent inter-observer reliability for five out of nine of the measured angles used to assess component alignment post-TKA, making it a useful tool for surgical outcome prediction and success.
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Lei K, Liu LM, Luo JM, Ma C, Feng Q, Yang L, Guo L. Could surgical transepicondylar axis be identified accurately in preoperative 3D planning for total knee arthroplasty? A reproducibility study based on 3D-CT. ARTHROPLASTY 2022; 4:46. [PMID: 36244969 PMCID: PMC9575283 DOI: 10.1186/s42836-022-00147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical transepicondylar axis (sTEA) is frequently used for positioning of femoral component rotation in total knee arthroplasty (TKA). Previous studies showed that intraoperative identification of sTEA was not reliable. While surgeons or engineers need to identify sTEA with three-dimensional (3D) computer-aid techniques pre- or intraoperatively, the reproducibility of sTEA identification on preoperative 3D images has not been explored yet. This study aimed to investigate the reproducibility of identifying sTEA in preoperative planning based on computed tomography (CT). METHODS Fifty-nine consecutive patients (60 knees involved) who received TKA in our center from April 2019 to June 2019 were included in this study. Six experienced TKA surgeons identified sTEA three times on 3D model established on the basis of knee CT data. The projection angle of each sTEA and the posterior condyle axis on the transverse plane were measured and analyzed. RESULTS The overall intra-observer reproducibility was moderate. The median intra-observer variation was 1.27°, with a maximum being up to 14.07°. The median inter-observer variation was 1.24°, and the maximum was 11.47°. The overall intra-class correlation coefficient (ICC) for inter-observer was 0.528 (95% CI 0.417, 0.643). CONCLUSION The identification of sTEA on a 3D model established on the basis of knee CT data may not be reliable. Combined with the previous cadaveric and surgical studies, caution should be exercised in determining femoral component rotation by referencing sTEA both preoperatively and intraoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kai Lei
- grid.410570.70000 0004 1760 6682Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
| | - Li Ming Liu
- grid.410570.70000 0004 1760 6682Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
| | - Jiang Ming Luo
- grid.410570.70000 0004 1760 6682Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
| | - Chao Ma
- grid.410570.70000 0004 1760 6682Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
| | - Qing Feng
- grid.410570.70000 0004 1760 6682Minimally Invasive Gastrointestinal Surgery Center, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
| | - Liu Yang
- grid.410570.70000 0004 1760 6682Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
| | - Lin Guo
- grid.410570.70000 0004 1760 6682Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038 China
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Fujita M, Matsumoto T, Nakano N, Ishida K, Kuroda Y, Maeda T, Hayashi S, Kuroda R. Rotational mismatch between femoral and tibial components should be avoided in JOURNEY II bi-cruciate stabilized total knee arthroplasty. Knee 2022; 38:69-75. [PMID: 35930895 DOI: 10.1016/j.knee.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/25/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND JOURNEY II bi-cruciate stabilized (BCS) knee system, a guided motion total knee arthroplasty (TKA), has been reported to reproduce physiological knee kinematic motion with good clinical outcomes. However, this guided system may be sensitive to the femorotibial rotational alignment. METHOD Forty-four patients (50 knees) who underwent JOURNEY II BCS TKA were included in this retrospective study. The 2011 Knee Society Score (KSS) and range of motion were assessed pre-operatively and one year postoperatively. The femoral component rotational angle relative to the surgical epicondylar axis and the tibial component rotational angle relative to Akagi's line were measured postoperatively. The absolute difference between the femoral and tibial component rotational angles was defined as femorotibial component rotational mismatch. The correlation between the parameters of these rotational alignments and postoperative clinical outcomes was evaluated. Additionally, receiver operating characteristic curve analysis was performed to determine the optimal cut-off point of the femorotibial component rotational mismatch. RESULTS Mean femoral and tibial component rotational angles were 0.4° (internal rotation) and 0.7° (external rotation), respectively. The rotational mismatch of the femorotibial component was 3.2°. There were negative correlations between femorotibial rotational mismatch and clinical outcomes, including objective knee indicators, patient satisfaction, functional activities, and total 2011 KSS. The area under the curve of the femorotibial component rotational mismatch was 0.768 and the cut-off value identified by the Youden index was 2.8°. CONCLUSIONS Excessive rotational mismatch between the femoral and tibial components can negatively influence the clinical outcomes of JOURNEY II BCS TKA.
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Affiliation(s)
- Masahiro Fujita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihisa Maeda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Digennaro V, Manzetti M, Bulzacki Bogucki BD, Barile F, Panciera A, Viroli G, Ferri R, Cecchin D, Ruffilli A, Faldini C. Total knee replacements using rotating hinge implants in polio patients: clinical and functional outcomes. Musculoskelet Surg 2022:10.1007/s12306-022-00755-w. [PMID: 35947326 DOI: 10.1007/s12306-022-00755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
Little evidences are available in the literature concerning the outcomes of total knee replacement (TKR) in poliomyelitis patients with severe knee deformities or degeneration. Encouraging results have been reported concerning the use of constrained implants, i.e., rotating hinge knee prosthesis (RHK), compared to less constrained ones. The purpose of this paper is to report our experience with rotating hinge total knee replacement, using only RHK prosthesis, to determine functional results, complications, and survival of TKR in poliomyelitis patients. We performed a retrospective chart review of 14 patients with a history of knee osteoarthritis following poliomyelitis that underwent primary TKR, for a total of 15 surgical procedure (one bilateral case). Preoperative and postoperative clinical measurements have been conducted for all patients using the Knee Society Score (KSS). Hip-knee angle, recurvatum knee angle, and Insall-Salvati index were evaluated with full weight-bearing panoramic view X-ray preoperatively and postoperatively. The 2-year postoperative clinical KSS significantly improved from the preoperative scores. The average clinical KSS improved from 32,9 (range 3-48) preoperatively to 77,4 (range 60-88) postoperatively (P value < 0.005). The average functional KSS improved from 32,5 (range 10-60) preoperatively to 59,4 (range 30-95) postoperatively (P value < 0.005). TKR is a successful treatment in improving knee function and patient's quality of life. Using constrained implants, especially rotating hinge implants in polio patients with a quadriceps muscle weakness, could be a good alternative to maintain a physiological kinematics and reducing the revision rate due to knee instability.
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Affiliation(s)
- V Digennaro
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - M Manzetti
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - B D Bulzacki Bogucki
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - F Barile
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Panciera
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Viroli
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - R Ferri
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - D Cecchin
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Rajgopal A, Sudarshan P, Kumar S, Aggarwal K. Failure modes in malrotated total knee replacement. Arch Orthop Trauma Surg 2022; 143:2713-2720. [PMID: 35920891 DOI: 10.1007/s00402-022-04569-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Achieving normal rotational alignment of both components in total knee arthroplasty (TKA) is essential for improved knee survivorship and function. However, malrotation is a known complication resulting in higher revision rates. Understanding malrotation of the components and its concomitant clinical and functional outcomes are important for early diagnosis and management. The purpose of this study was to evaluate the effect of malrotation on clinical outcomes and failure modes in both single and combined rotational malalignment. METHODS From our hospital database of 364 revisions, a cohort of 76 knees with patellar maltracking, stiffness, reduced range of motion and early aseptic failure were reviewed and investigated for component malrotation using computed tomography following Berger protocol. CT findings confirmed component malrotation in 70 of these patients. Investigations included (1) measurement of femoral component malrotation using surgical transepicondylar axis, (2) measurement of tibial component malrotation using anteroposterior axis and (3) measurement of combined component rotational errors. RESULTS The correlation of CT analysis and clinical outcomes after primary TKA revealed association of patellar maltracking with femoral internal rotation, pain and instability with tibial internal rotation and knee stiffness in patients with combined component malrotation as the commonest mode of presentation. Our study showed that patients with isolated femoral, tibial and combined malrotation presented at a mean period of 3.4 ± 1.34, 1.7 ± 0.8 and 2.3 ± 0.69 years, respectively, after the index surgery. Post-revision, the mean Knee Society Score and Oxford Knee Score improved from 29.1 to 78.7, and 10.5 to 32.8, respectively, and the mean range of motion improved from 74.9 ± 24.8 to 97.1 ± 12.7 degrees at a mean follow-up of 42 months. CONCLUSION Early detection of malrotation in TKA and its management with revision of both components can lead to better clinical and functional outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ashok Rajgopal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta - The Medicity, Sector 38, Gurugram, 122002, Haryana, India.
| | - Paneendra Sudarshan
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta - The Medicity, Sector 38, Gurugram, 122002, Haryana, India
| | - Sumit Kumar
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta - The Medicity, Sector 38, Gurugram, 122002, Haryana, India
| | - Kalpana Aggarwal
- Institute of Musculoskeletal Disorders and Orthopaedics, Medanta - The Medicity, Sector 38, Gurugram, 122002, Haryana, India
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Computer-assisted surgery and patient-specific instrumentation improve the accuracy of tibial baseplate rotation in total knee arthroplasty compared to conventional instrumentation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2654-2665. [PMID: 33646370 DOI: 10.1007/s00167-021-06495-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/05/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine whether patient-specific instrumentation (PSI), computer-assisted surgery (CAS) or robot-assisted surgery (RAS) enable more accurate rotational alignment of the tibial baseplate in primary total knee arthroplasty (TKA) compared to conventional instrumentation, in terms of deviation from the planned target and the proportion of outliers from the target zone. METHODS The authors independently conducted three structured electronic literature searches using the PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases from 2007 to 2020. Studies were included if they compared rotational alignment of the tibial baseplate during TKA using conventional instrumentation versus PSI, CAS, and/or RAS, and reported deviation from preoperatively planned rotational alignment of the tibial baseplate in terms of absolute angles and/or number of outliers. Methodological quality of eligible studies was assessed by two researchers according to the Downs and Black Quality Checklist for Health Care Intervention Studies. RESULTS Fifteen studies, that reported on 2925 knees, were eligible for this systematic review, of which 6 studies used PSI, and 9 used CAS. No studies were found for RAS. Of the studies that reported on angular deviation from preoperatively planned rotational alignment, most found smaller deviations using PSI (0.5° to 1.4°) compared to conventional instrumentation (1.0° to 1.6°). All studies that reported on proportions of outliers from a target zone (± 3°), found lower rates of outliers using PSI (0 to 22%) compared to conventional instrumentation (5 to 96%). Most studies reported smaller angular deviation from preoperatively planned rotational alignment using CAS (0.1° to 6.9°) compared to conventional instrumentation (1.1° to 7.8°). Of the studies that reported on proportions of outliers from a target zone (± 3°), most found fewer outliers using CAS (10 to 61%) compared to conventional instrumentation (17 to 78%). CONCLUSION This systematic review and meta-analysis revealed that both CAS and PSI can improve the accuracy of rotational alignment of the tibial baseplate by decreasing angular deviation from the preoperatively planned target and reducing the proportion of outliers from the target zone. The clinical relevance is that PSI and CAS can improve alignment, though the thresholds necessary to grant better outcomes and survival remain unclear. LEVEL OF EVIDENCE IV.
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Cherian NJ, Ohnoutka C, Peissig EJ, Hsing TM, Aggarwal A, Keeney JA. Cemented Patellar Implant Malposition: A Non-Issue for the Painful Total Knee Arthroplasty. J Arthroplasty 2022; 37:S859-S863. [PMID: 35151808 DOI: 10.1016/j.arth.2022.02.020] [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: 11/16/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Non-optimal patellofemoral relationships may influence treatment decisions during revision total knee arthroplasty (TKA). We performed this study to determine whether patellar implant malposition or patellar tilt is associated with inferior patient-reported outcome scores or patient satisfaction after primary TKA. METHODS We identified 396 TKA patients (439 knees) from an institutional registry who had undergone patellar resurfacing, with preoperative and 6-week postoperative radiographs available, and patient-reported outcome measures (PROMs) completed at least 1 year after surgery (mean 505 days). Preoperative patient demographic characteristics, patient-reported expectations, National Institutes of Health - Patient Reported Outcomes Measurements Instrument Systems global health, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and University of California Los Angeles activity scores were compared between 60 TKAs performed with non-optimal patellofemoral relationships (36 patellar implant malposition, 24 patellar tilt) and 379 TKAs performed with optimal patellar implant placement. RESULTS There were no differences between the 2 cohorts regarding demographic features, preoperative radiographic disease severity, expectations, and PROMs; or postoperative tibiofemoral component alignment, PROMs, and patient-reported satisfaction (P = .48). Knee Injury and Osteoarthritis Outcome Score for Joint Replacement improved similarly (P = .62) for patients with optimal resurfacing (48.5-77.6 points) and non-optimal resurfacing (47.7-76.6 points). A similar proportion of optimal and suboptimal resurfaced patients reported being satisfied with their TKA (92.7% vs 88.1%, P = .29). CONCLUSION Although suboptimal patellofemoral relationships may prompt treatment considerations during revision TKA, the data obtained from this study do not suggest that patellar implant malposition or patellar tilt independently contribute to postoperative pain, functional limitation, or dissatisfaction. LEVEL OF EVIDENCE This is a level III, retrospective cohort study.
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Affiliation(s)
- Nathan J Cherian
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Cole Ohnoutka
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Evan J Peissig
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Thomas M Hsing
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Ajay Aggarwal
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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Cretu B, Serban B, Iordache S, Cursaru A, Costache M, Cirstoiu C. New anatomical landmark for rotational assessment of total knee arthroplasty. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One of the most controversial topics in total knee arthroplasty is rotation of the femoral component. The current gold-standard in total knee arthroplasty consists in positioning the femoral component in 3 degrees of external rotation to the epicondylar axis, having as reference the tangent to the posterior condyles. Achieving the correct rotation of the femoral components is one of the main goals during total knee arthroplasty. Multiple complications can result from internal femoral rotation, such as lateral patellar tilt, patellar subluxation or dislocation, mobilization with movement on pain, and low survival rates of the femoral components. Postoperative rotational assessment of protective components can only be performed correctly using computed tomography. The known evaluation methods are related to anteversion of the femoral neck, femoral trans-epicondylar line, insertion of the posterior cruciate ligament from the tibia and tibial tuberosity. The purpose of this study was to evaluate the rotation of the prosthetic components in the group of patients with the methods validated by studies and to find alternatives to evaluate the rotation of the femoral component. Thirty-four patients diagnosted with gonarthrosis, proposed for total knee arthroplasty, were included in the study. This is a prospective cohort study in which applied statistics consisted of analyzing data using frequency and percentage for qualitative and mean variables and standard deviation for quantitative variables
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Mizu-Uchi H, Ma Y, Ishibashi S, Colwell CW, Nakashima Y, D'Lima DD. Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty. Sci Rep 2022; 12:12319. [PMID: 35854017 PMCID: PMC9296446 DOI: 10.1038/s41598-022-15759-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Patellofemoral joint complications remain an important issue in total knee arthroplasty. We compared the patellofemoral contact status between cruciate-retaining and posterior-stabilized designs with varying degrees of tibial sagittal and rotational alignment using a computer simulation to ensure proper alignments in total knee arthroplasty. Knee kinematics, patellofemoral contact force and quadriceps force were computed using a musculoskeletal modeling program (LifeMOD/KneeSIM 2010; LifeModeler, Inc., San Clemente, California) during a weight-bearing deep knee bend. Two different posterior tibial slope (PTS)s (3° and 7°) and five different tibial tray rotational alignments (neutral, internal 5° and 10°, and external 5° and 10°) were simulated. Patellofemoral contact area and stresses were next computed using finite element analysis. The patellofemoral contact force for the posterior-stabilized design was substantially lower than the cruciate-retaining design after post-cam contact because of increasing femoral roll-back. Neutral rotational alignment of the tibial component resulted in smaller differences in patellofemoral contact stresses between cruciate-retaining and posterior-stabilized designs for PTSs of 3° or 7°. However, the patellar contact stresses in the cruciate-retaining design were greater than those in posterior-stabilized design at 120° of knee flexion with PTS of 3° combined with internal rotation of the tibial component. Our study provides biomechanical evidence implicating lower PTSs combined with internal malrotation of the tibial component and the resultant increase in patellofemoral stresses as a potential source of anterior knee pain in cruciate-retaining design.
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Affiliation(s)
- Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Clifford W Colwell
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA.
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Eseonu O, Mactier M, Ferguson E, Quondamatteo F, Blyth M, Jones B. Soft-tissue landmarks for tibial baseplate rotational alignment in total knee arthroplasty: A cadaveric study. Clin Anat 2022; 35:1107-1113. [PMID: 35668648 DOI: 10.1002/ca.23921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 11/11/2022]
Abstract
The tip of the tibial tubercle (TTT) is used to assess tibial baseplate rotation in total knee arthroplasty (TKA); however, it can be difficult to palpate and visualize intraoperatively. Several more easily accessible soft-tissue structures have been proposed as intraoperative assessments, including the patellar tendon's medial border (MBPT) and the junction of the medial third of the patellar tendon (mt-PT). No studies have described the relationship between the TTT and these proposed landmarks. The aims of the study were to (1) determine the relationship of the soft-tissue landmarks to the TTT and (2) identify any sex differences in these measures. Measurements of the position of these soft-tissue landmarks relative to the TTT were made on 56 cadaveric knees (28 female) by two observers at the level of the standard tibial cut (10 mm distal to the lateral tibial plateau). The results obtained were compared by sex and side. On average, 50.7% (SD 6.79, range 33.1%-63.1%) of the patellar tendon footprint was medial to the TTT. There were no significant differences between the sexes or left and right lower limbs. However, there was large variability in the position of all the soft-tissue landmarks relative to the TTT. The results indicate that, on average, the patellar tendon footprint is evenly spread around the TTT. However, there is a large variability in the anatomical relationship between the soft-tissue landmarks and the TTT. Caution is advised if relying on these structures intraoperatively.
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Affiliation(s)
- Onyedikachi Eseonu
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Mhairi Mactier
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, Scotland
| | | | - Fabio Quondamatteo
- Department of Anatomy and Regenerative Medicine, RCSI, Dublin 2, Ireland
| | - Mark Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Bryn Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, Scotland
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35
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Clark G, Quinn M, Murgier J, Wood D. Tibial component rotation alters soft tissue balance in a cruciate retaining total knee arthroplasty. Comput Assist Surg (Abingdon) 2022; 27:35-40. [PMID: 35649126 DOI: 10.1080/24699322.2022.2078738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Our aim was to understand whether using different landmarks for tibial component rotation influenced articular contact pressures in a balanced total knee arthroplasty (TKA). Twelve patients underwent TKA (Triathlon CR, Stryker Inc., Mahwah, NJ) and contact pressures were assessed using a wireless sensor. Robotic arm assisted TKA using a functional alignment technique was performed, with balanced gaps between medial and lateral compartments. Compartment pressures were measured with the trial tibial component rotated to Akagi's line and to Insall's axis respectively. Rotating the tibial component to Akagi's line resulted in a significantly greater proportion of knees being balanced and lower contact pressures than when the tibial component was rotated to Insall's axis at 10°, 45° and 90° of flexion (p < 0.05). Medial compartment pressures were significantly increased in 10° of flexion, as were lateral compartment pressures in all positions when the tibial component was aligned to Insall's axis (p < 0.05). The mean difference in rotation observed with the two landmarks was 6.9° (range 4.1-9.1°). Rotational alignment of the tibial component using Akagi's line reduced contact pressures, improved balance and reduced the need for soft tissue release when compared with Insall's axis in robotic arm assisted TKA.
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Affiliation(s)
- Gavin Clark
- Perth Hip and Knee Clinic, Subiaco, Australia.,St John of God Subiaco Hospital, Subiaco, Australia.,University of Western Australia, Perth, Australia
| | - Mark Quinn
- Tallaght University Hospital, Dublin, Ireland
| | - Jerome Murgier
- Aguilera Private Clinic, Ramsey générale de Santé, Biarritz, France
| | - David Wood
- University of Western Australia, Perth, Australia
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Sasaki R, Niki Y, Kaneda K, Yamada Y, Nagura T, Nakamura M, Jinzaki M. A novel anteroposterior axis of the tibia for total knee arthroplasty: An upright weight-bearing computed tomography analysis. Knee 2022; 36:80-86. [PMID: 35561561 DOI: 10.1016/j.knee.2022.04.009] [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: 08/13/2021] [Revised: 03/13/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The traditional anteroposterior (AP) axis (i.e., Akagi's line) has been widely used as the tibial component AP axis during total knee arthroplasty (TKA). However, this AP axis has been defined based on computed tomography (CT) in a non-weight-bearing supine position. In this study, AP axes of the tibial plateau from upright CT in weight-bearing and non-weight-bearing positions were determined and compared. METHODS This study included 43 knees from 23 healthy volunteers. CT images were obtained in weight-bearing and non-weight-bearing standing positions using a 320-detector row upright CT scanner. The line perpendicular to surgical transepicondylar axis projected onto the tibia plateau was determined as the AP axis in upright weight-bearing and non-weight-bearing conditions. Angular differences between these two conditions were measured. RESULTS The upright weight-bearing AP axis was positioned in a mean of 7.4 ± 4.3° of internal rotation relative to the traditional AP axis. Distance between the traditional and upright weight-bearing AP axis was 2.9 ± 1.6 mm at the edge of the tibial plateau. The upright non-weight-bearing AP axis was positioned in a mean of 3.5 ± 4.1° of internal rotation relative to the traditional AP axis. Mean angular difference between weight-bearing and non-weight-bearing conditions was 3.9 ± 4.1°. CONCLUSIONS The upright weight-bearing AP axis was positioned in 7.4° of internal rotation relative to the traditional AP axis, showing one-seventh of the tibial tuberosity away from the medial border of the tibial tubercle, which represents a practical landmark for the tibial component AP axis during TKA.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Kazuya Kaneda
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Kreuzer S, Brar A, Campanelli V. Dimensional accuracy of TKA cut surfaces with an active robotic system. Comput Assist Surg (Abingdon) 2022; 27:41-49. [DOI: 10.1080/24699322.2022.2080116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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38
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Hattori Y, Asai N, Mori K, Mori S, Ikuta K, Kazama Y, Sato T, Kaneko A. Evaluation of an operation support system using the femoral anterior tangent line to determine intraoperative femoral component rotation in total knee arthroplasty. J Orthop Sci 2022; 27:658-664. [PMID: 33867199 DOI: 10.1016/j.jos.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/25/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The femoral anterior tangent (FAT) line refers to a line parallel to the anterior surface of the distal femur in the axial plane. This study aimed to evaluate the effectiveness of a new operation support system which uses the FAT line to set the femoral component rotational alignment in total knee arthroplasty (TKA). METHODS A total of 170 consecutive knees in 139 patients undergoing primary TKA with the JIGEN (Jig Engaged Three-dimensional (3D) Pre-Operative Planning Software for TKA) operation support system was examined. The JIGEN system creates 3D models of bones using computed tomography data, allowing for surgical simulations such as positioning of implants while calculating positions of the intramedullary alignment rod (IM rod) and surgical jig. We retrospectively analyzed the FAT line angle relative to the surgical epicondylar axis (SEA) on the axis plane perpendicular to the IM rod and evaluated the accuracy of the femoral component alignment after TKA with the 3D measurement system. RESULTS The FAT line was 9.6° ± 3.7° (range, 1.4°-20.4°) internally rotated relative to the SEA. The average absolute error was 1.4° ± 1.1° in the coronal plane, 2.0° ± 1.5° in the sagittal plane, and 1.6° ± 1.3° in the axial plane. The femoral component outliers (i.e., >3° away from the goal alignment) were 7.7% in the coronal plane, 20.6% in the sagittal plane, and 10.3% in the axial plane. CONCLUSIONS Our findings suggest that the FAT line is a reliable and reproducibly identifiable axis for the accurate determination of proper rotational alignment in TKA. An operation support system which uses the FAT line for determining intraoperative femoral component rotation can effectively achieve highly accurate positioning of the femoral component in TKA.
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Affiliation(s)
- Yosuke Hattori
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan.
| | - Nobuyuki Asai
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
| | - Koichi Mori
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
| | - Shotaro Mori
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
| | - Ken Ikuta
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
| | - Yusuke Kazama
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
| | - Tomotaro Sato
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
| | - Atsushi Kaneko
- National Hospital Organization Nagoya Medical Center, Orthopaedic Surgery and Rheumatology, Nagoya, Japan
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Hull ML, Howell SM. Differences in Trochlear Morphology from Native Using a Femoral Component Interfaced with an Anatomical Patellar Prosthesis in Kinematic Alignment and Mechanical Alignment. J Knee Surg 2022; 35:625-633. [PMID: 32927493 DOI: 10.1055/s-0040-1716413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellofemoral complications following total knee arthroplasty can be traced in part to alignment of the femoral component. Kinematic alignment (KA) and mechanical alignment (MA) use the same femoral component but align the component differently. Our objective was to determine differences in trochlear morphology from native for a femoral component interfaced with an anatomical patellar prosthesis in KA and MA. Ten three-dimensional femur-cartilage models were created by combining computed tomography and laser scans of native human cadaveric femurs free of skeletal abnormalities. The femoral component was positioned using KA and MA. Measurements of the prosthetic and native trochlea were made along the arc length of the native trochlear groove and differences from native were computed for the medial-lateral and radial locations of the groove and sulcus angle. Mean medial-lateral locations of the prosthetic groove were within 1.5 and 3.5 mm of native for KA and MA, respectively. Mean radial locations of the prosthetic groove were as large as 5 mm less than native for KA and differences were greater for MA. Sulcus angles of the prosthetic trochlea were 10 degrees steeper proximally, and 10 degrees flatter distally than native for both KA and MA. Largest differences from native occurred for radial locations and sulcus angles for both KA and MA. The consistency of these results with those of other fundamentally different designs which use a modified dome (i.e., sombrero hat) patellar prosthesis highlights the need to reassess the design of the prosthetic trochlea on the part of multiple manufacturers worldwide.
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Affiliation(s)
- Maury L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, California.,Department of Mechanical Engineering, University of California Davis, Davis, California.,Department of Orthopaedic Surgery, University of California Davis, Davis, California
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California Davis, Davis, California
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Jin Y, Li P, Yang Y, Zeng X, Shen H, Zhang L, Tsai TY, Chen J. A New Reference Axis for Tibial Component Rotation in Total Knee Arthroplasty: A Three-dimensional Computed Tomography Analysis. Front Surg 2022; 9:872533. [PMID: 35574544 PMCID: PMC9091956 DOI: 10.3389/fsurg.2022.872533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to introduce a new reference axis for tibial rotation in total knee arthroplasty (TKA) and verify its reliability. A consecutive series of 80 knees that underwent TKA from 2018 to 2020 as well as 80 healthy knees were analyzed using a three-dimensional tibial model. A coordinate system was established based on the standard TKA tibial cut. The line connecting the lateral-tibial eminence and the medial 1/3rd of the tibial tubercle or the medial border of the tibial tubercle was identified as the lateral eminence line (LE line) and the medial lateral eminence line (MLE line), respectively. To evaluate the reliability of the new reference axis, Akagi's line, the medial third of the tibial tubercle (1/3 line) was compared with the LE and MLE lines by measuring the angle between the lines and the Z-axis. In the coronal view, the intersection angle (TPA), which is composed of the line connecting the center of the medial and lateral tibial plateau with the Z-axis, was measured. The mean angle between Akagi's line and the Z-axis in the healthy group and the osteoarthritis (OA) group was 87.57 ± 3.48° and 87.61 ± 3.47°, respectively. The mean angle between the LE line and Z-axis in the healthy and OA groups was 87.15 ± 4.13° and 86.78 ± 3.95°, respectively. A weak correlation was found between the TPA and Akagi's line and the 1/3 line. A moderate correlation was observed between the TPA and LE lines. There were no significant differences between the healthy and OA groups (P > 0.05) in any of the four reference axes. The LE line showed excellent intra- and inter-observer reliability and reproducibility. The novel and easily drawn LE line is a preferable option for tibial component rotational alignment in TKA.
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Affiliation(s)
- Yan Jin
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Pingyue Li
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Pingyue Li
| | - Yiming Yang
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xianli Zeng
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongyuan Shen
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lihang Zhang
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education, Beijing, China
| | - Jiarong Chen
- Department of Orthopedics, PLA General Hospital of Southern Theatre Command, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Sharma M, Dhanjani B, Upadhyaya AR. Accuracy and Validity of Sharma's Venn Diagram Method for Assessment of Tibial Component Rotation in Total Knee Arthroplasty. Indian J Orthop 2022; 56:1291-1302. [PMID: 35813533 PMCID: PMC9232673 DOI: 10.1007/s43465-022-00627-2] [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: 10/03/2021] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Malrotation of the tibial component in a total knee replacement leads to anterior knee pain, patella dislocations, extensor mechanism disruptions, knee stiffness and prosthesis loosening. Techniques like free-floating technique, medial 1/3 rd of the tibial tubercle, medial border of the tibial tuberosity, Akagi's line, transcondylar line of tibia, posterior condylar line of tibia, midsulcus of tibial spines, curve on curve technique have been advocated. None of these have been shown to be accurate and reproducible. We developed a novel 'Sharma's Venn Diagram' method to assess the tibial component rotation. METHODS Fifty-two consecutive knee replacements were included in a prospective observational study. The average age of the study group was 53.6 years (48-76 years) Thirty-one were females and 3 were males. The patients were followed a minimum of one years (max 2 years, average 1.8 years). 'Sharma's Venn diagram Method (C)' was compared to free-floating method (F) and post-op CT scans using Berger protocol (B). RESULTS Tibial rotation calculated using Sharma's Venn diagram method (C) coincided with the final component placement in 50/52 knees. The free floating method (F) coincided with method (C) in 30/52 knees with an average 4.8° external rotation in 5 knees and an average of 5.2° internal rotation in 17 knees. Bland Altman method was used to compare method (C) with Method (F), The difference was statistically significant p < 0.0001. CONCLUSION Sharma's Venn diagram method is reliable, accurate and easily reproducible by any surgeon performing tkr and correlates with postoperative 2D CT-based assessment of tibial component rotation. LEVEL II STUDY Prospective observational study.
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Affiliation(s)
- Mrinal Sharma
- Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India
| | - Bharat Dhanjani
- Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India
| | - Akshay Raj Upadhyaya
- Asian Institute of Medical Sciences, Badkal Flyover Road, Sec 21A, Faridabad, Delhi NCR India
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Pongcharoen B, Tantarak N, Pholsawatchai W. Is standard total knee arthroplasty with lateral femoral overhanging a cause of anterior knee pain? A randomized controlled trial. SICOT J 2022; 8:3. [PMID: 35191829 PMCID: PMC8862639 DOI: 10.1051/sicotj/2022003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: Anterior knee pain (AKP) may persist after total knee arthroplasty (TKA), even if well aligned and stable, and is reported in up to 30% of patients, leading to patient dissatisfaction. The gender-specific knee prostheses have been designed to reduce femoral component overhanging in females and improve patient satisfaction. The purpose of this study was to determine AKP between gender-specific knee prosthesis and unisex knee prosthesis following minimally invasive surgery (MIS) TKA with patellar resurfacing. Methods: This study was a randomized trial comparing a gender-specific vs. unisex knee prosthesis in females with knee osteoarthritis. Follow-up occurred at 6 weeks, 3 months, 6 months, 1 year, and 2 years. Pre- and postoperative AKP were measured at each follow-up. Intraoperative lateral overhanging of the femoral component and patellar tracking were also measured and compared between the two groups. Results: Sixty females were recruited; 30 underwent gender-specific knee prosthesis (Gp1) and 30 underwent unisex knee prosthesis (Gp2). No patients were lost to follow-up. The incidence rates of AKP and visual analog scale AKP pain scores at 2 years were 7 vs. 7% (p = 1.00) and 0.95 ± 0.31 (0–1) points vs. 1.10 ± 0.28 (0–1) points (p = 0.68) for gender and unisex prostheses, respectively. Patellar tilt and patellar shift were similar between the two groups. Patellar tilt and patellar shift were 2.56° ± 2.03 (0–8) vs. 2.67° ± 2.35 (0–9) (p = 0.46) and 1.25 ± 1.09 (0–3.2) mm vs. 1.15 ± 0.97 (0–2.9) mm (p = 0.34) for Gp1 and Gp2, respectively. Mean lateral femoral overhanging was 0.23 ± 0.63 mm (range: 1–2 mm, Gp1) vs. 1.57 ± 1.36 mm (range: 1–3 mm, Gp2) (p ≤ 0.001). Conclusion: Both types of prostheses had similar incidence rates of AKP, VAS scores for AKP. Lateral femoral overhanging of ≤ 3 mm was not the cause of AKP.
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Affiliation(s)
- Boonchana Pongcharoen
- Department of Orthopaedic Surgery, Thammasat University 95 Paholyothin Road KlongLuang 12120 Thailand
- Corresponding author:
| | - Narong Tantarak
- Department of Orthopaedic Surgery, Thammasat University 95 Paholyothin Road KlongLuang 12120 Thailand
| | - Waroot Pholsawatchai
- Chulabhorn International Collage of Medicine, Thammasat University 99 Moo 18 Paholyothin Road Pathumthani 12120 Thailand
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Dalyan S, Ozan F, Altun İ, Kahraman M, Günay AE, Özdemir K. The Influence of Component Rotational Malalignment on Early Clinical Outcomes in Total Knee Arthroplasty. Cureus 2022; 14:e22444. [PMID: 35345680 PMCID: PMC8942043 DOI: 10.7759/cureus.22444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
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Murgier J, Clatworthy M. Variable rotation of the femur does not affect outcome with patient specific alignment navigated balanced TKA. Knee Surg Sports Traumatol Arthrosc 2022; 30:517-526. [PMID: 32783080 DOI: 10.1007/s00167-020-06226-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Excessive internal and external rotation of the femoral component has been associated with poor outcome with a measured-resection neutral mechanical alignment TKA. This technique assumes that every tibia is in 3° of varus so the femoral component is placed in 3° of external rotation relative to the posterior condylar axis to enable a balanced flexion gap. This is not the case as there is wide variability in the bony anatomy and soft tissue envelope of the knee so flexion imbalance may occur. A patient-specific alignment navigated balanced TKA technique was performed whereby the tibia is cut anatomically up to 3° of varus, then a ligament tensor is used to determine the optimal femoral component position for a balanced TKA. This results in variable femoral rotation. The hypothesis is that matching the femoral component rotation to the patient's anatomic tibial cut and soft tissue envelope will not affect clinical outcome METHODS: In a single surgeon series 287 consecutive varus aligned TKA's were performed using this technique with an Attune cruciate retaining fixed bearing TKA with an anatomic patella resurfacing. The angle between the posterior femoral cuts and the posterior condylar axis was collected using Brainlab software. Functional scores were collected prospectively preoperatively and at two years. The variable femoral component rotation was correlated with and compared with the functional outcome scores. RESULTS The femoral rotation varied from 7° of internal rotation to 8°of external rotation relative to the posterior condylar axis. The mean rotation was 1.1° of external rotation. There was no significant difference in the Oxford score, WOMAC score, Forgotten Knee Score, KOOS Joint Replacement score or Patient Satisfaction in respect to the variable femoral rotation relative to the posterior condylar axis. CONCLUSION When a more anatomic-balanced TKA technique is used variable femoral rotation will not affect clinical outcome at two years LEVEL OF EVIDENCE: II Prospective Cohort Study.
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Affiliation(s)
- Jérôme Murgier
- Orthopaedic Department, Aguiléra Private Clinic, Ramsey Santé, Biarritz, France
| | - Mark Clatworthy
- Department of Orthopaedics, Middlemore Hospital, 100 Hospital Rd, Otahuhu, Auckland, 2025, New Zealand.
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Ohmori T, Kabata T, Kajino Y, Inoue D, Ueno T, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueoka K, Yamamuro Y, Tsuchiya H. Importance of Three-Dimensional Evaluation of Surgical Transepicondylar Axis in Total Knee Arthroplasty. J Knee Surg 2022; 35:32-38. [PMID: 32512597 DOI: 10.1055/s-0040-1712087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In total knee arthroplasty, the surgical transepicondylar axis (SEA) is one of the most reliable rotation axes for stabilizing of the patellofemoral joint. The SEA is identified with reference to the lateral epicondyle and the medial sulcus of the medial epicondyle. However, these two structures rarely appear on the same plane on computed tomography (CT), and it is necessary to take two points in separate images. Many surgeons measure the SEA on the same image (pseudo SEA) instead. We aimed to determine the difference between true SEAs and pseudo SEAs. A total of 31 normal knees and 24 varus knees were included in this study. Three-dimensional (3D) models of the femur were reconstructed from CT images, and a reconstructed plane was made using the International Society of Biomechanics coordinate system. Pseudo SEAs drawn in the plane passing through the lateral epicondyle and medial sulcus were defined as l-SEA and m-SEA, respectively. L-SEA, m-SEA, true SEA, and posterior condylar axis (PCA) were projected onto the International Society of Biomechanics coordinate plane and, "p l-SEA," "p m-SEA," "p true SEA," and "p PCA" were obtained. The true SEA angle was defined as the angle between p true SEA and p PCA. The l-SEA angle or m-SEA angle was defined as the angle between the p l-SEA or p m-SEA and p PCA, respectively. There were no statistically significant differences between true SEA angle (2.64 ± 2.01 degrees) and pseudo SEA angle (l-SEA angle: 2.74 ± 2.07 degrees, m-SEA: 2.54 ± 2.19 degrees). Conversely, 12 knees in the normal group and 2 knees in the varus group had differences of more than 1 degree (p = 0.01). Among them, 6 knees in the normal group and 0 knees in the varus group had a difference of 2 degrees or more (p = 0.03). In most cases, pseudo SEA can be substituted for true SEA.
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Affiliation(s)
- Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tadashi Taga
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Yamamoto
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomoharu Takagi
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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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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Twiggs J, Miles B, Roe J, Fritsch B, Liu D, Parker D, Dickison D, Shimmin A, BarBo J, McMahon S, Solomon M, Boyle R, Walter L. Can TKA outcomes be predicted with computational simulation? Generation of a patient specific planning tool. Knee 2021; 33:38-48. [PMID: 34543991 DOI: 10.1016/j.knee.2021.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Computer simulations of knee movement allow Total Knee Arthroplasty (TKA) dynamic outcomes to be studied. This study aims to build a model predicting patient reported outcome from a simulation of post-operative TKA joint dynamics. METHODS Landmark localisation was performed on 239 segmented pre-operative computerized tomography (CT) scans to capture patient specific soft tissue attachments. The pre-operative bones and 3D implant files were registered to post-operative CT scans following TKA. Each post-operative knee was simulated undergoing a deep knee bend with assumed ligament balancing of the extension space. The kinematic results from this simulation were used in a Multivariate Adaptive Regression Spline algorithm, predicting attainment of a Patient Acceptable Symptom State (PASS) score in captured 12 month post-operative Knee Injury and Osteoarthritis Outcome Scores (KOOS). An independent series of 250 patients was evaluated by the predictive model to assess how the predictive model behaved in a pre-operative planning context. RESULTS The generated predictive algorithm, called the Dynamic Knee Score (DKS) contained features, in order of significance, related to tibio-femoral force, patello-femoral motion and tibio-femoral motion. Area Under the Curve for predicting attainment of the PASS KOOS Score was 0.64. The predictive model produced a bimodal spread of predictions, reflecting a tendency to either strongly prefer one alignment plan over another or be ambivalent. CONCLUSION A predictive algorithm relating patient reported outcome to the outputs of a computational simulation of a deep knee bend has been derived (the DKS). Simulation outcomes related to tibio-femoral balance had the highest correlation with patient reported outcome.
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Affiliation(s)
| | | | - Justin Roe
- North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, North Sydney 2060, Australia
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
| | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, Gold Coast 4221, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute, Sydney 2067, Australia
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Kazarian GS, Lieberman EG, Hansen EJ, Nunley RM, Barrack RL. Clinical impact of component placement in manually instrumented total knee arthroplasty : a systematic review. Bone Joint J 2021; 103-B:1449-1456. [PMID: 34465158 DOI: 10.1302/0301-620x.103b9.bjj-2020-1639.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA). METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included. Study quality was assessed, evidence was graded (one-star: no evidence, two-star: limited evidence, three-star: moderate evidence, four-star: strong evidence), and recommendations were made based on the available evidence. RESULTS A total of 49 studies were identified for inclusion. With respect to PROMs, there was two-star evidence in support of mechanical axis alignment (MAA), femorotibial angle (FTA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), femoral rotation, tibial and combined rotation/mismatch, and implant size/overhang or offset on PROMs, and one-star evidence in support of tibial sagittal angle (TSA), impacting PROMs. With respect to survival, there was three- to four-star evidence in support FTA, FCA, TCA, and TSA, moderate evidence in support of femoral rotation, tibial and combined rotation/mismatch, and limited evidence in support of MAA, FSA, and implant size/overhang or offset impacting survival. CONCLUSION Overall, there is limited evidence to suggest that PROMs are impacted by the accuracy of implant placement, and malalignment does not appear to be a significant driver of the observed high rates of patient dissatisfaction following TKA. However, FTA, FCA, TCA, TSA, and implant rotation demonstrate a moderate-strong relationship with implant survival. Efforts should be made to improve the accuracy of these parameters in order to improve TKA survival. Cite this article: Bone Joint J 2021;103-B(9):1449-1456.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth G Lieberman
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Erik J Hansen
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
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Kaneko T, Igarashi T, Takada K, Yoshizawa S, Ikegami H, Musha Y. Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements. Knee 2021; 31:64-76. [PMID: 34118583 DOI: 10.1016/j.knee.2021.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/06/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study was to compare the accuracy of prosthetic alignment with three-dimensional computed tomography (3DCT) measurements following total knee arthroplasty (TKA) performed using a robotic-assisted surgical technique versus a conventional TKA. METHODS 41 TKAs were performed with a handheld robotic-assisted surgical procedure (Robot group) between 2019 and 2020. Another 41 patients underwent TKA with a conventional manual surgical procedure (Manual group) using the same prosthesis. The operation durations between both groups were investigated. 3DCT scans of the entire lower extremities were taken before and after the surgery and femoral and tibial alignments in the coronal, sagittal, and axial planes were measured using computer software. The differences in prosthetic alignment and translation between the preoperative 3DCT plan and postoperative 3DCT image were also measured. RESULTS There were no statistically significant differences in the post-operative outliers of the femorotibial angle between the groups. In the tibial-axial plane, the mean of prosthetic alignment in the anteroposterior plane was 4.0° in the Robot group and 6.7° in the Manual group (p < 0.01). The rate of outliers for tibial-axial alignment in the Robot group was significantly less than in the Manual group (p < 0.01). There were no statistically significant differences in prosthetic translation in the proximal-distal, anterior-posterior and medial-lateral orientations between the groups. CONCLUSIONS In a radiologic study using 3DCT, robotic-assisted TKA reduced the outliers for rotational alignment of the tibial prosthesis in comparison to conventional TKA, which can lead to improved tracking of the femoral-tibial bearing surfaces.
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Affiliation(s)
- Takao Kaneko
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | | | - Kazutaka Takada
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | - Shu Yoshizawa
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
| | - Yoshiro Musha
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
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Three Degrees External to the Posterior Condylar Axis Has Little Relevance in Femoral Component Rotation: A Computed Tomography-Based Total Knee Arthroplasty Simulation Study. J Arthroplasty 2021; 36:S380-S385. [PMID: 33431188 DOI: 10.1016/j.arth.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Femoral component rotation in total knee arthroplasty (TKA) has a significant impact on balance and patellofemoral kinematics. However, normal anatomic relationships between rotational axes are poorly understood. As such, we sought to characterize anatomic femoral rotational axes in patients undergoing primary TKA. METHODS We identified 100 patients who underwent a primary TKA with a preoperative computed tomography scan. The angles between the surgical epicondylar axis (SEA) and the anterior-posterior (AP) axis to the posterior condylar axis (PCA) were measured independently by a musculoskeletal fellowship-trained radiologist and a fellowship-trained arthroplasty surgeon. We simulated an ideal TKA in which the femoral component was placed exactly 3° external to the PCA and measured resulting rotation. RESULTS The SEA was on average 1.5° externally rotated to the PCA (range 3.1° internal to 7.0° external). The AP axis was on average 4.5° externally rotated to the PCA (range 2.3° internal to 10.3° external). The AP axis was a mean 2.7° externally rotated to the SEA (range 6.3° internal to 10.3° external). Routinely setting femoral rotation 3° external to the PCA would result in only 51 (51%) TKAs within ±2° of the SEA and 23 (23%) femoral components internally rotated relative to the SEA. CONCLUSION Normal anatomic rotational axes of arthritic knees are highly variable, with a 10° range in the SEA and 16° range in the AP axis. Routinely setting femoral rotation 3° external to the PCA will yield significant error in aligning the femoral component with either the SEA or AP axis.
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