A gyroscope-based system for intraoperative measurement of tibia coronal plane alignment in total knee arthroplasty

Objective: Computer assisted total knee arthroplasty (CA TKA) platforms can provide detailed kinematic data that is presented in various forms including a coronal plane graphic that maps the flexion arc from full extension to deep flexion. Graphics obtained from normal tibiofemoral articulations reveal varied and complex kinematic patterns that have yet to be explained. An understanding of what drives curve variation would allow prediction of how a preoperative curve would be altered by total knee arthroplasty. Implant position could then be tailored to maintain a desirable curve or avoid an undesirable one. Methods: An articulated lower limb saw bone with a stable hip pivot was obtained. Adjustable osteotomies were created so that femoral torsion, femoral varus-valgus and tibial varus-valgus could be altered independently. The saw bone limb was registered with a CA TKA navigation system using the posterior condyles as a rotational axis. Axial and coronal plane morphology of the distal femur and coronal plane morphology of the proximal tibia were systematically altered and a kinematic curve obtained for each morphologic combination. Femoral rotational position was varied from 100 of internal torsion to 100 of external torsion in 20 increments. Similarly, femoral coronal position was varied from 20 of varus to 60 of valgus and tibial coronal position was varied from 5.50 of varus to 10 of valgus. Curves were obtained by manually flexing the joint through a full range of motion with the femoral condyles in contact with proximal tibia at all times. Results: Varying femoral rotation has no effect in full extension but drives the curve away from neutral as the knee flexes. Maximal deviation is seen at around 900 of flexion. Internal torsion drives the curve into valgus as the knee flexes and external torsion has a reciprocal effect. Varying femoral varus-valgus causes maximal deviation from neutral in full extension. Femoral varus drives the curve from varus in extension towards valgus as the knee flexes with the effect peaking in maximal flexion. Femoral valgus has a reciprocal effect. Varying tibial varus-valgus has no effect on curve shape but does move the curve either side of neutral. Complex (parabolic) curves are caused by large rotations or the opposing effects of femoral varus-valgus and femoral rotation. The modal human anatomy of slight femoral internal rotation, slight femoral valgus and slight tibial varus produces a straight neutral curve. Conclusion: Kinematic curve shape is driven by distal femoral anatomy. The typical changes made to distal femoral articular anatomy in TKA by externally rotating a neutrally orientated femoral component will bring many native curves towards neutral. Externally rotating when the preoperative curve begins neutral and drives into varus as the knee flexes will drive the curve harder into varus. Conversely, kinematic femoral placement will reconstitute the premorbid curve morphology. Which outcome is preferable has yet to be determined.

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Extramedullary Guide Alignment Is not Affected by Obesity in Primary Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1701438 ◽

2020 ◽

Author(s):

Jocelyn Compton ◽

Jessell Owens ◽

Jesse Otero ◽

Nicolas Noiseux ◽

Timothy Brown

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Primary Total Knee Arthroplasty ◽

Coronal Plane ◽

Coronal Alignment ◽

Primary Tkas ◽

Significant Difference ◽

Total Knee ◽

Valgus Alignment

AbstractCoronal alignment of the tibial implant correlates with survivorship of total knee arthroplasty (TKA), especially in obese patients. The purpose of this study was to determine if obesity affects coronal plane alignment of the tibial component when utilizing standard extramedullary tibial guide instrumentation during primary TKA. A retrospective review from June 2017 to February 2018 identified 142 patients (162 primary TKAs). There were 88 patients (100 knees) with body mass index (BMI) < 35 kg/m2 and 54 patients (62 knees) with BMI ≥ 35.0 kg/m2. The cohorts did not differ in age (p = 0.37), gender (p = 0.61), or Charlson's comorbidity index (p = 0.54). Four independent reviewers measured the angle between the base of the tibial component and the mechanical axis of the tibia on the anteroposterior view of long-leg film at first postoperative clinic visit. Outliers were defined as patients with greater than 5 degrees of varus or valgus alignment (n = 0). Reoperations and complications were recorded to 90 days postoperatively. There was no significant difference in mean tibial coronal alignment between the two groups (control alignment 90.8 ± 1.2 degree versus obese alignment 90.8 ± 1.2 degree, p = 0.91). There was no difference in varus versus valgus alignment (p = 0.19). There was no difference in the number of outliers (two in each group, p = 0.73). There was no difference in rate of reoperation (p = 1.0) or complication (p = 0.51). Obesity did not affect coronal plane alignment of the tibial component when using an extramedullary guide during primary TKA in our population.

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Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00047 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0004

Author(s):

Prettysia Suvarly ◽

Nyoman Aditya Sindunata ◽

Rio Aditya ◽

Rusli Muljadi ◽

John Butarbutar

Keyword(s):

Total Knee Arthroplasty ◽

Linear Regression ◽

Knee Arthroplasty ◽

Femoral Shaft ◽

Coronal Plane ◽

Coronal Alignment ◽

Geriatric Population ◽

X Ray ◽

Cutting Angle ◽

Total Knee

Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis. Methods: Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24. Results: Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa. Conclusion: Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates. References: Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42

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Radiographic outcomes in the coronal plane with iASSIST™ versus optical navigation for total knee arthroplasty: A preliminary case-control study

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.01.018 ◽

2016 ◽

Vol 102 (3) ◽

pp. 363-368 ◽

Cited By ~ 17

Author(s):

A. Desseaux ◽

P. Graf ◽

F. Dubrana ◽

R. Marino ◽

A. Clavé

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Control Study ◽

Case Control ◽

Coronal Plane ◽

Optical Navigation ◽

Radiographic Outcomes ◽

Total Knee ◽

Control Study

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

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80477 ◽

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.

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Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: A systematic review and meta-analysis

The Surgeon ◽

10.1016/j.surge.2017.12.003 ◽

2018 ◽

Vol 16 (4) ◽

pp. 237-244 ◽

Cited By ~ 5

Author(s):

Ashim Mannan ◽

James Vun ◽

Christopher Lodge ◽

Alistair Eyre-Brook ◽

Simon Jones

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Coronal Plane ◽

Robotic Assisted ◽

Total Knee

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Coronal Plane Stability Before and After Total Knee Arthroplasty

Clinical Orthopaedics and Related Research ◽

10.1097/blo.0b013e318137a182 ◽

2007 ◽

Vol 463 ◽

pp. 43-49 ◽

Cited By ~ 9

Author(s):

Robert A Siston ◽

Stuart B Goodman ◽

Scott L Delp ◽

Nicholas J Giori

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Coronal Plane ◽

Before And After ◽

Total Knee

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Can total knee arthroplasty restore the correlation between radiographic mechanical axis angle and dynamic coronal plane alignment during gait?

The Knee ◽

10.1016/j.knee.2019.02.012 ◽

2019 ◽

Vol 26 (3) ◽

pp. 586-594 ◽

Cited By ~ 1

Author(s):

Gabriel Larose ◽

Alexandre Fuentes ◽

Frederic Lavoie ◽

Rachid Aissaoui ◽

Jacques de Guise ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Coronal Plane ◽

Total Knee

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Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0040-1710362 ◽

2020 ◽

Author(s):

Michael McAuliffe ◽

Patrick O'Connor ◽

Lisa Major ◽

Gautam Garg ◽

Sarah L. Whitehouse ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Coronal Plane ◽

Soft Tissue Release ◽

Computer Assisted ◽

Soft Tissue Balancing ◽

Total Knee ◽

And Function

AbstractSoft tissue balancing, while accepted as crucial to total knee arthroplasty (TKA) outcomes, is incompletely defined as the subject of broad recommendations. We analyzed 120 computer-assisted, posterior stabilized TKA undertaken for osteoarthritis. Coronal plane laxity was measured, in the 91 varus and 29 valgus knees, prior to any bone resection or soft tissue release, and again after implant insertion. Soft tissue laxity parameters were correlated to the American Knee Society Score (2011) at a minimum follow-up of 12 months with a focus on patient function and satisfaction. Thirteen specific laxity parameters showed a significant correlation to satisfaction, one parameter correlated to function, and another to both functional and satisfaction outcomes. Most correlations were weak, the strongest related to postoperative decreases in coronal plane laxity. Greater preoperative varus but not valgus deformity was associated with higher satisfaction scores. Additionally, 30 patients who reported 40 of 40 satisfaction and that their TKA knee felt normal at all times did not have soft tissue balancing parameters distinguishing them from other subjects. Patient satisfaction and function outcomes demonstrated limited correlation to coronal plane soft tissue parameters. It appears that optimizing TKA satisfaction and function is not as simple as producing a narrow range of coronal laxity parameters. The ongoing debate around optimal coronal plane alignment and its subsequent effect on coronal plane soft tissues may not be as independently important as currently argued. Soft tissue balance may need to be considered as a more complex global envelope.

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