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Kiran Eachempati K, Parameswaran A, Apsingi S, Dannana CS, Gautam D, Sheth NP. Influence of the functional status of the anterior cruciate ligament on the posterior medial femoral condyle among varus osteoarthritic knees. J Orthop 2025; 68:1-6. [PMID: 39925627 PMCID: PMC11803135 DOI: 10.1016/j.jor.2025.01.028] [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: 12/16/2024] [Revised: 01/13/2025] [Accepted: 01/19/2025] [Indexed: 02/11/2025] Open
Abstract
Background Morphologic changes in the posterior medial femoral condyle (PMFC) among varus osteoarthritic knees have not been described in the past. The aims of this study were to compare anterior cruciate ligament (ACL) competent and deficient varus osteoarthritic knees during computer-navigation assisted (CAS) total knee arthroplasty (TKA) in terms of their pre-operative deformity, rotation of the posterior condylar axis (PCA) with respect to Whiteside's axis, and prevalence of PMFC hyperplasia or attrition. Methods Data pertaining to pre-operative varus deformity, rotation of the PCA with respect to Whiteside's axis, and presence of PMFC hyperplasia or attrition were analyzed for 250 consecutive patients each, with ACL-competent and deficient knees, who underwent CAS TKA for varus osteoarthritis of the knee. Results ACL-deficient knees, compared to ACL-competent knees, were associated with greater pre-operative stressed (9.94° ± 6.14° versus 7.29° ± 4.48°, P < 0.001) and corrected (3.62° ± 4.36° versus 2.41° ± 3.08°, P < 0.001) varus deformities, internal rotation of the PCA with respect to Whiteside's axis (4.06° ± 2.32° versus 3.08° ± 2.03°, P < 0.001), and prevalence of PMFC attrition (8.4 % versus 0 %, P < 0.001) and hyperplasia (27.2 % versus 9.6 %, P < 0.001). Conclusion Chronic ACL deficiency in varus osteoarthritic knees may result in progression of the coronal deformity, PMFC attrition, increased internal rotation of the PCA with respect to Whiteside's axis, and eventually PMFC hyperplasia. This needs to be borne in mind during TKA to prevent inadvertent placement of the femoral component in inappropriate rotation.
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Affiliation(s)
| | - Apurve Parameswaran
- Department of Orthopaedics, Medicover Hospitals, HITEC City, Hyderabad, Telangana, India
| | - Sunil Apsingi
- Department of Orthopaedics, Medicover Hospitals, HITEC City, Hyderabad, Telangana, India
| | - Chandra Sekhar Dannana
- Department of Orthopaedics, Medicover Hospitals, HITEC City, Hyderabad, Telangana, India
| | - Deepak Gautam
- Department of Orthopaedics, BVP Medicover Hospital, Navi Mumbai, Maharashtra, India
| | - Neil P. Sheth
- Penn Orthopaedics at Pennsylvania Hospital, University of Pennsylvania, 1 Cathcart, 800 Spruce Street, 8 Preston Building, Philadelphia, PA, 19107, USA
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Gregori P, Koutserimpas C, Giovanoulis V, Batailler C, Servien E, Lustig S. Functional alignment in robotic-assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short-term outcomes. Knee Surg Sports Traumatol Arthrosc 2025; 33:2187-2196. [PMID: 39821487 DOI: 10.1002/ksa.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 12/31/2024] [Accepted: 01/01/2025] [Indexed: 01/19/2025]
Abstract
PURPOSE Functional alignment (FA) in total knee arthroplasty (TKA) prioritizes soft tissue balancing and anatomical restoration without systematic correction to neutral alignment. Most studies have focused on varus deformity, with little evidence available about FA in valgus deformity. The hypothesis of the present study was that FA in robotic-assisted TKA for valgus deformity would demonstrate correction of the coronal alignment and yield satisfactory short-term outcomes. METHODS This retrospective study included 58 patients with valgus coronal alignment (hip-knee-angle [HKA] ≥ 183°) who underwent robotic-assisted TKA using the FA technique with a minimum of 1-year follow-up. Outcomes were assessed through the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and radiographic measurements of alignment and phenotypes. Complication and revision rates were also analyzed. RESULTS The cohort included 39 females and 19 males with a median age of 70. Post-operatively, 86.2% of cases achieved coronal alignment within the safe zone (HKA 177-183°). Significant improvements were observed in KSS (part 1: 69.5-95, part 2: 65-94, p < 0.001), while OKS and FJS exhibited optimal outcomes. Two complications were recorded: one aseptic loosening (1.7%) and one early infection (1.7%). Kaplan-Meier survival analysis indicated favourable implant survivorship at a median follow-up of 18 months. CONCLUSION FA in image-based robotic TKA is a safe and effective approach for patients with valgus deformity. This procedure resulted in a modest correction of the coronal alignment, where no soft tissue releases were needed. The majority of the cases fell within the target coronal alignment boundaries by only accommodating the individual laxities, suggesting the aim of FA to restore each knee's pre-pathological alignment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pietro Gregori
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Christos Koutserimpas
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
| | - Vasileios Giovanoulis
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, Lyon, France
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王 鑫, 马 剑, 张 淞, 谭 瑞. [Application of femoral condyle sliding osteotomy in initial total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2025; 39:425-433. [PMID: 40240037 PMCID: PMC12011504 DOI: 10.7507/1002-1892.202501059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/28/2025] [Accepted: 03/28/2025] [Indexed: 04/18/2025]
Abstract
Objective To investigate the effect of femoral condyle sliding osteotomy (FCSO) on the flexion gap and external rotation of the prosthesis in balancing coronal instability during initial total knee arthroplasty (TKA). Methods Between November 2021 and October 2024, FCSO technique was applied to balance the coronal medial and lateral spaces during initial TKA in 3 patients, including medial condyle sliding osteotomy (MCSO) and lateral condyle sliding osteotomy (LCSO). There were 1 male and 2 females with the age of 81, 68, and 68 years old. The affected knee has varus or valgus deformity, with tibia-femoral angles of 169.7°, 203.3°, and 162.2°, respectively. The hip-knee-ankle angle (HKA), range of motion (ROM), knee society scoring system (KSS), and pain visual analogue scale (VAS) score were used to evaluate joint function and pain relief. Based on model bone, the thickness and bone bed area of the medial and lateral femoral condyle osteotomy blocks in FCSO were measured. During TKA in 12 patients, the range of osteotomy block movement was evaluated. By simplifying the upward and forward movement of the osteotomy block into a geometric model, the impact of movement on the flexion gap and external rotation of the prosthesis was calculated. Results After application of FCSO during TKA, the limb alignment and medial and lateral balance at extension and flexion positions were restored in 3 patients. Three patients were followed up 23, 11, and 3 months, respectively. Postoperative HKA, pain VAS score, KSS score, and ROM all showed significant improvement compared to preoperative levels. The maximum thickness of osteotomy blocks by MCSO and LCSO was 17 and 12 mm, respectively. The simple upward movement of the osteotomy block mainly affected the extension gap, and had little effect on the flexion gap and external rotation of the prosthesis. Moving the osteotomy block forward at the same time had a significant impact on the flexion gap and external rotation of the prosthesis, especially on LCSO. Mild forward movement leaded to a decrease in external rotation of more than 3°, which had a serious impact on the patellar trajectory. Conclusion FCSO can effectively solve the problem of imbalance between the medial and lateral spaces during initial TKA, avoiding knee joint instability caused by excessive loosening and limiting the use of constrained condylar prosthesis. The distance for the downward movement of the osteotomy block in MCSO and LCSO was 3-5 mm and 6-8 mm, respectively, with 10-15 mm of space for forward movement and almost no space for backward movement. For MCSO, the upward and forward movement of the osteotomy block will increase the external rotation of the prosthesis, which is beneficial for improving the patellar trajectory and suitable for valgus knee. LCSO is suitable for varus knee, and the osteotomy block only slides vertically up and down without moving forward and backward.
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Affiliation(s)
- 鑫 王
- 重庆医科大学附属璧山医院骨科（重庆 402760）Department of Orthopedics, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, P. R. China
| | - 剑 马
- 重庆医科大学附属璧山医院骨科（重庆 402760）Department of Orthopedics, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, P. R. China
| | - 淞炎 张
- 重庆医科大学附属璧山医院骨科（重庆 402760）Department of Orthopedics, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, P. R. China
| | - 瑞 谭
- 重庆医科大学附属璧山医院骨科（重庆 402760）Department of Orthopedics, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, P. R. China
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Naraoka T, Soneda H, Hori R, Morioka S, Matsuyama Y. Evaluation of soft tissue balancing and component alignment in computer-navigated TKA for valgus knee. J Orthop 2025; 62:160-164. [PMID: 40226528 PMCID: PMC11993182 DOI: 10.1016/j.jor.2025.03.054] [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: 03/20/2025] [Accepted: 03/25/2025] [Indexed: 04/15/2025] Open
Abstract
Purpose Computer-navigated total knee arthroplasty (CN-TKA) is useful for improving the accuracy of osseous cuts, soft tissue balance, and component placement. However, the usefulness of CN-TKA for valgus deformity remains unclear. This study aimed to assess the availability of CN-TKA for valgus deformities and compare it with CN-TKA for varus knees. Methods A total of 74 cruciate-retaining CN-TKAs (20 valgus, 54 varus) were included in this study. After implantation, the intraoperative hip-knee-ankle (HKA) angle was recorded during full extension and at 30° and 90° of flexion under three conditions (no stress, valgus stress, and varus stress), and the medial and lateral laxities were calculated. The femorotibial angle (FTA), HKA angle, patellar tilt, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured on postoperative radiographs. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm score were determined at 1 year postoperatively. Results The lateral laxity of varus knee in full extension was significantly larger than that of valgus knee (valgus: 0.5 ± 0.7°, varus: 1.2 ± 1.0°, p = 0.011). The medial laxity of valgus knee at 90° of flexion was significantly larger than that of varus knee (valgus: 0.4 ± 0.6°, varus: 0.1 ± 0.3°, p = 0.004). There were no significant differences in the FTA, HKA angle, patellar tilt, mLDFA, mMPTA, KOOS scores, or Lysholme score between the two groups postoperatively. Conclusion CN-TKA for valgus knee demonstrated acceptable soft tissue balancing and component alignment and good early clinical results comparable to those of CN-TKA for varus knees.
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Affiliation(s)
- Takuya Naraoka
- Department of Orthopaedic Surgery, Fujinomiya City General Hospital, 3-1 Nishiki-cho, Fujinomiya, Shizuoka, 418-0076, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hikaru Soneda
- Department of Orthopaedic Surgery, Fujinomiya City General Hospital, 3-1 Nishiki-cho, Fujinomiya, Shizuoka, 418-0076, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Runa Hori
- Department of Orthopaedic Surgery, Fujinomiya City General Hospital, 3-1 Nishiki-cho, Fujinomiya, Shizuoka, 418-0076, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - So Morioka
- Department of Orthopaedic Surgery, Fujinomiya City General Hospital, 3-1 Nishiki-cho, Fujinomiya, Shizuoka, 418-0076, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Howgate DJ, Makovicka JL, Austin RP, Bingham JS, Spangehl MJ, Clarke HD. Hypoplasia of the Lateral Femoral Condyle Is Not Associated With Valgus Knee Alignment. J Arthroplasty 2025:S0883-5403(25)00099-3. [PMID: 39909086 DOI: 10.1016/j.arth.2025.01.048] [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: 12/02/2024] [Revised: 01/26/2025] [Accepted: 01/27/2025] [Indexed: 02/07/2025] Open
Abstract
BACKGROUND Valgus lower limb alignment has anecdotally been associated with lateral femoral condyle (LFC) hypoplasia. However, limited scientific evidence exists to substantiate this doctrine. This study aimed to investigate the association between coronal plane alignment (CPA) and bony distal femoral geometry. METHODS Routine preoperative computed tomography scans and full-length weight-bearing radiographs were analyzed for patients undergoing primary total knee arthroplasty, and standardized measurements of bony distal femoral geometry were recorded. Ratios between lateral to medial structure measurements were used to adjust for size differences between patients. Patients were grouped by CPA and sex with statistical analysis performed to determine any significant groupwise differences for each measurement/ratio. RESULTS There were 156 patients included, with 83 women (53.2%) and 73 men (46.8%). There were 100 patients (64.1%) who demonstrated varus (women n = 49; men n = 51) and 56 patients (35.9%) who had valgus alignment. No significant differences were observed between groups in age, body mass index, race, or laterality of the imaged knee. Linear regression modeling demonstrated no significant groupwise differences in lateral/medial condyle anteroposterior (AP) distance or lateral/medial posterior condyle offset ratios in relation to CPA and sex, or in lateral/medial condyle diameter ratio in relation to CPA alone. Valgus alignment was associated with significantly reduced lateral/medial epicondyle to posterior condyle distance ratio, lateral/medial femoral column length ratios, and increased lateral femoral AP condyle distance to transcondylar width. CONCLUSIONS No statistically significant differences exist across most standardized measurements of lateral distal femoral geometry in relation to CPA. Contrary to conventional thought, patients who had valgus alignment did not demonstrate reduced bony AP diameter of the LFC. Perceived LFC hypoplasia in patients who have valgus alignment may be attributable to differences in cartilage wear of the LFC, relative shortening of the lateral femoral column, or a relative posterior position of the lateral epicondyle resulting in an internally rotated appearance of the distal femur in the axial plane relative to the transepicondylar axis.
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Affiliation(s)
| | | | - Roman P Austin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ; University of New Mexico School of Medicine, Albuquerque, NM
| | | | | | - Henry D Clarke
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ
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Pierre-Henri V, Vincent G, Bertrand B, Frédéric F, Thomas N, Rémi P. Can robotic arm-assisted total knee arthroplasty be applied to valgus deformity. Arch Orthop Trauma Surg 2025; 145:137. [PMID: 39849167 DOI: 10.1007/s00402-025-05756-5] [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: 07/03/2024] [Accepted: 01/07/2025] [Indexed: 01/25/2025]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) in valgus knees is challenging. Optimal ligament balance, implant neutral or moderate valgus alignment are crucial but conventional instrumentations usually lead to outliers. Robotic arm assisted TKA (RATKA) advantages could answer this challenge. Objectives were to assess RATKA frontal alignment accuracy for valgus knees, rotational femoral component reliability, revision surgery rate and functional outcomes for this population. METHODS This study is based on a continuous series of 454 RATKA. Implants were positioned according to a patient-specific alignment and postero-stabilised inserts were used. Valgus values, range of motion, KOOS and revision surgery rates were assessed at one-year postoperative. Femoral component rotation was analysed intraoperatively. RESULTS MAKO navigation system confirmed valgus preoperative deformity for 34 patients. Mean postoperative valgus value was - 1.5°±1.53 (range, -5 to 1), 85% patients had a residual valgus between 0 and - 3°, 97% of patients had a difference < 3° between valgus planned and valgus measured at one year postoperatively. Mean femoral rotation was + 2.65°±1.87 (range, 0 to 6.8°) of external rotation related to posterior condylar angle. No revision surgery has been performed. Mean KOOS value at one year was 80.79. 76% of patients (n = 26) had a good (70-80) or excellent (> 80) KOOS score. Mean flexion value was 133°±12 (range, 100 to 140). CONCLUSION RATKA can be applicable in valgus knee, offering high precision in component positioning with very few outliers. It also facilitates component rotation positioning, providing excellent functional results and ROM.
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Affiliation(s)
- Vermorel Pierre-Henri
- Department of Orthopaedic Surgery, University Hospital centre (Saint Etienne), Avenue Albert Raimond, Saint-priest-en-Jarez, 42270, France.
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Saint-Etienne, F-42023, France.
| | - Genestoux Vincent
- Department of Orthopaedic Surgery, University Hospital centre (Saint Etienne), Avenue Albert Raimond, Saint-priest-en-Jarez, 42270, France
| | - Boyer Bertrand
- Department of Orthopaedic Surgery, University Hospital centre (Saint Etienne), Avenue Albert Raimond, Saint-priest-en-Jarez, 42270, France
| | - Farizon Frédéric
- Department of Orthopaedic Surgery, University Hospital centre (Saint Etienne), Avenue Albert Raimond, Saint-priest-en-Jarez, 42270, France
| | - Neri Thomas
- Department of Orthopaedic Surgery, University Hospital centre (Saint Etienne), Avenue Albert Raimond, Saint-priest-en-Jarez, 42270, France
- Laboratoire Interuniversitaire de Biologie de la Motricité, Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Saint-Etienne, F-42023, France
| | - Philippot Rémi
- Department of Orthopaedic Surgery, University Hospital centre (Saint Etienne), Avenue Albert Raimond, Saint-priest-en-Jarez, 42270, France
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Polascik BA, Levin JM, Wixted CM, Warren E, Bethell MA, Briggs DV, Faraz K, Goltz D, Helmkamp J, Bolognesi MP, Jiranek W, Seyler T. Coronal plane deformity in total knee arthroplasty is associated with increased operative time and disposition to skilled nursing facility. Arch Orthop Trauma Surg 2024; 145:104. [PMID: 39739045 DOI: 10.1007/s00402-024-05737-0] [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: 11/05/2024] [Accepted: 12/13/2024] [Indexed: 01/02/2025]
Abstract
PURPOSE Studies demonstrate similar long-term Total Knee Arthroplasty (TKA) outcomes in patients with significant versus minimal preoperative coronal plane deformity. Limited short-term outcomes data, which determine costs of care, exist. METHODS We retrospectively explored the impact of preoperative coronal plane deformity on operative time, length of stay (LOS), and discharge to skilled nursing facility (SNF) in TKA. A total of 3,964 patients undergoing unilateral primary TKA at our institution from 2014 to 2019 were included (1,158 > 10˚ deformity: mean age 67.2 years, 47% male; 2,806 < 10˚ deformity: mean age 67 years, 37.4% male). The degree of coronal plane deformity (mechanical axis deviation on preoperative radiographs) was recorded. Patients with no knee radiographs ≤ 3 years preoperatively were excluded. Statistical analysis included Chi-Square tests, Student's t-tests, Mann-Whitney U tests, and uni- and multivariable linear and logistic regression analyses. RESULTS The > 10˚ deformity cohort had a longer time from procedure start to finish (113.56 vs. 110.68 min; p = 0.020), greater deviation from surgeon mean operative time (+ 6.19 vs. + 0.69 min; p < 0.001), and higher proportion of cases requiring > 15 (26.8% vs. 22%;p = 0.001) and > 30 (12.3% vs. 7.8%;p < 0.001) additional minutes over their scheduled times. LOS was similar between cohorts (median 2 days, IQR 1-3). The deformity cohort more likely discharged to SNF (19.9% vs. 15.8%;p = 0.002). For every 1˚ increase in coronal plane deformity, operative time increased by 0.566 min (p = 0.000). The odds of SNF discharge increased with increasing coronal plane deformity (OR 1.029 [1.009,1.050]; p = 0.004). CONCLUSION Greater preoperative coronal deformity is associated with increased operative time and odds of discharge to SNF in TKA.
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Affiliation(s)
- Breanna A Polascik
- Duke University School of Medicine, Durham, USA.
- Northwestern Memorial Hospital, Chicago, USA.
| | | | - Colleen M Wixted
- Duke University School of Medicine, Durham, USA
- New York University Langone Medical Center, New York, USA
| | - Eric Warren
- Duke University School of Medicine, Durham, USA
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Nkachukwu K, Alejo A, Toman J, Jwayyed J, Iwuagwu J, Alejo A. Denervation of the Patella During Knee Arthroplasty: An Updated Systematic Global Review. J Clin Med 2024; 13:6942. [PMID: 39598085 PMCID: PMC11594293 DOI: 10.3390/jcm13226942] [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: 11/01/2024] [Revised: 11/12/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024] Open
Abstract
Background: Total knee arthroplasty is a widely endorsed surgical intervention, extensively recognized within the orthopedic field for its efficacy in significantly reducing pain and enhancing overall mobility in patients suffering from advanced stages of osteoarthritis. Despite a general consensus on the core procedural steps, the rapid advancements in implant technology and the nuanced techniques in knee reconstruction have inevitably introduced subtle variations in surgical approaches. These variations often emerge due to individual surgeon preferences, their unique expertise, and comfort levels with specific techniques. Anterior knee pain, however, remains a frequent postoperative complication, likely attributed to the extensive and complex innervation of the patella. To address this challenge, some surgeons have adopted patellar denervation, hypothesizing that by reducing nerve signaling from the patellar region, patients may experience a measurable decrease in pain. Methods: A systematic search was performed to include eight recent level I studies to analyze this issue. Results: Of the eight reviews, there were four strong studies that concluded patellar denervation helps decrease anterior knee pain in the acute period, but this may not last long term. The other four papers did not show a difference in anterior knee pain after denervation. Conclusions: This review synthesizes and critically analyzes the current body of literature, aiming to provide clinicians with evidence-based insights into the potential benefits and limitations of incorporating patellar denervation into their surgical especially during the acute post-operative period.
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Affiliation(s)
- Kennedy Nkachukwu
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Amanda Alejo
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Jeffrey Toman
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Jalal Jwayyed
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Justin Iwuagwu
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Andrew Alejo
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
- Department of Orthopaedics, Stony Brook University Hospital, Stony Brook, NY 11794, USA
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Kage T, Kono K, Tomita T, Yamazaki T, Taketomi S, Yamagami R, Kawaguchi K, Murakami R, Arakawa T, Kobayashi T, Inui H, Tanaka S. Medial pivot total knee arthroplasty for valgus knees provides equivalent medial stability compared to that for varus knees: In vivo kinematic study. J Exp Orthop 2024; 11:e70013. [PMID: 39703832 PMCID: PMC11655669 DOI: 10.1002/jeo2.70013] [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: 06/08/2024] [Accepted: 07/02/2024] [Indexed: 12/21/2024] Open
Abstract
Purpose The efficacy of medial pivot total knee arthroplasty (MP TKA) in treating valgus knees that may cause medial instability is unknown. The purpose of this study was to investigate the in vivo kinematics of MP TKA for the valgus knees and compare them to those for the varus knees. Methods The kinematics of 19 valgus knees and 19 varus knees operated in the MP TKA were investigated under fluoroscopy during squatting using a two- to three-dimensional registration technique. Accordingly, the valgus and varus knees were evaluated and compared in terms of knee flexion angle, anteroposterior translation for the medial and lateral low contact points, axial rotation and valgus-varus angle of the femoral component relative to the tibial component, as well as kinematic pathways. Results The knee flexion angle was found to be identical in both knees. There was no anterior translation on the medial side of the valgus knees, and no difference was detected between the two knees. On the lateral side, posterior translation was observed in both knees, with no difference between the two. Femoral external rotation was observed in both knees, and no difference was detected between the two. There was no valgus-varus change in the valgus knees, nor was there a difference between the two knees. The valgus knees demonstrated MP motion, whereas the varus knees demonstrated MP motion and bicondylar rollback. Conclusion The medial side of the valgus knees treated with MP TKA showed comparable stable kinematics to the varus knees. The MP TKA is an effective procedure for valgus knees to stabilize the medial compartment. Level of Evidence Level Ⅲ.
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Affiliation(s)
- Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Tetsuya Tomita
- Graduate School of Health SciencesMorinomiya University of Medical SciencesOsakaJapan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of EngineeringSaitama Institute of TechnologyFukayaSaitamaJapan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Takashi Kobayashi
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
- Department of Orthopaedic Surgery, Saitama Medical CenterSaitama Medical UniversityKawagoe CitySaitamaJapan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoBunkyo‐kuTokyoJapan
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10
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Nedopil AJ, Dhaliwal AS, Klasan A, Howell SM, Hull ML. No Radiographic Evidence of Medial Collateral Ligament Elongation in Valgus Osteoarthritic Knees Enables Treatment with Kinematically Aligned Total Knee Arthroplasty. J Knee Surg 2024. [PMID: 39163998 DOI: 10.1055/a-2395-6831] [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: 08/22/2024]
Abstract
When performing caliper-verified kinematically aligned total knee arthroplasty (KA TKA) in the osteoarthritic (OA) knee with valgus deformity, an elongated medial collateral ligament (MCL) could result in a valgus setting of the tibial component. The present study analyzed KA TKA in patients with valgus deformities (i.e., tibiofemoral angle > 10 degrees of valgus) and determined (1) the occurrence of radiographic MCL elongation, (2) the incidence of lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) release and the use of constrained components, and (3) whether the 1-year Forgotten Joint Score (FJS), Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Likert satisfaction score were comparable to KA TKAs for OA deformities ≤10 degrees of valgus. One hundred and two consecutive patients who underwent KA TKA by a single surgeon were analyzed radiographically and clinically at a minimum follow-up of 1 year. Radiographic MCL elongation was identified by a greater than 1 degree of valgus orientation of the tibial component relative to the OA tibial joint line. Twenty-six patients had a radiographic anatomic tibiofemoral angle greater than 10 degrees of valgus (range of OA deformity: 11-23 degrees of valgus). Seventy-six had an OA deformity ≤10 degrees of valgus (10-degree valgus to -14-degree varus). No patient had MCL elongation or a ligament release, or required constrained components. The median FJS of 78, OKS of 42, and KOOS JR of 76, and the 85% satisfaction rate of the patients with greater than 10 degrees of OA valgus deformity were not significantly different from those with ≤10 degrees of OA valgus deformity (p ≥ 0.17). Because MCL elongation was not detected in OA deformities up to 23 degrees of valgus, the risk of under-correcting the valgus deformity leading to instability and poor outcome scores is low when performing KA TKA using primary components without releasing the LCL and/or PCL. LEVEL OF EVIDENCE:: IV.
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Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | | | - Antonio Klasan
- Department of Orthopaedics and Traumatology, AUVA UKH Steiermark, Graz, Austria
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California at Davis, Davis, California
| | - Maury L Hull
- Department of Biomedical Engineering, University of California at Davis, Davis, California
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11
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Gorur A, Czerwonka N, El-Othmani MM, Held MB, Neuwirth AL, Geller JA. Outcomes of Image-Free Robotic Assisted Total Knee Arthroplasty in Patients Who Have Valgus Knee Deformities. J Arthroplasty 2024; 39:S235-S240. [PMID: 38518959 DOI: 10.1016/j.arth.2024.03.032] [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: 12/08/2023] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Valgus knee deformities pose a unique challenge in total knee arthroplasty (TKA) due to the complexity of achieving ligamentous balance and satisfactory alignment compared to varus or neutral deformities. Robotic-assisted (RA) TKA could aid in achieving improved component alignment and balance. METHODS We retrospectively evaluated a matched cohort of patients to compare image-free RA-TKA (n = 44) versus conventional manual (CM) TKA (n = 30) techniques in patients who have valgus deformity of 5 to 15 degrees, including radiographic and patient-reported outcomes measures (PROMs) over a 3-year period. The patient reported outcome measures (PROMs) studied to determine outcomes were: Western Ontario McMaster University Arthritis Index, Knee Society Score-Function Score, and Short Form 12-item Survey. RESULTS Overall, the RA-TKA cohort showed faster improvement in PROMs (37.16 ± 1 8.8 versus 25.74 ± 17.7, P = .02), shorter length of stay (1.41 versus 2.29 days, P = .02), and shorter operating room times (120.79 versus 123.67 minutes, P = .02) than CM-TK). Additionally, there was no difference in the use of primary versus varus-valgus constrained polyethylene liners between the cohorts. CONCLUSIONS In this investigation, RA-TKA yielded a slightly faster patient recovery, more objective measurements of ligamentous balance, and proved noninferior PROMs compared to CM-TKA for preoperative valgus knee deformities.
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Affiliation(s)
- Alaka Gorur
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Mouhanad M El-Othmani
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael B Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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12
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Schrott J, Affortunati S, Stadler C, Hintermüller C. DEIT-Based Bone Position and Orientation Estimation for Robotic Support in Total Knee Arthroplasty-A Computational Feasibility Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:5269. [PMID: 39204964 PMCID: PMC11359506 DOI: 10.3390/s24165269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
Total knee arthroplasty (TKA) is a well-established and successful treatment option for patients with end-stage osteoarthritis of the knee, providing high patient satisfaction. Robotic systems have been widely adopted to perform TKA in orthopaedic centres. The exact spatial positions of the femur and tibia are usually determined through pinned trackers, providing the surgeon with an exact illustration of the axis of the lower limb. The drilling of holes required for mounting the trackers creates weak spots, causing adverse events such as bone fracture. In the presented computational feasibility study, time differential electrical impedance tomography is used to locate the femur positions, thereby the difference in conductivity distribution between two distinct states s0 and s1 of the measured object is reconstructed. The overall approach was tested by simulating five different configurations of thigh shape and considered tissue conductivity distributions. For the cylinder models used for verification and reference, the reconstructed position deviated by about ≈1 mm from the actual bone centre. In case of models mimicking a realistic cross section of the femur position deviated between 7.9 mm 24.8 mm. For all models, the bone axis was off by about φ=1.50° from its actual position.
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Affiliation(s)
- Jakob Schrott
- Institute of Measurement Technology, Johannes Kepler University, 4020 Linz, Austria
| | - Sabrina Affortunati
- Institute of Measurement Technology, Johannes Kepler University, 4020 Linz, Austria
| | - Christian Stadler
- Department for Orthopedics and Traumatology, Kepler University Hospital, 4020 Linz, Austria
- Medical Faculty, Johannes Kepler University, 4020 Linz, Austria
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13
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Liu XY, Yu QP, Chen XM, Zeng WN, Zhou ZK. Effects of preoperative valgus deformity in patients undergoing neutrally aligned total knee arthroplasty: A retrospective cohort study with a minimum five-year follow-up. Jt Dis Relat Surg 2024; 35:529-537. [PMID: 39189561 PMCID: PMC11411898 DOI: 10.52312/jdrs.2024.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/19/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between the severity of preoperative valgus deformity and clinical outcomes of neutrally aligned total knee arthroplasty (TKA). PATIENTS AND METHODS A total of 376 knees with valgus deformity who underwent TKA from January 2006 to March 2014 were retrospectively screened, and 287 knees (242 patients; 32 males, 210 females; mean age: 64.5±8.8 years; range, 35 to 83 years) aligned neutrally after the operation were included. Patients were divided into four groups based on the preoperative hip-knee-ankle (HKA): mild (0°< HKA ≤5°, n=94), moderate (5°< HKA ≤10°, n=74), severe (10°< HKA ≤15°, n=75), and very severe (HKA >15°, n=44) groups. Range of motion (ROM), Knee Society Score (KSS), Visual Analog Scale (VAS) dynamic pain scores, and Forgotten Joint Score (FJS) were evaluated. Mechanical failures were recorded to assess prosthesis survival. A survival rate analysis was performed using Kaplan-Meier survival analysis. RESULTS The degree of preoperative valgus deformity did not have a significant impact on the postoperative ROM, KSS, VAS dynamic pain scores, or FJS at the last follow-up. There were no significant differences in cumulative survival rates of neutrally aligned TKAs at 10 years between the four groups (p=0.513). CONCLUSION The severity of preoperative valgus deformity did not affect the clinical outcomes of neutrally aligned TKAs in the minimum five-year follow-up. Additionally, it did not impact the survival rates of neutrally aligned TKAs over 10 years.
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Affiliation(s)
| | | | | | | | - Zong-Ke Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China.
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14
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Parameswaran A, Reddy JN, Ponnala VK, Apsingi S, Eachempati KK. Precise Calibration of Femoral Component Rotation Using the Posterior Condylar Axis as a Reference during Image-free Robot-assisted Total Knee Arthroplasty: A Technical Note. J Orthop Case Rep 2024; 14:191-197. [PMID: 38910981 PMCID: PMC11189082 DOI: 10.13107/jocr.2024.v14.i06.4548] [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: 03/05/2024] [Revised: 04/30/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction The use of image-free robotic systems for total knee arthroplasty (TKA) is gaining popularity. Although the surgical transepicondylar axis (sTEA) is considered the optimal femoral rotational reference during TKA, it is difficult to define intra-operatively. Conventional and image-free robot-assisted TKA (RA-TKA) therefore rely on the use of Whiteside's axis (WSA) or the posterior condylar axis (PCA) as surrogate references. The PCA is considered to be associated with less variability than the WSA. The authors present a simple technique to permit calibration of femoral component rotation (FCR) using the PCA as a reference for image-free robotic systems that do not permit this option. Technique The image-free robotic systems used by the authors (Navio and CORI, Smith and Nephew, Memphis, TN, USA) permit calibration of FCR only when the perpendicular to WSA is used as a reference. When the PCA is selected as a reference, a fixed 3° of external rotation is set by the robot. The technique proposed by the authors involves the use of the former setting, followed by internal rotation of the perpendicular to the WSA to co-align it with the PCA. The planning menu subsequently permits virtual surgical planning using the PCA as the femoral rotational reference and permits adjustments in rotational positioning of the femoral component while displaying the effect of rotation on bony resection and vice versa in real time. In addition, coaligning the perpendicular to the anatomic trans-epicondylar axis (aTEA) displays the internal rotation of the PCA with respect to the aTEA. This information can be used for setting rotational boundaries with respect to the PCA while using various alternate alignment strategies, like functional alignment, since the relation between the aTEA and sTEA is less likely to be affected by dyplasia and wear when compared with the PCA or WSA. Conclusion This simple technique permits optimally calibrated rotational positioning of the femoral component during image-free RA-TKA, using the PCA as a reference. It can be applied for optimizing surgery in knees with altered or outlier anatomy, as well as routinely, especially when alternate alignment strategies are used.
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Affiliation(s)
- Apurve Parameswaran
- Department of Orthopaedic Surgery, Medicover Hospitals, Hyderabad, Telangana, India
| | - Jakkidi N Reddy
- Department of Orthopaedic Surgery, Medicover Hospitals, Hyderabad, Telangana, India
| | - Vinay K Ponnala
- Department of Orthopaedic Surgery, Medicover Hospitals, Hyderabad, Telangana, India
| | - Sunil Apsingi
- Department of Orthopaedic Surgery, Medicover Hospitals, Hyderabad, Telangana, India
| | - Krishna K Eachempati
- Department of Orthopaedic Surgery, Medicover Hospitals, Hyderabad, Telangana, India
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15
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Entezari B, Lex JR, Peck J, Igbokwe EN, Kubik JF, Backstein DJ, Wolfstadt JI. Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis. Arthroplast Today 2024; 27:101330. [PMID: 39071823 PMCID: PMC11282402 DOI: 10.1016/j.artd.2024.101330] [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: 08/23/2023] [Revised: 12/11/2023] [Accepted: 01/27/2024] [Indexed: 07/30/2024] Open
Abstract
Background Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA. Methods This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation. Results Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (P = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P = .007), stemmed implants (23.8% vs 4.8%, P = .013), and patellar resurfacing (59.5% vs 26.2%, P = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (P = .777). Conclusions TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.
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Affiliation(s)
- Bahar Entezari
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Queen’s University School of Medicine, Kingston, ON, Canada
| | - Johnathan R. Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jonathan Peck
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Emmanuel N. Igbokwe
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy F. Kubik
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - David J. Backstein
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jesse I. Wolfstadt
- Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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16
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An JS, Jacquet C, Loddo G, Mabrouk A, Koga H, Argenson JN, Ollivier M. Deformity in valgus knee malalignment is not only in the femur but also in tibia or both, based on demographic and morphological analysis before and after knee osteotomies. Knee Surg Sports Traumatol Arthrosc 2024; 32:1087-1095. [PMID: 38506121 DOI: 10.1002/ksa.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE This study aims to identify the demographic and morphological features of valgus knee deformity with unilateral osteoarthritic knee in the coronal plane. A secondary aim was to identify the distinct phenotypes of valgus knees in Hirschmann's phenotype and the coronal plane alignment of the knee (CPAK) classifications before and after a knee osteotomy (KO). METHODS A total of 107 patients (57 female and 50 male) with a mean age of 42.4 ± 17.2 years, who underwent varisation osteotomy for symptomatic unilateral knee osteoarthritis (OA) and constitutional valgus deformity, were enrolled in the study, and the mean follow-up period was 29.1 ± 7.3 months. The included cases comprised 60 cases of distal femoral osteotomy, 10 cases of double-level osteotomy and 33 cases of high tibial osteotomy. All patients underwent preoperative and postoperative clinical, functional and radiological evaluations, analysed by analysis of variance tests. RESULTS An analysis of the location of the valgus deformities demonstrated that 56 cases (52.3%) were femoral based, 18 cases (16.8%) were both femoral and tibial based and 33 cases (30.9%) were tibial based. Twelve preosteotomy cases (11.2%) and 38 postosteotomy cases (35.5%) matched the most common eight Hirschmann's phenotypes, phenotyping the coronal lower limb alignment based on the native alignment in young patients without OA. Four (3.7%) preosteotomy cases and 89 postosteotomy cases (83.1%) matched the most common three CPAK phenotypes (Ⅰ, Ⅱ, Ⅴ) based on constitutional alignment and joint line obliquity in healthy and osteoarthritic knees. CONCLUSION In valgus knee malalignment, the location of the deformity is not only solely femoral-based but also solely tibial-based or combined femoral and tibial-based. An individualised osteotomy approach would be recommended to achieve careful preoperative planning that considers the location of the deformity and the resultant joint line. Hirschmann's and CPAK classification would not be relevant when KO is considered. LEVEL OF EVIDENCE Level Ⅳ, retrospective case-control study.
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Affiliation(s)
- Jae-Sung An
- Orthopedic Surgery Department, Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Christophe Jacquet
- Orthopedic Surgery Department, Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Glauco Loddo
- Orthopedic Surgery Department, Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Ahmed Mabrouk
- Orthopedic Surgery Department, Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
- Orthopedic Surgery Department, Leeds Teaching Hospitals, Leeds, UK
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jean-Noël Argenson
- Orthopedic Surgery Department, Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Matthieu Ollivier
- Orthopedic Surgery Department, Institute du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
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17
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Rezaei A, Moon J, Lichtig A, Mera B, Drake B, Choubey AS, Kim S, Tueni N, Piponov H, Koh J, Karam J, Amirouche F. Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty. Front Surg 2024; 11:1331902. [PMID: 38645507 PMCID: PMC11026714 DOI: 10.3389/fsurg.2024.1331902] [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: 11/01/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release. Methods Cadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed. Results A total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm-7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm-26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm-4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm-25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988). Discussion Our results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.
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Affiliation(s)
- Arash Rezaei
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - John Moon
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Asher Lichtig
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Barbara Mera
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Brett Drake
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Apurva S. Choubey
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Sunjung Kim
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Nicole Tueni
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Hristo Piponov
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Jason Koh
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL, United States
| | - Joseph Karam
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Farid Amirouche
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL, United States
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18
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Sterneder CM, Faschingbauer M, Haralambiev L, Kasparek MF, Boettner F. Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review. J Clin Med 2024; 13:1302. [PMID: 38592153 PMCID: PMC10932440 DOI: 10.3390/jcm13051302] [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: 01/28/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient's native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1-2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis.
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Affiliation(s)
- Christian Manuel Sterneder
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Maximilian F. Kasparek
- Department of Orthopedics, Evangelisches Krankenhaus, Hans-Sachs Gasse 10-12, 1180 Vienna, Austria
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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19
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Chaudhary C, Kothari U, Shah S, Pancholi D. Functional and Clinical Outcomes of Total Knee Arthroplasty: A Prospective Study. Cureus 2024; 16:e52415. [PMID: 38371004 PMCID: PMC10869992 DOI: 10.7759/cureus.52415] [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: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION A key to successful patient outcomes following knee procedures like total knee arthroplasty (TKA) is achieving normal knee alignment. Normal mechanical balance in the joints must be restored in order to lessen the failure rate of TKA, and precise assessment of lower extremity alignment and component location is thought to be the primary determinant of a good clinical outcome over the long term. OBJECTIVE The aim of this study was to assess the early functional and clinical outcomes of TKA by analyzing post-operative mechanical axis and Knee Society Score (KSS) data. The study also aimed to investigate the importance of achieving neutral mechanical alignment in TKA for long-term results. METHODS A prospective and retrospective observational study was conducted, involving 40 patients with primary osteoarthritis who underwent bilateral or unilateral TKA. Demographic information, pre-operative comorbidities, knee abnormalities, and radiographic assessment were collected. Post-operative mechanical axis and implant placement were evaluated using CT scanograms. Clinical and functional assessments were performed using the Knee Society Score at regular intervals. The KSS scores were obtained at six-month intervals following surgery. The scores were categorized as excellent, very good, good, fair, or poor based on predefined criteria. RESULTS A total of 47 knees from 40 patients were analyzed. The mean age of the study population was 65.6 years. Female patients accounted for 67.5% of the sample. The majority of patients (57.4%) achieved an excellent KSS score, followed by very good (25.5%) and good (17%) scores. The mean KSS score significantly improved from 177 points pre-surgery to 225 points post-surgery. The post-operative mechanical axis ranged from 1.1 degrees valgus to 9 degrees valgus, with a mean value of 3.5 degrees valgus. The range of motion improved from 10 to 90 degrees post-operatively, with a mean range of 0-110 degrees. CONCLUSION This study suggests that total knee replacement surgery resulted in positive outcomes, with most patients achieving excellent or very good scores on the Knee Society scale. Proper axial and rotational alignment of the components during TKA enhanced functional outcomes and contributed to long-term clinical success. Restoration of neutral mechanical alignment and optimal component placement may lead to lower revision rates and increased durability after TKA. Further studies with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Chintan Chaudhary
- Department of Orthopedics, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, IND
| | - Udit Kothari
- Department of Orthopedics, Aashray Orthopaedic Hospital, Modasa, IND
| | - Samarth Shah
- Department of Orthopedics, Gujarat Medical Education and Research Society (GMERS) Medical College, Vadnagar, IND
| | - Deval Pancholi
- Department of Orthopedics, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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Palanisami D, Dhanasekaran S, Kanugula SK, Natesan R, Shanmuganathan R. Outcomes of lateral femoral sliding osteotomy in primary total knee arthroplasty for type two fixed valgus deformity. INTERNATIONAL ORTHOPAEDICS 2024; 48:111-117. [PMID: 37648763 DOI: 10.1007/s00264-023-05950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The aim of our study was to determine the surgical outcomes of patients who underwent lateral femoral sliding osteotomy (LFSO) with total knee arthroplasty (TKA) for Ranawat's type 2 fixed valgus deformity. METHODS The consecutive patients who underwent primary TKA with posterior-stabilized implant and LFSO for fixed valgus deformity were reviewed. The radiological parameters analyzed were pre- and postoperative hip-knee-ankle (HKA) angle and tibio-femoral angle in varus-valgus stress views. The clinical outcome was measured by Oxford knee score (OKS), knee society score (KSS), and functional score (KSS-F). The complications and any reoperation were noted in the follow-up. RESULTS There were total 28 patients included with an average follow-up time of 47.2 ± 24.9 months. The average arc of motion was 101.3 ± 23.8° preoperatively and 102.7 ± 11.8° postoperatively (p > 0.05). The average deformity in varus and valgus stress views was 196.6 ± 4.8 and 207.8 ± 7.4°, respectively. There was significant improvement in HKA from 205.2 ± 8.3° preoperatively to 181.9 ± 3.7° postoperatively (p < 0.05). At the final follow-up, bony union of the osteotomy fragment was noted in all the patients. There was significant improvement in OKS, KSS, and KSS-F score from a preoperative 15.1 ± 3.9, 35.1 ± 10.6, and 26.6 ± 12.6 to 40.3 ± 2.9, 85.6 ± 4.8, and 89.4 ± 7.7, postoperatively (p < 0.05), respectively. One patient had acute periprosthetic joint infection that was managed with debridement and polyethylene insert exchange. CONCLUSION Lateral femoral sliding osteotomy is an effective technique for optimal soft tissue balance in fixed valgus deformity. It provides satisfactory clinical outcome with restoration of knee alignment without using the constrained implants.
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Affiliation(s)
| | | | - Sandeep Kumar Kanugula
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Rajkumar Natesan
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Mannino A, Weinberg ME, Scuderi GR. Total Knee Arthroplasty in the Valgus Knee. J Knee Surg 2024; 37:86-91. [PMID: 37800175 DOI: 10.1055/a-2186-6013] [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: 10/07/2023]
Abstract
An estimated 10 to 15% of total knee arthroplasties (TKAs) are implanted for a diagnosis of arthritis when a valgus deformity is present. There are various techniques and considerations that must be considered for a successful TKA in a patient with a valgus deformity. This article provides a detailed summary of the anatomy, pathology, bone preparation, soft tissue management, implant selection, and complications when performing a TKA in a patient with valgus deformity.
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Affiliation(s)
- Angelo Mannino
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York
| | - Maxwell E Weinberg
- Department of Orthopedic Surgery, Long Island Jewish Valley Stream, Valley Stream, New York
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York
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Wang Y, Geng L, Zhao R, Yang J, Cheng L, Xin P, Wang Y, Zhang G. Extra-articular biceps tendon supplement release in total knee arthroplasty for valgus deformity combined with severe flexion contracture. J Orthop Res 2023; 41:2433-2441. [PMID: 37186321 DOI: 10.1002/jor.25578] [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: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
To investigate the efficacy of extra-articular biceps tendon supplement (EBS) release in the treatment of valgus knee with severe flexion contracture. We retrospectively studied 27 patients who received EBS release for valgus knee combined with severe flexion contracture from 2018 to 2021. The full-length radiograph of the lower limbs in a standing position was taken before and after the operation, and the tibiofemoral angles before and after the operation were measured on the full-length radiograph of the lower limbs. Knee joint motion measurement and KSS scoring were performed before and after the operation (3 months, 6 months, and 1 year), and the obtained data were compared before and after the operation to evaluate clinical results. Compared with preoperation, postoperative HKA (p < 0.01), ROM at 3 months (p < 0.01), 6 months (p < 0.01), and 1 year (p < 0.01) were significantly improved, and KSS scores at 3 months (p < 0.01), 6 months (p < 0.01), and 1 year (p < 0.01) were significantly improved. Our EBS release has good clinical results for the treatment of valgus knee with severe flexion contracture.
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Affiliation(s)
- Yiming Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Lei Geng
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Runkai Zhao
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jianfeng Yang
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Long Cheng
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Peng Xin
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Guoqiang Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
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Baek JH, Lee SC, Jin H, Kim JW, Ahn HS, Nam CH. Long-term outcomes of total knee arthroplasty in patients with windswept deformity. J Orthop Sci 2023; 28:1068-1073. [PMID: 36075842 DOI: 10.1016/j.jos.2022.08.002] [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: 01/16/2022] [Revised: 07/07/2022] [Accepted: 08/07/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study compared the functional outcomes, implant survival rates, and complications of total knee arthroplasty (TKA) performed in patients with windswept deformity (WSD) and non-WSD patients over at least 10 years of follow-up. METHODS From January 2008 to December 2010, 40 TKAs were performed in 20 patients with WSD (WSD group). Additionally, 60 propensity score-matched patients without WSD who had undergone primary bilateral TKA were chosen for the control group in a three-to-one ratio. Then, the functional outcomes, implant survival rates, and complications of TKA in the two groups were compared. The mean follow-up periods were 10.8 years in the WSD group and 11.5 years in the control group. RESULTS The mean Knee Society knee scores in the WSD and control groups improved from 37.7 to 38.1 points preoperatively to 79.5 and 79.2 points at final follow-up (p = 0.974), while the mean function scores in the WSD and control groups improved from 36.5 to 37.2 points preoperatively to 77.8 and 77.4 points at final follow-up (p = 0.863). Two knees in the WSD group required revision surgery, including one due to septic loosening and one due to aseptic loosening. Five knees in the control group required revision surgery, including three due to septic loosening and two due to aseptic loosening. Kaplan-Meier survivorship analysis with the revision of either component as an endpoint in the WSD and control groups estimated 95.0% and 95.8% chances of survival for 10 years, respectively (p = 0.824). CONCLUSIONS TKA performed in patients with WSD yielded good clinical outcomes and survivorship at least 10 years later. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea
| | - Hosun Jin
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Hye Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea.
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Huang J, Sun H, Li D, Wang Y, Xu J, Ma R. Knee valgus deformity and lateral bone defects affect the function of superficial medial collateral ligament: A finite element analysis. J Orthop 2023; 40:17-22. [PMID: 37168615 PMCID: PMC10164751 DOI: 10.1016/j.jor.2023.04.017] [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: 02/17/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose The superficial medial collateral ligament (sMCL) is the primary restraint to valgus laxity of the knee, which is one of the significant indicators of implant selection in valgus knee. Our purpose is to explore the influence of knee valgus deformity and lateral bone defects in the function of sMCL. Methods the right knee joint of a healthy male volunteer was subjected to CT and MRI scans. The scanned data were imported into Mimics, Geomagic, Solidworks and Ansys software to establish a three-dimensional finite element model of the human knee joint. Femorotibial angle (FTA)5°,10°,15°,20°,25°,30°,35° and lateral bone defect 0,0.5,1,1.5,2 cm are controlled in Solidworks. Tensile test in vitro of maximum load on sMCL was simulated in Ansys. Results The peak stress of sMCL is raising with valgus deformity while there is no lateral defect. Increasing lateral bone defect can lessen the augmentation of the stress of sMCL caused by the valgus deformity. The peak stress of sMCL when it is in maximum load is 35.252 MPa. While valgus 35°, the peak stress of sMCL exceeds the value, with or without bone defect; the same is true for the valgus 30° with 0, 0.5, 1 cm bone defect and valgus 25° without defect. Conclusion Our findings allow for preoperative evaluation of sMCL function in the valgus knee, which would play an instructive role to some extent for implant selection in total knee arthroplasty.
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Affiliation(s)
- Junming Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, Guangdong, China
| | - Hao Sun
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Deng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Yimin Wang
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, Guangdong, China
| | - Jie Xu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
| | - Ruofan Ma
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China
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Wang B, Zhang G, Pu R, Li Q, Wang Y. Clinical significance of distal femur morphology in a healthy Mongolian youth population. Sci Rep 2023; 13:8187. [PMID: 37210457 DOI: 10.1038/s41598-023-35463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/18/2023] [Indexed: 05/22/2023] Open
Abstract
Morphological parameters of knee joint are related to race and nationality. At present, knee prosthesis come from white male population. Due to the mismatch between the prosthesis and other ethnic groups, the prosthesis life span is reduced, revision surgery and the patients' economic burden are increased. There is no data of the Mongolian ethnic group. In order to treat patients more accurately, we measured the Mongolian data of the femoral condyle. A total of 122 knee joints were scanned in 61 volunteers (21 males and 40 females) with an average age of 23.259 ± 1.395 years. The Mimics software was used to reconstruct the 3D image and measure the data of each line. The data were analyzed by statistical methods such as t test, and P < 0.05 was taken as the significant. 122 normal femoral condyle data were obtained. The mean transverse diameter of femoral condyle is 76.472 ± 5.952 mm, medial condyle is 29.259 ± 11.461 mm, and the sagittal diameter of the medial condyle was 56.758 ± 4.163 mm. The transverse diameter of the lateral femoral condyle is 29.388 ± 3.157 mm, the sagittal diameter of the lateral condyle is 58.937 ± 3.527 mm and the femoral plane rate is 1.264 ± 0.072. (1) There was no statistical significance in the left and right knee joint data (P > 0.05). (2) The different genders data of femoral condyle were statistically significant (P < 0.05). (3) Compared with other nationalities and races, the data of femoral condyle are different. (4) There are differences between femoral surface ratio and mainstream prosthesis data.
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Affiliation(s)
- Boyang Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Guoliang Zhang
- Department of Orthopedics, The Affiliated Hospital of Inner Mongolia Medical University, Tongdaobeilu No.1, Hohhot, 010050, Inner Mongolia Autonomous Region, China
| | - Ribusurong Pu
- Department of Orthopedics, The Affiliated Hospital of Inner Mongolia Medical University, Tongdaobeilu No.1, Hohhot, 010050, Inner Mongolia Autonomous Region, China
| | - Qiang Li
- Department of Orthopedics, The Affiliated Hospital of Inner Mongolia Medical University, Tongdaobeilu No.1, Hohhot, 010050, Inner Mongolia Autonomous Region, China
| | - Yuewen Wang
- Department of Orthopedics, The Affiliated Hospital of Inner Mongolia Medical University, Tongdaobeilu No.1, Hohhot, 010050, Inner Mongolia Autonomous Region, China.
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Lee S, Choi Y, Lee J, Lee H, Yoon J, Chang C. Valgus Arthritic Knee Responds Better to Conservative Treatment than the Varus Arthritic Knee. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040779. [PMID: 37109737 PMCID: PMC10146304 DOI: 10.3390/medicina59040779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus arthritic knees. Materials and Methods: Medical records of 834 patients who received knee OA treatment were retrospectively reviewed. Patients with Kellgren-Lawrence grades III and IV were divided into two groups according to knee alignment (varus arthritic knee, hip-knee-ankle angle [HKA] > 0° or valgus arthritic knee, HKA < 0°). The Kaplan-Meier curve with total knee arthroplasty (TKA) as an endpoint was used to compare the survival probability between varus and valgus arthritic knees at one, two, three, four, and five years after the first visit. A receiver operating characteristic (ROC) curve was used to compare the HKA thresholds for TKA between varus and valgus arthritic knees. Results: Valgus arthritic knees responded better to conservative treatment than varus arthritic knees. With TKA as an endpoint, the survival probabilities for varus and valgus arthritic knees were 24.2% and 61.4%, respectively, at the 5-year follow-up (p < 0.001). The thresholds of HKA for varus and valgus arthritic knees for TKA were 4.9° and -8.1°, respectively (varus: area under the ROC curve [AUC] = 0.704, 95% confidence interval [CI] 0.666-0.741, p < 0.001, sensitivity = 0.870, specificity = 0.524; valgus: AUC = 0.753, 95% CI 0.693-0.807, p < 0.001, sensitivity = 0.753, specificity = 0.786). Conclusions: Conservative treatment is more effective for valgus than for varus arthritic knees. This should be considered when explaining the prognosis of conservative treatment for knees with varus and valgus arthritis.
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Affiliation(s)
- SeungHoon Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - YunSeong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - JaeHyuk Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - HeeDong Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - JungRo Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - ChongBum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnamsi 13620, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Wen L, Yu Y, Ma D, Wang Z. Effect of joint line orientation parameters on initial bone resection in mechanically aligned total knee arthroplasty: a retrospective clinicoradiological correlation study. BMC Musculoskelet Disord 2023; 24:222. [PMID: 36964533 PMCID: PMC10037864 DOI: 10.1186/s12891-023-06299-9] [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: 09/07/2022] [Accepted: 03/07/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Discrepancies in bone resection between the medial and lateral compartments are very common in total knee arthroplasty (TKA) when mechanical alignment (MA) is used. The purpose of this study was to explore whether and how joint line orientation affects the initial bone resection in mechanically aligned TKA. METHODS A total of 194 patients (225 knees) diagnosed with osteoarthritis (OA) were included. Virtual bone resection was conducted in the coronal view using full-length weight-bearing radiographs according to the technical requirements of MA, and the reliability of the virtual resection was verified via intraoperative caliper measurements. Correlation and regression analyses were conducted between the initial bone resection within the extension gap (EG) and various parameters, including the hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), joint line congruence angle (JLCA), and medial proximal tibial angle (MPTA). Moreover, the correlation between intraoperative bone resection adjustments and joint line orientation parameters was also investigated. RESULTS All knees in the current case series were artificially divided into 4 subgroups: subgroup 1, containing 148 varus knees (65.8%) with valgus femurs; subgroup 2, containing 48 varus knees (21.3%) with varus femurs; subgroup 3, containing 17 valgus knees (7.6%) with varus tibias; and subgroup 4, containing 12 valgus knees (5.3%) with valgus tibias. In subgroup 1, the mLDFA and MPTA were positively correlated with the initial bone resection with regression coefficients of 0.670 and 0.089, respectively. Moreover, in all varus knees, intraoperative bone resection adjustments were negatively correlated with mLDFA and MPTA, with categorical regression coefficients of -0.426 and - 0.230, respectively. CONCLUSION When MA-TKAs are performed in varus knees with valgus femurs, the initial bone resection within the EG is mainly positively correlated with mLDFA, while the intraoperative bone resection adjustment is significantly correlated with mLDFA and MPTA in all varus knees.
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Affiliation(s)
- Liang Wen
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 100020, Beijing, China
| | - Yang Yu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 100020, Beijing, China
| | - Desi Ma
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 100020, Beijing, China
| | - Zhiwei Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 100020, Beijing, China.
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Rougereau G, Pujol N, Langlais T, Boisrenoult P. Is lateral femoral condyle hypoplasia a feature of genu valgum? A morphological computed tomography study of 200 knees. Orthop Traumatol Surg Res 2023; 109:103582. [PMID: 36868309 DOI: 10.1016/j.otsr.2023.103582] [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: 12/19/2021] [Revised: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND Young surgeons are taught that genu valgum deformity is associated with hypoplasia of the lateral femoral condyle, despite the absence of supporting evidence. The objective of this study was to determine whether the lateral condyle was hypoplastic in genu valgum, by assessing the morphological features of the distal femur and their variations according to the severity of the coronal deformity. HYPOTHESIS The lateral femoral condyle is not hypoplastic in genu valgum deformity. MATERIAL AND METHODS The 200 included patients treated by unilateral total knee arthroplasty were divided into five groups based on their preoperative hip-knee-ankle (HKA) angle. The HKA angle, valgus cut angle (VCA), and anatomical lateral distal femoral angle (aLDFA) were measured on long-leg radiographs. Computed tomography images were then used to measure the medial and lateral anterior-posterior condylar lengths (mAPCL and lAPCL) and condylar thicknesses (mCT and lCT), distal femoral torsion (DFT), medial and lateral posterior condylar heights (mPCH and lPCH), and medial and lateral condylar volumes (mCV and lCV). RESULTS No significant differences were demonstrated across the five mechanical-axis groups for mAPCL, lAPCL, mCT, lCT, mPCH, or lPCH. The groups differed significantly regarding the VCA (p<0.0001), aLDFA (p<0.0001), DFT (p<0.0001), and mCV/lCV ratio (p<0.0001). VCA and aLDFA were smaller when the valgus exceeded 10°. DFT was similar in all varus knees (2.2°-2.6°) but significantly greater for knees with moderate (4.0°) or severe (6.2°) valgus. Finally, lCV was greater than mCV in valgus knees compared to varus knees. CONCLUSION The presence of lateral condyle hypoplasia in knees with genu valgum seems open to question. Apparent hypoplasia noted during the standard physical examination may be chiefly ascribable to distal valgus of the femoral epiphysis in the coronal plane and, with the knee flexed, to distal epiphyseal torsion, whose severity increases with the degree of valgus deformity. These considerations should be taken into account when performing distal femoral cuts for TKA, to ensure the restoration of normal anatomy in patients with genu valgus. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique et traumatologique, hôpital André-Mignot, université Île-de-France Ouest, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - Nicolas Pujol
- Service de chirurgie orthopédique et traumatologique, hôpital André-Mignot, université Île-de-France Ouest, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Tristan Langlais
- Département d'orthopédie pédiatrique, hôpital des enfants, Purpan, université de Toulouse, Toulouse, France
| | - Philippe Boisrenoult
- Service de chirurgie orthopédique et traumatologique, hôpital André-Mignot, université Île-de-France Ouest, 177, rue de Versailles, 78150 Le Chesnay, France
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Omata M, Kaneko T, Amemiya K, Yamamoto A, Takada K, Yoshizawa S. Analysis of Gait Ability and Patient Reported Outcome Measurements after Robotic-assisted Total Knee Arthroplasty for Osteoarthritis of the Knee with Windswept Deformity. J Orthop Case Rep 2023; 13:1-7. [PMID: 37187816 PMCID: PMC10178820 DOI: 10.13107/jocr.2023.v13.i03.3562] [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: 01/13/2023] [Revised: 01/28/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Windswept deformity (WD) refers to valgus deformity in one knee and varus deformity in the other. We performed robotic-assisted (RA) total knee arthroplasty (TKA) for osteoarthritis of the knee with WD, made patient reported outcome measurements (PROMs), and performed gait analysis based on triaxial accelerometery. Case Report A 76-year-old woman presented to our hospital with bilateral knee pain. Image-free handheld RA TKA was performed on the left knee with severe varus deformity and severe pain during walking. RA TKA was performed on the right knee with severe valgus deformity 1 month later. The RA technique was used to determine implant positioning and the plan for osteotomy intraoperatively, taking into account soft-tissue balance. This made it possible to use a posterior stabilized implant instead of a semi-constrained implant for severe valgus knee deformity with flexion contracture (Krachow classification Type 2). At 1 year after TKA, PROMs were inferior in the knee with pre-operative valgus deformity. Gait ability improved after surgery. Even with the RA technique, it took 8 months to achieve left-right balance while walking and for the variability of the gait cycle to become equivalent to that of a normal knee. Conclusion Primary RA TKA is a viable option for osteoarthritis of the knee with WD. It took time for the gait ability of both knees to become equal and PROMs were better with the varus deformity compared to before surgery.
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Affiliation(s)
- Masaru Omata
- Department of Rehabilitation, Ichinomiya Onsen Hospital, Ichinomiya, Japan
| | - Takao Kaneko
- Department of Orthopedic, Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan
| | - Kazuki Amemiya
- Department of Rehabilitation, Ichinomiya Onsen Hospital, Ichinomiya, Japan
| | - Ayakane Yamamoto
- Department of Orthopedic, Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan
| | - Kazutaka Takada
- Department of Orthopedic Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Shu Yoshizawa
- Department of Orthopedic Surgery, Toho University School of Medicine, Tokyo, Japan
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Effect of total knee arthroplasty for valgus knee correction on clinical outcome and patellar position. INTERNATIONAL ORTHOPAEDICS 2023; 47:735-743. [PMID: 36645475 PMCID: PMC9931837 DOI: 10.1007/s00264-023-05689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/01/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose was to investigate the effect of different degrees of valgus deformity correction on patellar position and clinical outcome in patients with valgus knees after total knee arthroplasty (TKA). METHODS We retrospectively analyzed and followed 118 patients with valgus knees. Based on the post-operative hip-knee-ankle (HKA), patients were divided into three groups: neutral (±3°), mild (3-6°), and severe (> 6°). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and Knee Society Score (KSS) were used to evaluate post-operative clinical efficacy. Also, the patellar tilt angle (ε-angle), congruence angle (θ-angle), and Insall-Salvati index (ISI) were used to represent the patellar position. Post-operative observation indicators included HKA, angle of the femur (α-angle), tibial angle (β-angle), femoral component flexion angle (γ-angle), and tibial component posterior slope angle (δ-angle). RESULTS All patients showed significant improvements in HKA, ROM, WOMAC, and KSS after operation (P < 0.001). Regarding patellar position, the ISI values decreased to varying degrees (P < 0.05). The patellar tilt angle was significantly increased in the severe valgus group compared to that in the mild valgus and neutral groups (P < 0.001). Univariate analysis showed that the degree of post-operative residual valgus was significantly affected by WOMAC, KSS, α-, ε-, and θ-angles. CONCLUSION Minor valgus undercorrection did not affect the short-term outcome after TKA; however, when the residual valgus angle was > 6°, the post-operative scores were significantly reduced. Inadequate valgus correction does not result in significant changes in patellar height but may increase the risk of poor patellar tracking.
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Functional Alignment Philosophy in Total Knee Arthroplasty-Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning. J Pers Med 2023; 13:jpm13020212. [PMID: 36836446 PMCID: PMC9961945 DOI: 10.3390/jpm13020212] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
Functional alignment (FA) is a novel philosophy to deliver a total knee arthroplasty (TKA) that respects individual bony and soft tissue phenotypes within defined limitations. The purpose of this paper is to describe the rationale and technique of FA in the valgus morphotype with the use of an image-based robotic-platform. For the valgus phenotype the principles are personalized pre-operative planning, reconstitution of native coronal alignment without residual varus or valgus of more than 3°, restoration of dynamic sagittal alignment within 5° of neutral, implant sizing to match anatomy, and achievement of defined soft tissue laxity in extension and flexion through implant manipulation within the defined boundaries. An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable assessment of soft tissue laxity is performed in extension and flexion. Implant positioning is then manipulated in all three planes if necessary to achieve target gap measurements and a final limb position within a defined coronal and sagittal range. FA is a novel TKA technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that respects variations in individual anatomy and soft tissues within defined limits.
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Park HK, Han JY, Cho YS, Nam KI. Distribution of the tensor of the vastus intermedius. Clin Anat 2023; 36:607-611. [PMID: 36597837 DOI: 10.1002/ca.24000] [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: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023]
Abstract
The tensor of the vastus intermedius (TVI) was first described by Grob et al. in 2016. It originates from the anteroinferior greater trochanter and inserts into the upper patella and receives blood and nerves independently of other muscles. It has been overlooked, but since micro-surgery and detailed rehabilitation treatments are being developed, more research on it is warranted. Here we report on the TVI in a Korean cadaveric study. A total of 58 cadavers (41 males and 17 females) were included. Thighs were examined using a standardized dissection protocol. The quadriceps femoris muscle was identified and its components were defined by blunt dissection. A total of 116 lower limbs were dissected. In 40 of them, there was a separately innervated TVI muscle belly between the fasciae of the vastus lateralis (VL) and the vastus intermedius (VI) muscles. TVIs were classed as independent (ID), VI, and VL types according to the relative relationship between the TVI, VL, and VI, and subdivided into two parts: Part 1 was the proximal muscular portion of the TVI attached to the VL or VI, and part 2 was the distal aponeurotic area. TVIs were analyzed in detail via 58 Korean cadavers. We subdivided them on the basis of their location and association with related muscles. A larger study is needed to clarify the function and prevalence of the TVI.
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Affiliation(s)
- Hyeng-Kyu Park
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Young-Suk Cho
- Department of Anatomy, Chonnam National University Medical School, Jeonnam, Republic of Korea
| | - Kwang-Il Nam
- Department of Anatomy, Chonnam National University Medical School, Jeonnam, Republic of Korea
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Yamagami R, Inui H, Taketomi S, Kono K, Kawaguchi K, Sameshima S, Kage T, Arakawa T, Tanaka S. Intraoperative femoral rotational kinematics are similar in varus and valgus knees during medial pivot total knee arthroplasty. Clin Biomech (Bristol, Avon) 2023; 101:105857. [PMID: 36521411 DOI: 10.1016/j.clinbiomech.2022.105857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medial-pivot type total knee arthroplasty is designed to reproduce physiological femoral rotational kinematics during knee flexion; however, its rotational kinematics in valgus knees remain unknown. This study's hypothesis is that its kinematics show the similar medial pivot motion in valgus knees as in varus knees. METHODS This retrospective study included 50 cases of primary medial-pivot type total knee arthroplasty performed with navigation for knee osteoarthritis. Cases were grouped as valgus (n = 20) or varus (n = 30). In valgus knees, surgeons used preoperative manual testing to confirm that alignment was correctable. They evaluated femoral rotational kinematics at maximum extension, 30°, 60°, 90°, and maximum flexion, using a navigation system, both before and after implantation. Finally, intraoperative rotational kinematics, postoperative patient-reported outcomes, and knee range of motion were compared between the two groups. FINDINGS Before implantation, both valgus and varus knees displayed external femoral rotation relative to the tibia during knee flexion. The rotation magnitude was significantly larger in varus knees at 60°, 90°, and maximum flexion angles compared to valgus knees (P < 0.05). In contrast, after implantation, both groups displayed external femoral rotation of 12-13° during knee flexion with no significant differences between the two groups at any knee flexion angle tested (P > 0.05). Short-term clinical outcomes were comparable between valgus and varus knees. INTERPRETATION Postoperatively, medial-pivot type total knee arthroplasty for knee osteoarthritis resulted in external femoral rotation during knee flexion. Notably, this occurred even in valgus knees with good short-term clinical outcomes.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Prevalence of extra-articular tibia valga morphology in valgus knees and its implications for primary total knee arthroplasty. J Orthop Surg Res 2022; 17:531. [PMID: 36494825 PMCID: PMC9733362 DOI: 10.1186/s13018-022-03418-5] [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: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Tibia valga, an extra-articular valgus deformity of the tibia, is common in valgus knees and can result in component misplacement and early total knee arthroplasty (TKA) failure. However, the prevalence and importance of tibia valga in TKA have been seldom reported. This study aims to describe the prevalence and characteristics of tibia valga morphology in valgus knees and describe implications for surgical planning in primary TKA. METHODS We prospectively examined pre-operative weightbearing whole-body EOS digital radiographs of patients with knee osteoarthritis listed for TKA between December 2018 and December 2020. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), joint line convergence angle (JLCA) and tibial morphology with centre of rotation of angulation of tibia (CORA-tibia) were measured and analysed. RESULTS In 830 knees, 253 (30%) and 577 (70%) were classified as valgus and varus, respectively. In valgus knees, 89 knees (35%) had tibia valga. Median CORA-tibia was 2.8° (range 0.2°-10.9°). Tibia valga knees had no difference in mLDFA, higher HKA (5.0o versus 3.0°, p = 0.002) and mMPTA (89.6° versus 88.1°, p < 0.01), and lower JLCA (2.1° versus 2.3°, p < 0.01) compared to non-tibia valga knees. Tibia valga deformity was weakly positively correlated with valgus HKA (ρ = 0.23, p < 0.001) and mMPTA (ρ = 0.38, p < 0.001). In varus knees, there were 52 cases of tibia valga (9%) with median CORA-tibia of 3.0° (range 0.5°-5.5°). Tibia valga knees had higher mMPTA (87.0° versus 85.2°, p < 0.05) and no difference in HKA, mLDFA and JLCA. CORA-tibia was weakly positively correlated with mMPTA. CONCLUSIONS Valgus knees may have an extra-articular deformity of the tibia which might be the primary contributor of the overall valgus HKA deformity rather than the distal femoral anatomy. To detect the deformity, full leg-length radiographs should be acquired pre-operatively. Intramedullary instrumentation should be used cautiously in knees with tibia valga when performing TKA.
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Song SJ, Lee HW, Kim YK, Park CH. Fixed distal femoral resection with a valgus cutting angle of 3° is more appropriate in intra-articular valgus deformity than juxta-articular valgus deformity in total knee arthroplasty: a retrospective single center study. ANNALS OF JOINT 2022; 7:35. [PMID: 38529156 PMCID: PMC10929302 DOI: 10.21037/aoj-22-8] [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: 03/03/2022] [Accepted: 06/06/2022] [Indexed: 03/27/2024]
Abstract
Background The traditionally recommended fixed valgus cutting angle (VCA) of 3° is used as the standard method in total knee arthroplasty (TKA) for valgus deformity. The accuracy of distal femur cutting can be affected by the type of valgus deformity because the intramedullary rod for distal femoral resection can become impinged on the femoral cortex. The purpose of this study is to analyze the accuracy and precision of a VCA of 3° in mechanical alignment in TKA for valgus deformity, based on the type of the deformity. Methods TKAs with a fixed VCA of 3° performed in 110 intra-articular and 102 juxta-articular valgus knees were retrospectively reviewed. The age (65.8 vs. 66.1 years), sex (female: male =78/32 vs. 70/32), body mass index (26.0 vs. 26.0), and severity of deformities (valgus 12.1 vs. valgus 12.5) were not significantly different (P>0.647). The mechanical-lateral-distal-femoral angle (mLDFA) and anatomical-mechanical-axis angle (AMA-A) were evaluated. The adjusted-VCA (aVCA) was defined as the maximum angle within the range without the intramedullary rod impinging on the femoral cortex. The proportion of well-aligned femoral component (mLDFA <90°±3°) was assessed. The correlation between AMA-A-3° or aVCA-3° and postoperative mLDFA-90° was analyzed. Results Despite the larger AMA-A in the juxta-articular group (6.2° vs. 6.8°, P<0.001), the aVCA was lesser in the juxta-articular group (5.4° vs. 4.1°, P<0.001). The mLDFA was more varus in the intra-articular group (91.7° vs. 90.6°, P<0.001) postoperatively. The proportion of well-aligned femoral component was higher in the juxta-articular group (85.3% vs. 70%, P=0.009). Postoperative mLDFA-90° was moderately correlated with aVCA-3° (r=0.301, r=387), but weakly correlated with AMA-A-3° (r=0.274, r=294) in both groups. Conclusions Although a fixed VCA of 3° is a reliable method in achieving mechanical alignment in valgus deformity, it can be more appropriate in juxta-articular deformity than in intra-articular deformity. The aVCA is a more reasonable predictor of femoral component alignment than the AMA-A, considering the femoral cortex impingement of the intramedullary rod.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Kook Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Dudek P, Marczak D, Okoń T, Grzelecki D, Szneider J, Kowalczewski J. Lateral or Medial Parapatellar Surgical Approach to the Valgus Osteoarthritic Knee? A Retrospective Single-Center Study. J Clin Med 2022; 11:jcm11195953. [PMID: 36233820 PMCID: PMC9572376 DOI: 10.3390/jcm11195953] [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: 08/11/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Aims: Total knee arthroplasty in patients with fixed valgus deformity is a demanding procedure. The aim of this study was to compare the clinical results of using the lateral approach [LA] versus the medial approach [MA] in the treatment of fixed valgus knee deformities. Methods: This single-center study compared the results of 143 consecutive patients with fixed valgus deformity (mean 21.55° valgus, mean age 68.2 years) undergoing LA Total Knee Arthroplasty [TKA] to 50 patients (mean 16.58° valgus, mean age 67.2 years) undergoing MA TKA. The mean follow-up period was 5.1 years (2−10 years). Data was collected from operative notes, routine postoperative visits, and radiological findings. Apart from a radiological evaluation, patients were clinically assessed both pre- and postoperatively using the Knee Society Score [KSS]. Descriptive statistics together with the Kolmogorov-Smirnov test, the Student’s t-test for independent samples, and the Mann-Whitney U test were used. The level of significance in this study was α = 0.05. Results: In the LA group, the KSS Knee was significantly higher than in the MA group [85.31 vs. 77.42, respectively, p-value < 0.001]. The difference was also in the KSS total but with no statistical significance [155.17 vs. 149.22, p-value 0.087]. The surgery time in the LA group was shorter than in the MA group [81 vs. 91 min, respectively, p-value—0.002]. The complication rate after surgery was higher in the MA group than in the LA group (14% vs. 9%, respectively). Conclusions: The lateral approach is a good alternative to the standard medial parapatellar approach in the treatment of fixed valgus knee deformities. A higher postoperative KSS Knee, shorter surgery time, and similar complication rate make the lateral approach a valuable option for treating patients with osteoarthritis and fixed valgus knee deformity.
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Affiliation(s)
- Piotr Dudek
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
- Correspondence:
| | - Dariusz Marczak
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
| | - Tomasz Okoń
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
| | - Dariusz Grzelecki
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
| | - Jan Szneider
- Centre of Postgraduate Medical Education, Department of Orthopaedics, 01-813 Warsaw, Poland
| | - Jacek Kowalczewski
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Rheumoorthopaedics, 01-813 Warsaw, Poland
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Eller K, Scior W, Graichen H. Dynamic gap analysis of valgus knees shows large inter-individual variability of gaps. Knee Surg Sports Traumatol Arthrosc 2022; 31:1398-1404. [PMID: 36083353 DOI: 10.1007/s00167-022-07088-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to investigate the dynamic gap widths of valgus knees in extension and flexion to evaluate the influence of deformity on gap differences and to find out whether different ligamentous subtypes in valgus knees exist. METHODS Dynamic gap widths of 1000 consecutive total knee arthroplasty (TKA) patients were measured at different flexion angles by applying a computer-assisted surgery (CAS) technique. 198 knees showed a valgus deformity and were assessed regarding its degree of fulfillment of the following criteria of valgus knee: 1. Medial extension gap greater than lateral; 2. Medial flexion gap greater than lateral; 3. Flexion gap greater than extension gap. A single-factor ANOVA subgroup analysis was performed, based on the amount of deformity. The effect of other patient factors (age, gender, weight) on gap differences was investigated. RESULTS The medial extension gap (3.7 ± 2.2 mm) was significantly (p < 0.01) larger than the lateral extension gap (1.1 ± 2.9 mm). The amount of deformity correlated highly with gap difference in extension (r2 = 0.67) but not in flexion. In 92.4% (183), the flexion gap (6.2 ± 3.1 mm) was significantly (p < 0.01) larger than the extension gap (2.4 ± 2.3 mm). Only 29.3% (58) of patients met all three criteria, this was mainly due to the fact that in flexion the medial gap was larger than the lateral in only 35.4% (70). Patient factors showed no significant influences (NS) on the gap widths. CONCLUSION Valgus knees show large variability in terms of gap widths. The extent of deformity correlates highly with gap difference in extension, but not in other flexion angles. Vast majority of valgus knees were valgus in extension only. Because of this variability, it should be aimed for an individualized balancing technique based on intraoperative gap sizes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kim Eller
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany.
| | - Wolfgang Scior
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany
| | - Heiko Graichen
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Lindenlohe 18, 92421, Schwandorf, Germany
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Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits. Knee Surg Sports Traumatol Arthrosc 2022; 30:2958-2965. [PMID: 35182169 DOI: 10.1007/s00167-022-06867-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function. METHODS From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA. Knees were aligned aiming to preserve or restore constitutional alignment within predetermined limits of 85°-95° for femoral mechanical angle (FMA) and tibial mechanical angle (TMA), and 175°-183° for hip knee ankle (HKA) angle. The KSS Knee and Function were collected preoperatively and 12 months postoperatively, to determine if patients achieved SCB. Uni- and multivariable analyses were performed to determine associations between KSS scores (Knee and Function) and patient demographics as well as pre- and postoperative radiographic alignments. RESULTS Of the initial cohort of 261 patients, 4 (1.8%) were reoperated for patellar resurfacing, 1 (0.4%) for lavage to treat infection, and 1 (0.4%) had arthroscopy to treat a stiff knee with < 90° range of motion. Complete clinical records were available for 227 patients (232 knees, 87%) that comprised 102 men (5 bilateral) and 125 women. At 12-month follow-up, mean improvements in KSS Knee and Function scores were, respectively, 61.0 ± 13.0 and 42.7 ± 16.7, which exceeded the SCB of KSS. Comparison of knees inside versus outside the target zone revealed no differences in KSS Knee (94.1 ± 9.1 versus 94.3 ± 9.0, n.s.) and Function (96.1 ± 9.2 versus 96.3 ± 8.9, n.s.). Multivariable analysis revealed worse KSS Knee in knees with preoperative FMA > 95° (β = - 6.21; p = 0.023), but no association between KSS Function and patient demographics or pre- and postoperative radiographic alignments. CONCLUSIONS Custom TKA combined with personalised alignment yielded improvements that exceeded substantial clinical benefits of KSS Knee and Function scores. These findings demonstrate the feasibility of custom TKA with 'personalised alignment' and encourage further investigations using comparative studies at longer follow-up. LEVEL OF EVIDENCE IV, case series.
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Sasaki U, Tamaki M, Tomita T, Okada S. Total Knee Arthroplasty With Patient-Specific Instrumentation to Correct Severe Valgus Deformity in a Patient With Hereditary Multiple Exostoses. Arthroplast Today 2022; 16:175-181. [PMID: 35789783 PMCID: PMC9249969 DOI: 10.1016/j.artd.2022.04.017] [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: 08/20/2021] [Revised: 04/03/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with hereditary multiple exostosis develop several benign osseocartilaginous bulge lesions throughout the body. A 62-year-old woman presented for evaluation of worsening left knee valgus deformity, and left knee pain. She had been diagnosed with hereditary multiple exostosis at the age of 12 years. Radiographic evaluation of the left knee revealed exostoses that caused continuous bulges from cortical bone at the metaphyseal regions of the femur and tibia as well as extra-articular deformity. We used patient-specific instrumentation to indicate the direction of the stem into curved metaphyseal bone regions and then corrected the patient’s left knee deformity by performing total knee arthroplasty with titanium-constrained prostheses. Soft tissue release was performed with only complete iliotibial band release at a minimum, and stability was obtained.
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Bar-Ziv Y, Beit ner E, Lamykin K, Essa A, Gilat R, Livshits G, Shohat N, Beer Y. Minimum 2-Year Radiographic and Clinical Outcomes of Kinematic Alignment Total Knee Arthroplasty in the Valgus Knee. J Pers Med 2022; 12:1164. [PMID: 35887663 PMCID: PMC9318663 DOI: 10.3390/jpm12071164] [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] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022] Open
Abstract
Kinematic alignment (KA) total knee arthroplasty (TKA) has gained popularity in the past decade, but outcomes of KA-TKA in the valgus knee have never been specifically evaluated. In this retrospective single institution study, we analyzed patient reported outcomes and radiographic measurements at minimum 2 years following KA-TKA for valgus knees (n = 51) and compared the results to KA-TKA performed for non-valgus knees (n = 275). The same approach, technique, and implants were used in both groups without the need to release soft tissues or use constrained implants. Surgery duration was similar between groups (p = 0.353). Lateral distal femoral angle was lower in the valgus group postoperatively (p = 0.036). In both groups significant improvement was seen in relieving pain and improving function, while average scores were superior in the non-valgus group for visual analog score (p = 0.005), oxford knee score (p = 0.013), and knee injury and osteoarthritis outcome score (p = 0.009). However, these differences did not translate to statistically significant differences in minimal clinical important difference achievement rates. In conclusion, KA-TKA is efficient in relieving pain and improving function, as reported in subjective questionnaires, and holds advantage in patients with valgus alignment by avoiding soft tissue releases and use of constrained implants. Future studies should examine whether bone loss occurs in the lateral distal femur.
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Affiliation(s)
- Yaron Bar-Ziv
- Assaf Harofeh Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv 6997801, Israel; (E.B.n.); (K.L.); (A.E.); (R.G.); (G.L.); (N.S.); (Y.B.)
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Rosso F, Rossi R, Benazzo F, Ghiara M, Bonasia DE, Rossi SMP. Primary TKA in patients with major deformities and ligament laxities: promising results of an intermediate constrained implant at mid-term follow-up. Arch Orthop Trauma Surg 2022; 143:2675-2681. [PMID: 35819516 DOI: 10.1007/s00402-022-04527-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) in major deformities with ligament insufficiency may require a higher constraint, with bone sacrifice and concerns about long-term survivorship. Mid-level constraint liners have been recently introduced, but few studies described their outcomes. The aim of this study is to evaluate the short to mid-term outcomes of a constrained postero-stabilized (CPS) insert for primary TKA in moderate to severe deformities. METHODS All patients who underwent TKA using a CPS liner in two centers between 2015 and 2017 were included in the study. The indications were: (1) valgus deformity type 2-3 partially correctable; (2) severe varus deformity with varus thrust; (3) post-traumatic deformity with major ligamentous insufficiency and any case of intra-operative ligament insufficiency. Patients were evaluated according to the Knee Society Scoring System (KSS), the Hospital for Special Surgery score (HSS), the Western Ontario and Mc Master University (WOMAC) and the Oxford Knee score (OKS). X-rays were evaluated according to the Knee Society Roentgenographic Evaluation System. RESULTS Forty-seven TKA were included, with an average age of 66.1 ± 10.3 years and an average follow-up of 68.4 ± 6 months. All patients demonstrated a moderate to severe pre-operative mediolateral instability. All the scores significantly improved (p < 0.0001). In 71.4% of cases, the outcomes were excellent or very good. There were no failures due to aseptic loosening but one failure due to a traumatic ligament rupture. The cumulative survivorship was 97.9% ± 2.1% at 84 months. CONCLUSIONS This mid-range constraint total knee replacement demonstrated promising outcomes and survival at mid-term follow-up. LEVEL OF EVIDENCE IV (case series).
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Affiliation(s)
- Federica Rosso
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy
| | - Roberto Rossi
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy.,Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, Via Po 8, 10100, Turin, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.,IUSS, Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Matteo Ghiara
- Clinica Ortopedica e Traumatologia, Università degli Studi di Pavia Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Edoardo Bonasia
- Dipartimento di ortopedia e Traumatologia Largo, AO Ordine Mauriziano, Turati 62, 10128, Turin, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy.
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Lv SJ, Wang XJ, Huang JF, Mao Q, He BJ, Tong PJ. Total knee arthroplasty in Ranawat II valgus deformity with enlarged femoral valgus cut angle: A new technique to achieve balanced gap. World J Clin Cases 2022; 10:6406-6416. [PMID: 35979319 PMCID: PMC9294892 DOI: 10.12998/wjcc.v10.i19.6406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/10/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nearly 10% of patients undergoing primary total knee arthroplasty (TKA) have valgus deformity (VD) of the knee. For severe VD of the knee, a more lateral structural release is needed to achieve balance between medial and lateral space and neutral femorotibial mechanical axis (FTMA), which is challenging and technical. AIM To introduce a new surgical technique of resection, soft tissue release, and FTMA for Ranawat type-II VD with a 5-year follow-up. METHODS A retrospective study was conducted on patients who underwent TKA from December 2011 to December 2014. Hip-knee-ankle (HKA), range of motion (ROM), Oxford knee score (OKS), and knee society score (KSS) were used to assess the joint activity of patients in the new theory TKA group (NT-TKA) and were compared with those of the conventional TKA group (C-TKA). RESULTS A total of 103 people (103 knees) were included in this study, including 42 patients with an average follow-up period of 83 mo in the C-TKA group and 61 patients with an average follow-up period of 76 mo in the NT-TKA group. Six patients had constrained prosthesis, one had common peroneal nerve injury, and two had joint instability in the C-TKA group, but none of these occurred in the NT-TKA group. There were significant statistical differences in constrained prosthesis usage and complications between the groups (P = 0.002 and P = 0.034, respectively). The KSS at 1 mo post-operation for the C-TKA and NT-TKA groups were 11.2 ± 3.8 and 13.3 ± 2.9, respectively, with a significant difference (P = 0.007). However, the data of HKA, ROM, OKS KSS, and prosthesis survival rate were insignificant (P > 0.05) in both the preoperative and follow-up periods. CONCLUSION Adopting 5°-7° valgus cut angle for VD and sacrificing 2° neutral FTMA for severe VD which cannot be completely corrected during TKA can reduce the need for soft tissue release, maintain early joint stability, reduce the use of constrained prostheses, and minimize postoperative complications.
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Affiliation(s)
- Shuai-Jie Lv
- Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Xiao-Jian Wang
- The First Clinical Medical School, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jie-Feng Huang
- Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Qiang Mao
- Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Bang-Jian He
- Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Pei-Jian Tong
- Department of Orthopedics and Traumatology, The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Chalmers BP, LaGreca M, Addona J, Sculco PK, Haas SB, Mayman DJ. Characterizing the Magnitude of and Risk Factors for Functional Limb Lengthening in Patients Undergoing Primary Total Knee Arthroplasty. HSS J 2022; 18:271-276. [PMID: 35645637 PMCID: PMC9097002 DOI: 10.1177/15563316211009140] [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: 11/24/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Background: There is little data on the magnitude and factors for functional leg lengthening after primary total knee arthroplasty (TKA). Questions/Purpose: We sought to determine the incidence of and risk factors for functional leg lengthening after primary TKA. Methods: We retrospectively reviewed consecutive unilateral primary TKAs at a single institution from 2015 to 2018. Of the 782 TKAs included, 430 (55%) were performed in women; the mean age was 66 years, and the mean body mass index was 29 kg/m2. Preoperatively, 541 (69%) knees were varus deformities and 223 (29%) were valgus deformities. Hip to ankle biplanar radiographs were obtained preoperatively and 6 weeks postoperatively for all patients. Two independent researchers measured leg length, coronal plane deformity, lateral knee flexion angle, and overall mechanical alignment on all preoperative and postoperative radiographs. Results: The mean overall ipsilateral functional leg lengthening was 7.0 mm. Seven hundred knees (90%) were overall functionally lengthened, including 462 (59%) knees lengthened >5 mm and 250 (31%) knees lengthened 10 mm or more. A valgus deformity and coronal plane deformity of 10° or more were significant risk factors for increased functional lengthening. Patients with severe valgus deformities (>10°) had the largest amount of functional lengthening, at a mean of 13.5 mm. Conclusion: After primary TKA, 90% of limbs are functionally lengthened, including roughly one-third over a centimeter. Valgus knee deformities and severe deformities (>10°) were significant risk factors for increased limb lengthening.
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Affiliation(s)
- Brian P. Chalmers
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA,Brian P. Chalmers, MD, Department of
Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for
Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Mark LaGreca
- Department of Medicine, Philadelphia
College of Osteopathic Medicine, Philadelphia, PA, USA
| | | | - Peter K. Sculco
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA
| | - Steve B. Haas
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA
| | - David J. Mayman
- Department of Orthopedic Surgery, Adult
Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY,
USA
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Sponer P, Korbel M, Kucera T. Challenges of total knee arthroplasty in osteogenesis imperfecta: case report and literature review. J Int Med Res 2022; 50:3000605221097369. [PMID: 35615788 PMCID: PMC9152202 DOI: 10.1177/03000605221097369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
The majority of adults with mild osteogenesis imperfecta report significant functional impairment due to musculoskeletal concerns. Knee osteoarthritis is common in these patients. Although total knee arthroplasty has become a highly efficient surgical technique for osteoarthritis, this procedure remains uncommon in patients with osteogenesis imperfecta. This current case report describes the important clinical aspects of osteogenesis imperfecta that must be considered during the planning and performance of a total knee replacement. A 62-year-old female patient with a history of osteogenesis imperfecta suffered from severe osteoarthritis of the knee with valgus deformity. Two years after posterior stabilized total knee arthroplasty, her Hospital for Special Surgery knee score had improved from preoperative 53 points to 85 points at the final follow-up. The current case report describes the crucial technical aspects of a successful total knee replacement in this uncommon scenario. Underlying deformities and concomitant pathologies constitute specific surgical challenges. Special care should be taken to protect the patient from potential complications.
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Affiliation(s)
- Pavel Sponer
- Department of Orthopaedic Surgery, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Martin Korbel
- Department of Orthopaedic Surgery, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomas Kucera
- Department of Orthopaedic Surgery, University Hospital in Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
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Li T, Liu Y, Li C, Zhang H. SMOC approach for total knee arthroplasty in valgus knees. J Orthop Surg Res 2022; 17:120. [PMID: 35193617 PMCID: PMC8862505 DOI: 10.1186/s13018-022-03002-x] [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: 10/09/2021] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study was performed to compare clinical outcomes among patients with valgus knees undergoing total knee arthroplasty via the medial parapatellar approach and the subvastus with minimal oblique cut approach. Methods A total of 232 patients (246 knees) undergoing total knee arthroplasty between December 2014 and December 2016 were retrospectively included in the investigation. The study population consisted of 120 patients (128 knees; 32 men and 88 women) with a mean age of 62.43 ± 8.12 years treated via the medial parapatellar approach, and 112 patients (118 knees; 30 men and 82 women with a mean age of 63.15 ± 7.83 years) treated via the subvastus with minimal oblique cut approach. Nine preoperative parameters (number of patients, sex, age, body mass index, number of knees, valgus angle, visual analogue scale score, range of motion, Hospital for Special Surgery score), five perioperative parameters (operative time, amount of drainage, Visual analogue scale score at 24 h after the operation, time to straight leg raising, radiological alignment), and two postoperative parameters (range of motion, Hospital for Special Surgery score) were assessed at 1 day, 1 week, 6 weeks, 8 weeks and 1 year after the operation, along with postoperative complications. Results There were no significant differences in the nine preoperative parameters between the two groups. The subvastus with minimal oblique cut group had a longer operative time, while the parapatellar approach group showed more drainage and a higher mean Visual analogue scale score. Compared to the medial parapatellar group, the subvastus with minimal oblique cut group had a shorter time to straight leg raising. There were no differences in radiological alignment between the two groups. The groups showed similar range of motion and Hospital for Special Surgery scores at 8 weeks and 1 year, but both were higher in the subvastus with minimal oblique cut group at 1 day, 1 week and 6 weeks. During postoperative follow-up, postoperative subluxation of the patella occurred in five cases in the medial parapatellar group. Neither group showed any instability, recurrent valgus deformity or radiographic loosening. Conclusion The subvastus with minimal oblique cut approach provides excellent early recovery for total knee arthroplasty of valgus knees with no increase in complications.
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Affiliation(s)
- Tao Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Yikai Liu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chenkai Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Puijk R, Rassir R, Kok LM, Sierevelt IN, Nolte PA. Common peroneal nerve palsy after TKA in valgus deformities; a systematic review. J Exp Orthop 2022; 9:12. [PMID: 35059901 PMCID: PMC8776926 DOI: 10.1186/s40634-021-00443-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this systematic review is to investigate the prevalence of Common Peroneal Nerve Palsy after total knee arthroplasty in valgus deformities. Furthermore, the effectiveness of a peroneal nerve release prior to arthroplasty to prevent the palsy will be investigated. METHODS PubMed and Google Scholar were searched. Search terms regarding valgus deformity and total knee arthroplasty were used. Data analysis and extraction were performed using the web application 'Rayyan QCRI' according to PRISMA guidelines and screened according to the inclusion and exclusion criteria. RESULTS Twenty-seven studies were included, representing 1397 valgus knees. Knee balancing was performed in 19 studies with lateral soft tissue releases (1164 knees) and 8 studies (233 knees) with an additional osteotomy. Two studies (41 knees) in the lateral soft tissue release group conducted a peroneal nerve release simultaneous to arthroplasty. Common peroneal nerve palsies occurred in 26 cases (1.9%). Overall, no significant difference in palsy ratio between studies was found by using a peroneal nerve release (p = 0.90), between lateral soft tissue releases and osteotomies (p = 0.11) or between releases of specific ligaments. CONCLUSION Common peroneal nerve palsies occur in 1.9% of the cases after total knee arthroplasty in valgus deformities. No difference in the number of palsies was seen when using a peroneal nerve release or using different balancing techniques. However, literature about peroneal nerve releases was very limited, therefore, the effectiveness of a peroneal nerve release remains unclear. LEVEL OF EVIDENCE LEVEL III: Systematic review.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2130AT, Hoofddorp, the Netherlands.
| | - Rachid Rassir
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2130AT, Hoofddorp, the Netherlands
| | - Laura M Kok
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2130AT, Hoofddorp, the Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2130AT, Hoofddorp, the Netherlands
- Specialized Center of Orthopedic Research and Education (SCORE), Xpert Orthopedie, Amsterdam, the Netherlands
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2130AT, Hoofddorp, the Netherlands
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Castellarin G, Bori E, Biava M, Talevi G, Innocenti B. The use of mobile bearing TKA in valgus deformities - A clinical study. J Orthop 2022; 29:6-10. [PMID: 35241879 PMCID: PMC8858731 DOI: 10.1016/j.jor.2021.12.002] [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: 12/02/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The number of patients presenting valgus deformities undergoing total knee arthroplasty (TKA) represents approximately 10% of the total number of TKAs performed: the presence of valgus deformity requires the implant to have proper alignment, stability and balance to achieve successful clinical outcomes, especially for knees with high coronal deformities, but these have proven to be difficult goals to achieve and therefore the use of constrained prostheses is often recommended for these cases. However, even though the use of unconstrained mobile bearing for severe knee deformities is rare, it has been shown to give successful outcomes and therefore the aim of this study is to evaluate whether this surgical technique can achieve satisfactory clinical results and correct alignment, as well as good patient satisfaction. METHODS This study presents the results of 69 TKA performed with cemented mobile bearing implants by a single surgeon on knee affected by valgus deformities. Asymmetric inserts were adopted for all the implants and an alignment surgical tool, dedicated for valgus patients, was used during the operation. Angles of valgus, WOMAC surveys and Numeric Rating Scale for pain were recorded to evaluate the results of the operations. RESULTS A total of 67 pre-op WOMAC questionnaire surveys were collected, with the mean result of this evaluation being 15.9 points. The Numeric Rating Scale for pain had an average of 2.2 for 68 tests. The deformities were corrected from a mean total preoperative valgus angle of 12.5° to a postoperative valgus deformity average of 0.6°. During follow-up, only one patient had serious complications due to the rupture of the extensor apparatus following a domestic accident involving falling. Further 10 patients have mild complications related to injuries such as pain of varying intensity, burning, or swelling of the knee. The level of satisfaction from 0 to 10 (0 not at all satisfied and 10 perfectly satisfied) had an average score of 7.7. CONCLUSIONS The surgical approach presented, involving a less constrained model if compared to the ones usually chosen, allowed to achieve correct alignment and high patient satisfaction using mobile bearing implants on valgus knee deformities; further patient follow-up will be performed to evaluate long-term outcomes, but the results achieved already represent a significative finding.
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Affiliation(s)
| | - Edoardo Bori
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mathieu Biava
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Giacomo Talevi
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
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Cho BW, Hong HT, Koh YG, Choi J, Park KK, Kang KT. Analysis of Gender Differences in the Rotational Alignment of the Distal Femur in Kinematically Aligned and Mechanically Aligned Total Knee Arthroplasty. J Clin Med 2021; 10:jcm10163691. [PMID: 34441989 PMCID: PMC8396944 DOI: 10.3390/jcm10163691] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
To compare the angle between the external rotation references of the femoral components in the axial plane by gender and lower limb alignment in Korean patients with osteoarthritis (OA). Magnetic resonance (MR) images of 1273 patients were imported into a modeling software and segmented to develop three-dimensional femoral bony and cartilaginous models. The surgical transepicondylar axis (sTEA), posterior condylar axis (PCA), the kinematically aligned axis (KAA), and anteroposterior axis were used as rotational references in the axial plane for mechanically aligned (MA) TKA. The relationship among axes were investigated. Among 1273 patients, 942 were female and 331 were male. According to lower limb alignment, the varus and valgus knee groups comprised 848 and 425 patients, respectively. All measurements, except PCA-sTEA, differed significantly between men and women; all measurements, except PCA-sTEA, did not differ significantly between the varus and valgus knee groups. In elderly Korean patients with OA, rotational alignment of the distal femur showed gender differences, but no differences were seen according to lower limb alignment. The concern for malrotation of femoral components during kinematically aligned TKA is less in Koreans than in Caucasians and relatively less in women than in men. In MA TKA, malrotation of the femoral components can be avoided by setting different rotational alignments for the genders.
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Affiliation(s)
- Byung-Woo Cho
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
| | - Hyoung-Taek Hong
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Korea;
| | - Jeehoon Choi
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
| | - Kwan-Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
- Correspondence: (K.-K.P.); (K.-T.K.); Tel.: +82-2-1599-1004 (K.-K.P.); +82-2-588-1006 (K.-T.K.)
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: (K.-K.P.); (K.-T.K.); Tel.: +82-2-1599-1004 (K.-K.P.); +82-2-588-1006 (K.-T.K.)
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The effect of surgical approach in total knee replacement on outcomes. An analysis of 875,166 elective operations from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Knee 2021; 31:144-157. [PMID: 34175672 DOI: 10.1016/j.knee.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/13/2021] [Accepted: 04/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee replacement (TKR) is clinically and cost-effective. The surgical approach employed influences the outcome, however there is little generalisable and robust evidence to guide practice. We compared outcomes between the common primary TKR surgical approaches. METHODS 875,166 primary TKRs captured in the National Joint Registry, linked to hospital inpatient, mortality and patient reported outcome measures (PROMs) data, with up to 15.75 years follow-up were analysed. There were 10 surgical approach groups: medial parapatellar, midvastus, subvastus, lateral parapatellar, 'other' and their minimally invasive versions. Survival methods were used to compare revision rates and 45-day mortality. Groups were compared using Cox proportional hazards regression and Flexible Parametric Survival Modelling (FPM). Confounders included age at surgery, sex, risk group (indications additional to osteoarthritis), American Society of Anesthesiologists grade, TKR fixation, year of primary, body mass index, and for mortality, deprivation and Charlson comorbidity subgroups. PROMs were analysed with regression modelling or non-parametric methods. RESULTS The conventional midvastus approach was associated with lower revision rates (Hazard Rate Ratio (HRR) 0.80 (95% CI 0.71-0.91) P = 0.001) and the lateral parapatellar with higher revision rates (HRR 1.35 (95% CI 1.12-1.63) P = 0.002) compared to the conventional medial parapatellar approach. Mortality rates were similar between approaches. PROMs showed statistically significant, but not clinically important, differences. CONCLUSIONS There is little difference in PROMs between the various surgical approaches in TKR with all resulting in good outcomes. However, the conventional midvastus approach (used in 3% of cases) was associated with a 20% reduced risk of revision surgery compared to the most commonly used knee approach (the conventional medial parapatellar: used in 91.9% of cases). This data supports the use of the midvastus approach and thus surgeons should consider utilising this approach more frequently. Minimally invasive approaches did not appear to convey any clinical advantage in this study over conventional approaches for primary TKR.
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Kaneko T, Igarashi T, Yoshizawa S, Takada K, Ikegami H, Musha Y. Robotic-Assisted Total Knee Arthroplasty for Distal Femur Fracture with Lateral Knee Osteoarthritis. Case Rep Orthop 2021; 2021:5576955. [PMID: 34007500 PMCID: PMC8100416 DOI: 10.1155/2021/5576955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/02/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. Open reduction and internal fixation (ORIF) of compound fractures around the knee in elderly patient raise concerns about long-term postoperative external fixation and complications. Total knee arthroplasty (TKA) has been proposed as an alternative solution. We report a case where robotic-assisted (RA) TKA was used to treat lateral knee osteoarthritis (OA) with distal femur fracture. Case Presentation. A 90-year-old female visited our hospital with complications of sustained knee pain after a fall at home. Fracture line from the trochlea to the intercondylar notch was diagnosed on plain radiographs, and prior to this injury, the patient was receiving conservative treatment for lateral OA. We selected a conventional TKA over ORIF because the latter is associated with residual pain and the need for long-term immobilization, which can lead to other complications. However, the fracture site was the entry point for intramedullary rod, and there was concern that the fracture site would be displaced by conventional TKA. Therefore, the unique aspect of the case is that the technique utilized involved robotic milling using the Navio system while temporarily stabilizing the fracture using two tracker pins. RA TKA could determine osteotomy and implant placement by predicting the postoperative patient's soft tissue balance for no medial loosening and lateral contracture. The arthritic cartilage and bone were then methodically removed using the handheld sculptor. After immobilizing the fracture site with a bone grasper before removing the pin tracker, reaming of the femur and insertion of a stem prosthesis with semiconstrained were performed. Primary RA TKA is a viable option for intra-articular fractures in elderly patients with advanced knee osteoarthritis.
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Affiliation(s)
- Takao Kaneko
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan
| | | | - Shu Yoshizawa
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan
| | - Kazutaka Takada
- Department of Orthopedic Surgery, Toho University School of Medicine, 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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