Does Patient-Specific Instrumentation Improve Femoral and Tibial Component Alignment in Total Knee Arthroplasty? A Prospective Randomized Study

Background: Long term survivorship of total knee arthroplasty (TKA) is significantly dependant on prostheses alignment. The debate on optimal referencing for femoral component is largely resolved with Intra-medullary jigs reproducing superior alignment. However there is still a contention about whether intramedullary or extramedullary jigs are better for tibial referencing. This study aims to compare the accuracy of tibial component alignment in TKA using intramedullary and extramedullary tibial referencing jigs.Methods: Between December 2012 and September 2014, 66 primary conventional cemented TKAs were performed using Nexgen-LPS Flex (Zimmer) implants in 55 patients, 50-80 y old (mean 65.54 y) with osteoarthritis/rheumatoid arthritis. Intramedullary and extramedullary tibial referencing was used in alternate patients undergoing TKA after excluding patients with BMI >35 kg/m2, knee deformity >150,excessive tibial bowing, previous fractures/surgeries/retained metalwork around knee. Postoperatively, tibial component alignment (TCA) in coronal plane was assessed using AP radiograph of leg. A 3º cutoff from neutral mechanical axis (i.e., 90o±3o) was considered acceptable.Results: The intramedullary group (n=33) had 4 outliers (TCA >93º or <87º) whereas the extramedullary group (n=33) had 7 outliers (p=0.511). The difference in mean TCA between intramedullary and extramedullary groups was not statistically significant [90.70±2.43 and 90.55±2.17 (p=0.790)]. There were no significant per-operative/post-operative complications in either group.Conclusions: We conclude that both intramedullary and extramedullary tibial referencing guides can be used to achieve desired tibial component alignment (90±3º) in TKA. However the surgeon should appreciate the benefits and deficiencies of either types of tibial referencing and use whichever is suited in a particular case.

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The effect of tibial component alignment on periprosthetic bone remodeling after total knee arthroplasty

European Orthopaedics and Traumatology ◽

10.1007/s12570-015-0328-9 ◽

2015 ◽

Vol 6 (4) ◽

pp. 433-437

Author(s):

Haytham Abdelazim ◽

Aya Yassin

Keyword(s):

Total Knee Arthroplasty ◽

Bone Remodeling ◽

Knee Arthroplasty ◽

Tibial Component ◽

Component Alignment ◽

Periprosthetic Bone ◽

Tibial Component Alignment ◽

Total Knee

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Using fibula as a reference can be beneficial for the tibial component alignment after total knee arthroplasty, a retrospective study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-2957-x ◽

2014 ◽

Vol 23 (7) ◽

pp. 2068-2073 ◽

Cited By ~ 5

Author(s):

Mehmet Erdem ◽

Deniz Gulabi ◽

Gultekin Sitki Cecen ◽

Cem Coskun Avci ◽

Murat Asci ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Retrospective Study ◽

Knee Arthroplasty ◽

Tibial Component ◽

Component Alignment ◽

Tibial Component Alignment ◽

Total Knee

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Pedobarographic Analysis in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0037-1599247 ◽

2017 ◽

Vol 30 (09) ◽

pp. 951-959 ◽

Cited By ~ 2

Author(s):

Onur Kocadal ◽

Budak Akman ◽

Uğur Şayli ◽

Faik Altıntaş ◽

Melih Güven

Keyword(s):

Total Knee Arthroplasty ◽

Gait Analysis ◽

Knee Arthroplasty ◽

Tibial Component ◽

Component Alignment ◽

Abnormal Gait ◽

Prosthetic Alignment ◽

Tibial Component Alignment ◽

Total Knee ◽

Component Malposition

AbstractPedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.

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No Evidence of Superiority in Reducing Outliers of Component Alignment for Patient-specific Instrumentation for Total Knee Arthroplasty: a Systematic Review

Orthopaedic Surgery ◽

10.1111/os.12150 ◽

2015 ◽

Vol 7 (1) ◽

pp. 19-25 ◽

Cited By ~ 10

Author(s):

Qing-meng Zhang ◽

Ji-ying Chen ◽

Heng Li ◽

Wei Chai ◽

Ming Ni ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Component Alignment ◽

Patient Specific Instrumentation ◽

Total Knee

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A study on radiological outcomes of accelerometer based hand held navigation system in total knee arthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201727 ◽

2020 ◽

Vol 6 (3) ◽

pp. 556

Author(s):

Hiranyakumar S. ◽

Shivaraj Nadagouda ◽

Vishnu Harikrishnan

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Navigation System ◽

Mechanical Axis ◽

Patient Specific ◽

Computer Assisted ◽

Component Alignment ◽

Patient Specific Instrumentation ◽

Wear And Tear ◽

Total Knee

Background: The goal of obtaining more accurate component alignment in total knee arthroplasty (TKA) has led to the development of techniques like portable accelerometer-based handheld navigation system, computer assisted system, patient specific instrumentation. Among which hand held navigation has showed promising results for achieving accurate resection and alignment and only few studies were done to assess radiological outcome or the effective component alignment using portable accelerometer-based hand held navigation system in TKA.Methods: TKA using portable accelerometer-based hand held navigation system (Smith and Nephew- knee align) was done on 25 knees with primary osteoarthritis. Preoperative and post-operative mechanical axis and component alignments were measured using hip-to-ankle radiographs.Results: Among the femoral components, 92.0% were placed within 90°±2° to the femoral mechanical axis in the coronal and 96.0% of the tibial components were placed within 90°±2° to the mechanical axis in the coronal plane, 94.3% of the TKAs had an overall lower extremity alignment within 3° of neutral to the mechanical axis, based on postoperative hip-to-ankle radiographs.Conclusions: The degree of accuracy in positioning the femoral and tibial component in TKA using portable accelerometer-based hand held navigation system (knee align) is very much promising and is an effective intraoperative tool for reducing the proportion of outliers for component placement and thus decreasing the chances of instability and early wear and tear of the components in TKA.

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