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.

scholarly journals Changes of ankle inclinations after total knee arthroplasty

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Murat Celal Sözbilen ◽  
Elcil Kaya Biçer ◽  
Semih Aydoğdu ◽  
Hakkı Sur
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Ankle Joint ◽  
Knee Arthroplasty ◽  
Joint Line ◽  
X Rays ◽  
Group I ◽  
Total Knee ◽  
Group Ii ◽  
Line Inclination

Aim: To evaluate the changes in ankle joint line inclination in patients who had total knee arthroplasty due to degenerative osteoarthritis. Material/Method: Sixty-two knees (with a mean age of 71,66±6,78 years, follow-up 52,34±27,42 months) which had undergone total knee arthroplasty between November 1996 and May 2014 were included in this retrospective study. The knee joint line orientations (KJLO) of the prosthesis and ankle joint line inclination (AJLI) relative to the floor were evaluated on postoperative standard standing long-leg X-rays. The AJLI relative to the floor was defined as the angle between the tangent to the subchondral plate of the talus and the horizontal grid line on radiographs. In order to determine the effects of KJLO and high varus on AJLI, patients were divided into two each groups that were pre-operative mechanical axes (MA) as <20° (n=35, group1) and >=20° (n=27, group2) and post-operative MA <3° (n=32, group a) and >=3° (n=30, group b). In addition, the changes in AJLI were compared between each group. The patients were regrouped as either <=3° (n=28, group i) or >3° (n=34, group ii), in terms of the postoperative KJLO. Inclination angles of the prosthesis were compared between each groups. Statistical analysis was performed with SPSS v18. Results: Mean MA of pre-operative and post-operative were 16,35±6,56° and 3,92±3,35°, respectively. All ankle inclinations were lateralized. AJLI, were significantly decreased from pre-operative mean 7,37°±3,19° to post-operative mean 3,71°±2,22° (p<0,0001). The mean of change was 3,65°±3,03°. However, pre-operative AJLIs were significantly increased in high varus group (group1: 6,34°±2,54°, group2: 8,70°±3,48°, p=0,003); post-operative AJLIs did not differ significantly (group1: 3,55°±2,36°, group2: 3,92°±2,05°, p=0,516) with respect to the MA. The changes in preop-postop AJLI’s were significantly higher in high varus group again (p=0,009). When the KJLO groups were compared, pre-operative AJLIs were significantly different (group i: 6,25°±2,33°, group ii: 8,29°±3,53°, p=0,004) while post-operative AJLIs did not differ significantly (group i: 3,46°±2,38°, group ii: 3,92°±2,08°, p=0,489). Conclusion: Pre-operatively high varus knees also had high ankle varus, hence ankle deformity was corrected by the restoration of the optimal lower limb aligment. Obtaining parallel orientation of the components relative to the ground, restored the AJLI. Pre-operative planning and convenient implantation of the components lead to achieve optimum knee orientation which restored the ankle joint line orientation independent from mechanical axes. Not only the goal of optimum mechanical axes but also optimum knee joint line orientation’s importance was demonsrated.

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.

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

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

Providing Inpatient Mobilization with a Mobility Technician Constrains Cost in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Thomas A. Novack ◽  
Christopher J. Mazzei ◽  
Jay N. Patel ◽  
Eileen B. Poletick ◽  
Roberta D'Achille ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Care Pathway ◽  
Primary Total Knee Arthroplasty ◽  
Cost Savings ◽  
Patient Discharge ◽  
Control Group ◽  
Study Group ◽  
Bundled Payment ◽  
Total Knee

AbstractSince the 2016 implementation of the comprehensive care for joint replacement (CJR) bundled payment model, our institutions have sought to decrease inpatient physical therapy (PT) costs by piloting a mobility technician program (MTP), where mobility technicians (MTs) ambulate postoperative total knee arthroplasty (TKA) patients under the supervision of nursing staff members. MTs are certified medical assistants given specialized gate and ambulation training by the PT department. The aim of this study was to examine the economic and clinical impact of MTs on the primary TKA postoperative pathway. We performed a retrospective review of TKA patients who underwent surgery at our institution between April 2018 and March 2019 and who were postoperatively ambulated by MTs. The control group included patients who had surgery during the same months of the prior year, preceding introduction of MTs to the floor. Inclusion criteria included: unilateral primary TKA for arthritic conditions and conversion to unilateral primary TKA from a previous knee surgery. Minitab Software (State College, PA) was used to perform the statistical analysis. There were 658 patients enrolled in the study group and 1,400 in the control group. The two groups shared similar demographics and an average age of 68 (p = 0.177). The median length of stay (LOS) was 2 days in both groups (p = 0.133) with 90.5% of patients in the study group discharged to home versus 81.5% of patients in the control group (p < 0.001). The ability of MTs to increase patient discharge to home without negatively impacting LOS suggest MTs are valuable both clinically to patients, and economically to the institution. Cost analysis highlighted the substantial cost savings that MTs may create in a bundled payment system. With the well-documented benefits of early ambulation following TKA, we demonstrate how MTs can be an asset to optimizing the care pathway of TKA patients.

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.

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

The Effect of Preoperative Video Based Pain Training on Postoperative Pain and Analgesic Use in Patients Undergoing Total Knee Arthroplasty: A Non-randomized Control Group Intervention Study

2020 ◽  
pp. 105477382098336
Author(s):  
Ceyda Su Gündüz ◽  
Nurcan Çalişkan
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Group Intervention ◽  
Intervention Study ◽  
Intervention Group ◽  
Control Group ◽  
Total Knee ◽  
Randomized Control ◽  
Analgesic Use

This non-randomized control group intervention study was conducted to determine the effect of preoperative video based pain training on postoperative pain and analgesic use in patients undergoing total knee arthroplasty. During the study, the patients in the control ( n = 40) received routine care and the patients in the intervention group ( n = 40) received video based pain training. İt was determined that the mean postoperative pain scores of the intervention group were significantly lower and their pain management was better compared to the control group ( p < .05). The intervention group was found to use significantly less paracetamol on operation day compared to the control group ( p < .05). The intervention group was determined to benefit from non-pharmacological methods more than the control group did ( p < .05). Providing video based pain training to patients undergoing total knee arthroplasty is recommended since it reduces postoperative pain levels and increases the use of non-pharmacological pain control methods.

scholarly journals Intravenous patient-controlled analgesia vs nurse administered oral oxycodone after total knee arthroplasty: a retrospective cohort study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Katarina Lahtinen ◽  
Elina Reponen ◽  
Anne Vakkuri ◽  
Riku Palanne ◽  
Mikko Rantasalo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Pain Medication ◽  
Secondary Outcome ◽  
Control Group ◽  
Patient Controlled Analgesia ◽  
Total Knee Arthroplasty Patient ◽  
Opioid Dose ◽  
Total Knee

AbstractShort CommunicationsSevere post-operative pain is common after total knee arthroplasty. Patient-controlled analgesia is an alternative method of pain management, whereby a patient administers his or her own pain medication. Patients seem to prefer this method over nurse-administered analgesia. However, it remains unclear whether patients using patient-controlled analgesia devices use higher or lower doses of opioids compared to patients treated with oral opioids.Objectives and MethodsThis retrospective study examined 164 patients undergoing total knee arthroplasty. Post-operatively, 82 patients received oxycodone via intravenous patient-controlled analgesia devices, while the pain medication for 82 patients in the control group was administered by nurses. The main outcome measure was the consumption of intravenous opioid equivalents within 24 h after surgery. Secondary outcome measures were the use of anti-emetic drugs and the length of stay. Furthermore, we evaluated opioid-related adverse event reports.ResultsThe consumption of opioids during the first 24 h after surgery and the use of anti-emetic drugs were similar in both groups. The median opioid dose of intravenous morphine equivalents was 41.1 mg (interquartile range (IQR): 29.5–69.1 mg) in the patient-controlled analgesia group and 40.5 mg (IQR: 32.4–48.6 mg) in the control group, respectively. The median length of stay was 2 days (IQR: 2–3 days) in the patient-controlled analgesia group and 3 days (IQR: 2–3 days) in the control group (p=0.02). The use of anti-emetic drugs was similar in both groups.ConclusionsThe administration of oxycodone via intravenous patient-controlled analgesia devices does not lead to increased opioid or anti-emetic consumptions compared to nurse-administered pain medication after total knee arthroplasty. Patient-controlled analgesia might lead to shortened length of stay.

scholarly journals Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Dongquan Shi ◽  
Xingquan Xu ◽  
Anyun Guo ◽  
Jin Dai ◽  
Zhihong Xu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Mechanical Alignment ◽  
Early Loosening ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted.Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement.Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P=0.03).Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

Sign in / Sign up

Export Citation Format

Share Document