Accelerometer-Based Navigation Is as Accurate as Optical Computer Navigation in Restoring the Joint Line and Mechanical Axis After Total Knee Arthroplasty

2016 ◽  
Vol 31 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Graham Seow-Hng Goh ◽  
Ming Han Lincoln Liow ◽  
Winston Shang-Rong Lim ◽  
Darren Keng-Jin Tay ◽  
Seng Jin Yeo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Joint Line ◽  
Total Knee ◽  
Optical Computer

scholarly journals Correction of Varus Alignment with Peripheral Osteophyte Removal during Total Knee Arthroplasty: An Assessment with Computer Navigation

2021 ◽  
Author(s):  
Nobuhiro Nishihara ◽  
Hironari Masuda ◽  
Naoya Shimazaki ◽  
Seikai Toyooka ◽  
Hirotaka Kawano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Repeated Measures ◽  
Soft Tissues ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Varus Deformity ◽  
Varus Alignment ◽  
Valgus Stress ◽  
Total Knee

AbstractTechniques for symmetrical balancing in flexion and extension have been described; however, the ideal technique is unclear. This study aimed to clarify whether resection of peripheral osteophytes could restore neutral hip–knee–ankle (HKA) angle of varus deformity of arthritic knees. Data from 90 varus arthritic knees that had undergone total knee arthroplasty (TKA) using a nonimage-based navigation system were analyzed. The change in the coronal mechanical axis, while applying manual valgus stress at extension and 90 degrees of knee flexion, was recorded after the following sequential procedures: (1) anterior cruciate ligament (ACL) sectioning, (2) subperiosteal stripping of the deep medial collateral ligament (MCL) from the underlying osteophytes on the medial tibia, and (3) complete removal of peripheral osteophytes from the proximal medial tibia and distal medial femoral condyle. Repeated measures of analysis of variance (ANOVA) were performed to compare the varus angle among each step, and a post hoc analysis by paired t-test was utilized to compare the parameters between baseline and each step. The varus alignment with valgus stress at extension and 90 degrees of flexion (mean: 6.0 ± 3.6 and 5.2 ± 3.9 degrees of varus, respectively) was significantly corrected to a near-neutral mechanical axis (mean: 0.9 ± 2.4 and 1.4 ± 4.2 degrees of varus, respectively) after peripheral osteophyte resection (p < 0.01, both). In many cases, varus deformity of arthritic knees could be corrected to near-neutral HKA angle by applying manual valgus stress after complete peripheral osteophyte resection. These procedures could facilitate soft tissue balancing in TKA, minimizing the risk of overrelease of the medial soft tissues.

scholarly journals Treatment Strategies and Clinical Outcomes of Knee Osteoarthritis With Extra-Articular Deformity

2021 ◽  
Author(s):  
Mingzhen Tao ◽  
Yufan Bu ◽  
Jiabang Huo ◽  
Xinjie Wang ◽  
Guangxin Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Osteoarthritis ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Femoral Osteotomy ◽  
Lower Limbs ◽  
Average Deviation ◽  
Total Knee

Abstract ObjectiveTo evaluate the methods, indications, and efficacy of the treatment of knee osteoarthritis with extra-articular deformity. MethodsA retrospective study of eight patients (three males and five females) with knee osteoarthritis complicated with extra-articular femoral deformity from February 2011 to April 2019; with an average age of 62.9 years (range 57 to 70 years). There were eight cases of coronal malformation with a mean angle of 15.5° (range 5° to 24°), and three cases of sagittal deformity with a mean angle of 14.0° (range12–16°). All eight patients underwent total knee arthroplasty (TKA). Three patients underwent femoral osteotomy and one-stage total knee arthroplasty, and one underwent femoral osteotomy and second-stage total knee joint replacement. ResultsThe mean follow-up time was 45.6 months (range 2 to 96 months). The average HSS score improved from 41.1 points (range, 28–53) preoperatively to 88.5 points (range, 71–95) at the time of the last follow-up. The average VAS score improved from 6.6 points (range, 3–10) preoperatively to 0.3 points (range, 0–1) at the time of the last follow-up. The average arc of knee motion improved from 66.3° (range 50° to 85°), preoperatively to 104.4°(range 95° to 120°) postoperatively. The average deviation of the mechanical axis of the knee improved from 17.3° (range 13° to 20°) preoperatively to 2.6°(range -6° to 6°) postoperatively. The differences between the preoperative data and postoperative follow-up data were statistically significant (P < 0.05). At the last follow-up visit, none of the eight patients had postoperative complications such as prosthesis loosening, infection, or deep vein thrombosis of the lower limbs. No bone nonunion, delayed union, or other complications occurred in the four patients with osteotomy. ConclusionAlthough it is difficult and complex to perform TKA surgery in patients with extra-articular deformity, a preoperative surgical plan should be made individually according to the patient's condition, and if necessary, the mechanical axis of the lower limbs can be effectively restored with the help of computer navigation technology or 3D printing technology, to achieve satisfactory surgical results.

How Frequently Do Five Total Arthroplasty Methods Change the Alignment of the Joint Lines and Limb From Normal?

2012 ◽  
Author(s):  
Yu S. Gu ◽  
Joshua D. Roth ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Joint Line ◽  
Coronal Plane ◽  
Mechanical Alignment ◽  
Gap Balancing ◽  
Total Arthroplasty ◽  
Straight Line ◽  
Total Knee

One strategy for aligning the limb and positioning components in total knee arthroplasty (TKA) in the coronal plane is mechanical alignment, which has the goal of positioning the center of the hip, knee, and ankle on a straight-line by establishing a femoral and tibial joint line at the knee that is perpendicular to the mechanical axis of the femur and tibia respectively. Another strategy is gap balancing, which has the goal of creating equal gaps between the medial and lateral compartments at 0° of extension and 90° of flexion.

scholarly journals Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Rohan Bhimani ◽  
Fardeen Bhimani ◽  
Preeti Singh
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Mechanical Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Introduction. Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods. We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient’s pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results. The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion. Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.

Kinematically Aligned TKA Aligns the Ankle Joint Line Closer to Those of the Native Ankle than Mechanically Aligned TKA in Bipedal Stance

2019 ◽  
Vol 32 (10) ◽  
pp. 1033-1038
Author(s):  
Jung-Taek Kim ◽  
Jun Han ◽  
Sumin Lim ◽  
Quan Hu Shen ◽  
Ye Yeon Won
Keyword(s):  
Total Knee Arthroplasty ◽  
Ankle Joint ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Joint Line ◽  
Control Group ◽  
Talar Dome ◽  
Bipedal Stance ◽  
Ankle Joints ◽  
Total Knee

AbstractMechanically aligned total knee arthroplasty (MATKA) aims to make alignment of the hip, knee, and ankle straight unexceptionally. However, emerging evidence suggests that unexceptional straightening the mechanical axis of the lower limb may lead to clinical and radiological problems of the ankle joint. By contrast, kinematically aligned total knee arthroplasty (KATKA) strives to restore the articular surface of the prearthritic knee. In this study, we examined results from KATKA and MATKA to determine which surgery restores the ankle joint orientation closer to the native ankle joint in bipedal stance and hypothesized that KATKA, rather than MATKA, would be more effective. Data from long-leg standing radiographs of 60 healthy adults (control group, n = 120 knees), patients who underwent MATKA (n = 90 knees), and patients who underwent KATKA (n = 90 knees) were retrospectively reviewed. The hip–knee–ankle angle, orientation of the tibial plafond and the talar dome relative to the ground (G-plafond and G-talus, respectively), and orientation of the plafond relative to the mechanical axis of the limb (M-plafond and M-talus, respectively) were measured and analyzed for comparison. Results show that bipedal stance alignment in patients who underwent KATKA (G-plafond: −0.65 ± 3.03 and G-talus: −1.72 ± 4.02) were not significantly different to native ankle joint alignment indicated by the control group. Compared with the native ankle joint measured in the control group (G-plafond: −0.76 ± 2.69 and G-talus: −1.30 ± 3.25), the tibial plafond and talar dome significantly tilted laterally relative to the ground in ankle joints after MATKA (G-plafond: −2.32 ± 3.30 and G-talus: −2.97 ± 3.98, p = 0.001 and p = 0.004, respectively). Thus, postoperative ankle joint line orientation after KATKA was horizontal to the floor and closer to that of native ankle joints than those after MATKA. The level of evidence is Level III.

Computer navigation is a useful intra-operative tool for joint line measurement in total knee arthroplasty

The Knee ◽  
2013 ◽  
Vol 20 (4) ◽  
pp. 256-262 ◽  
Author(s):  
Gerard Ee ◽  
Hee Nee Pang ◽  
Hwei Chi Chong ◽  
Mann Hong Tan ◽  
Ngai Nung Lo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Navigation ◽  
Joint Line ◽  
Line Measurement ◽  
Total Knee

Robot-Assisted Total Knee Arthroplasty Accurately Restores the Joint Line and Mechanical Axis. A Prospective Randomised Study

2014 ◽  
Vol 29 (12) ◽  
pp. 2373-2377 ◽  
Author(s):  
Ming Han Lincoln Liow ◽  
Zhan Xia ◽  
Merng Koon Wong ◽  
Keng Jin Tay ◽  
Seng Jin Yeo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Joint Line ◽  
Robot Assisted ◽  
Randomised Study ◽  
Total Knee ◽  
Prospective Randomised Study

scholarly journals Soft Tissue Envelope Preserving Technique for Computer Navigated Total Knee Arthroplasty

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0015
Author(s):  
Gavin Clark ◽  
Luke Mooney
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Clinical Results ◽  
Short Term ◽  
Soft Tissue Envelope ◽  
Total Knee

Objectives: Current techniques in Total Knee Arthroplasty(TKA) are utilitarian in that all patients are recommended to have the same alignment of neutral mechanical axis. It has been well established that the population has a varied natural alignment with less than 20% of patients naturally neutral. The ability to predictably individualise alignment for patients is hypothesised to result in greater patient satisfaction. This technique aims to modify mechanical axis technique to consider an individual’s soft tissue constraints. Methods: Soft Tissue Envelope Preserving (STEP) is an operative technique for performing TKA that utilises the soft tissue data obtained intra-operatively from computer navigation registration to determine the optimal alignment to provide balanced positioning of implants without the need for soft tissue releases. Hence balance is achieved through bone cuts rather than altering the patient’s soft tissue balance. The technique will be described in detail. Results: The last 100 patients performed with complete data sets including navigation files and both pre-op and one year post operative outcome measures were reviewed. The spread of overall alignments and bony resections have been compiled with no outliers outside 5 degrees of neutral. The clinical results were comparable with other series and patient satisfaction of greater than 90% was reported. There were no MCL or LCL releases performed. Ilio-tibial band partial releases were the only reported soft tissue releases made. Conclusions: This technique is a safe and effective method of performing TKA with good short term outcomes. It minimises the use of soft tissue releases by utilising the patient’s own soft tissue envelope to balance the knee whilst maintaining the basic principles of a measured resection mechanical axis technique. It has resulted in excellent patient satisfaction in the short term.

scholarly journals Pros and cons of navigated versus conventional total knee arthroplasty—a retrospective analysis of over 2400 patients

2021 ◽  
Author(s):  
Matthias Meyer ◽  
Tobias Renkawitz ◽  
Florian Völlner ◽  
Achim Benditz ◽  
Joachim Grifka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Analysis ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Complication Rates ◽  
Total Knee ◽  
One Year ◽  
Navigated Tka ◽  
Surgery Duration

Abstract Introduction Because of the ongoing discussion of imageless navigation in total knee arthroplasty (TKA), its advantages and disadvantages were evaluated in a large patient cohort. Methods This retrospective analysis included 2464 patients who had undergone TKA at a high-volume university arthroplasty center between 2012 and 2017. Navigated and conventional TKA were compared regarding postoperative mechanical axis, surgery duration, complication rates, one-year postoperative patient-reported outcome measures (PROMs) (WOMAC and EQ-5D indices), and responder rates as defined by the criteria of the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus (OMERACT-OARSI). Results Both navigated (1.8 ± 1.6°) and conventional TKA (2.1 ± 1.6°, p = 0.002) enabled the exact reconstruction of mechanical axis. Surgery duration was six minutes longer for navigated TKA than for conventional TKA (p < 0.001). Complication rates were low in both groups with comparable frequencies: neurological deficits (p = 0.39), joint infection (p = 0.42 and thromboembolic events (p = 0.03). Periprosthetic fractures occurred more frequently during conventional TKA (p = 0.001). One-year PROMs showed excellent improvement in both groups. The WOMAC index was statistically higher for navigated TKA than for conventional TKA (74.7 ± 19.0 vs. 71.7 ± 20.7, p = 0.014), but the increase was not clinically relevant. Both groups had a similarly high EQ-5D index (0.23 ± 0.24 vs. 0.26 ± 0.25, p = 0.11) and responder rate (86.5% [256/296] vs. 85.9% [981/1142], p = 0.92). Conclusion Both methods enable accurate postoperative leg alignment with low complication rates and equally successful PROMs and responder rates one year postoperatively. Level of evidence III. Retrospective cohort study.

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