Comparison with Navigation of a Novel Three-Step Technique for Improving Accuracy of the Distal Femoral Resection during Conventional TKA: A Case–Control Study

AbstractCorrect placement of the femoral component in the coronal plane during primary total knee arthroplasty (TKA) is related to long-term survival. The aim of this radiographic study was to determine the accuracy of a novel three-step technique for improving the accuracy of the distal femoral cut during conventional technique and compare it with computer navigation during TKA. A total of 458 TKAs were retrospectively analyzed (178 conventional TKAs with the novel technique and 280 navigated TKAs) for postoperative femoral component coronal alignment and compared between the two groups. Mean femoral component coronal alignment was not significantly different (p = 0.314) between the two groups. There was no significant difference in the mean femoral component coronal alignment between varus and valgus knees. The number of outliers (90 ± 3 degrees) for femoral component coronal alignment was not significantly different between the two groups when assessed separately for varus and valgus deformities. The mean value of femoral component alignment using the conventional technique in knees with varus deformity <10 degrees was 88.8 degrees, in knees with varus deformity 10 to 20 degrees was 89.4 degrees, and in those with varus deformity >20 degrees was 90.2 degrees. Femoral component alignment in knees with varus <10 degrees was significantly different from those >20 degrees (p = 0.006); there was no significant difference between knees with varus <10 degrees and those with 10 to 20 degrees varus (p = 0.251), nor between 10 and 20 degrees varus knees and those with varus >20 degrees (p = 0.116). Using the novel three-step technique during conventional TKA to perform the distal femoral cut can help achieve femoral component coronal alignment comparable to the navigation technique.

Download Full-text

Enhanced conventional method is as precise as navigation for distal femur resection during total knee replacement: a randomized controlled trial

F1000Research ◽

10.12688/f1000research.18154.1 ◽

2019 ◽

Vol 8 ◽

pp. 360

Author(s):

Rohan Bhimani ◽

Fardeen Bhimani ◽

Rohan Bir Singh ◽

Preeti Singh

Keyword(s):

Total Knee Replacement ◽

Femoral Component ◽

Knee Replacement ◽

Computer Navigation ◽

Varus Deformity ◽

Conventional Technique ◽

Coronal Alignment ◽

Significant Difference ◽

Total Knee ◽

The Mean

Introduction: The purpose of this prospective study was to determine the accuracy of distal femoral cut and femoral component placement in the coronal plane with the enhanced conventional technique when compared to computer navigation during total knee replacement (TKR). Methods: In total, 475 total knee arthroplasties (TKA) were analyzed (200 optimized conventional TKAs and 275 navigated TKAs) for postoperative mechanical alignment or hip-knee-ankle angle and femoral component coronal alignment and compared between the two groups Results: Mean femoral component coronal alignment was not significantly different (p=0.35) when navigation and enhanced conventional groups were compared. There was no significant difference in the mean femoral component coronal alignment between knees with a valgus correction angle (VCA) <5° (p=0.28), knees with VCA 5°-7° (p=0.48) and knees with >7° (p=0.09). No significant difference was noted in the mean femoral component coronal alignment between knees with varus deformity <10° (p=0.19), varus deformity 10°-20° (p=0.72) and valgus deformity (p=0.35). Conclusions: Using the enhanced conventional technique in each patient to perform distal femoral cut during total knee arthroplasty can help achieve the coronal alignment of the femoral component comparable to navigation technique. Registration: UMIN-CTR ID UMIN000036204.

Download Full-text

DOES NAVIGATION TOTAL KNEE REPLACEMENT REALLY MAKE A DIFFERENCE?

Journal of Musculoskeletal Research ◽

10.1142/s0218957713500073 ◽

2013 ◽

Vol 16 (02) ◽

pp. 1350007

Author(s):

P. Motwani ◽

A. Jariwala ◽

N. Valentine

Keyword(s):

Total Knee Replacement ◽

Tibial Component ◽

Sagittal Plane ◽

Computer Navigation ◽

Component Alignment ◽

Tibial Component Alignment ◽

Significant Difference ◽

Total Knee ◽

The Mean

Background: Computer Navigation in Total Knee Replacement (TKR) has completed more than a decade since its inception. From that time, numerous studies have been done to see its effect on the variables of surgery and its outcome. Some studies have shown that it is definitely beneficial while others have negated its superiority over conventional techniques. This is an early outcome study on the results of navigation TKR in terms of alignment and clinical outcome at three years post-operatively. Methods: In the present study, 128 patients who had undergone navigation TKR (128 TKR) between January 2006 and November 2009 were included. The navigation system used was orthoPilot®. Patients were assessed post-operatively at one and three year using knee society score (KSS) and knee function score (KFS). All patients completed one year follow-up and 55 patients completed three year follow-up. From 128 patients, 40 navigated TKR patients operated between November 2007 and 2009 and were compared with 40 patients operated by conventional TKR operated between July 2007 and December 2008. Results: The mean KSS at 1 year post-operatively was 85.60 and at 3 years was 85.87. The mean KFS at 1 year post-operatively was 69.30 and at 3 years was 68.00. There was no statistically significant difference between navigation TKR and conventional TKR in terms of anatomical femoro-tibial alignment, femoral component alignment in coronal and sagittal plane and tibial component alignment in coronal plane. However, there was statistically significant difference between tibial component alignment in sagittal plane (p = 0.000) between both the groups. Conclusion: Computer navigation TKR affords a possibility to place both the femoral and tibial component very precisely without the risk of any greater axis deviation from ideal value. It helps in reducing the outliers in alignment of the limb and that of component and that improves the overall implant survival for a long time post-operatively.

Download Full-text

Is the Femoral Component Flexion Affected by the Sagittal Femoral Shaft Bowing in Conventional Intramedually Guided TKA?

10.21203/rs.3.rs-853204/v1 ◽

2021 ◽

Author(s):

Xiaofeng Zhang ◽

Qianjin Wang ◽

Xingquan Xu ◽

Dongyang Chen ◽

Zhengyuan Bao ◽

...

Keyword(s):

Femoral Component ◽

Sagittal Plane ◽

Pearson Correlation ◽

Femoral Shaft ◽

Conventional Technique ◽

Component Alignment ◽

Chi Square ◽

Significant Difference ◽

Femoral Component Flexion ◽

Femoral Bowing

Abstract Background: The aim of the present study was to investigate the influence of sagittal femoral bowing on sagittal femoral component alignment, and whether there was correlation between sagittal femoral component alignment and coronal femoral component alignment.Methods: We retrospectively reviewed 77 knees in 71 patients who had undergone primary TKA for advanced osteoarthritis.All surgeries were performed by using a standard medial parapatellar approach. The osteotomy was performed with a conventional technique using an intramedullar rod for the femur and a mechanical extramedullar guiding system for the tibia. All patients enrolled in the study were evaluated with full-length lower extremity load-bearing standing scanograms and the patients had preoperative and postoperative radiographs of the knees. cFBA(coronal femoral bowing angle), sFBA(sagittal femoral bowing angle),and postoperatively, mTFA(mechanical tibiofemoral angle of the knee), β angle(femoral component flexion angle) were measured. The radiographic results of both groups were compared using Student's t test. A two-sided Pearson correlation coefficient was obtained to identify the correlations between FBA in the coronal and sagittal planes, as well as FBA and age or BMI, sFBA and β angle, cFBA and mTFA. Comparison of FSB incidence between different genders was using chi-square test. The p value <0.05 indicates a statistically significant difference.Results: The mean sFBA, cFBA, β angle, mTFA were 9.34°±3.56°(range 1°-16°), 3.25°±3.79°(range -7°-17°), 3.91°±3.15°(range -1°-13°), 0.60°±1.95°(range -3°-6°), respectively. There was no correlation between age and sFBA(CC=0.192, p=0.194) or cFBA(CC=0.192, p=0.194), similarly, there was no correlation between age and sFBA(CC=0.067, p=0.565) or cFBA(CC=0.069, p=0.549). The sFBA was correlated with cFBA and β angle(CC=0.540, p<0.01; CC=0.543, p<0.01; respectively) and the cFBA was correlated with mTFA(CC=0.430, p<0.01). There was no significant difference(p=0.247) of cFBA between the patients with sFSB and the patients without sFSB. Conclusions: The current study showed that the sFBA was correlated with cFBA in the patients undergoing TKA and the patients with sFSB usually presented non-cFSB. We also found that sFSB could affect the femoral component alignment in the sagittal plane and cFSB could affect the femoral component alignment in the coronal plane. The sFBA or cFBA was not correlated with age, BMI or gender.

Download Full-text

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02822-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiaofeng Zhang ◽

Qianjin Wang ◽

Xingquan Xu ◽

Dongyang Chen ◽

Zhengyuan Bao ◽

...

Keyword(s):

Femoral Component ◽

Sagittal Plane ◽

Pearson Correlation ◽

Femoral Shaft ◽

Conventional Technique ◽

Component Alignment ◽

Chi Square ◽

Significant Difference ◽

Femoral Component Flexion ◽

Femoral Bowing

Abstract Background The aim of the present study was to investigate the influence of sagittal femoral bowing on sagittal femoral component alignment, and whether there was correlation between sagittal femoral component alignment and coronal femoral component alignment. Methods We retrospectively reviewed 77 knees in 71 patients who had undergone primary TKA for advanced osteoarthritis. All surgeries were performed by using a standard medial parapatellar approach. The osteotomy was performed with a conventional technique using an intramedullary rod for the femur and a mechanical extramedullary guiding system for the tibia. All patients enrolled in the study were evaluated with full-length lower extremity load-bearing standing scanograms, and the patients had preoperative and postoperative radiographs of the knees. Coronal femoral bowing angle (cFBA), sagittal femoral bowing angle (sFBA), and postoperatively, mechanical tibiofemoral angle of the knee (mTFA), β angle (femoral component flexion angle) were measured. The radiographic results of both groups were compared using Student's t test. A two-sided Pearson correlation coefficient was obtained to identify the correlations between FBA in the coronal and sagittal planes, as well as FBA and age or BMI, sFBA and β angle, cFBA and mTFA. Comparison of FSB incidence between different genders was made using Chi-square test. The p value < 0.05 indicates a statistically significant difference. Results The mean sFBA, cFBA, β angle, mTFA were 9.34° ± 3.56°(range 1°–16°), 3.25° ± 3.79°(range − 7° to −17°), 3.91° ± 3.15°(range − 1° to −13°), 0.60° ± 1.95°(range − 3° to −6°), respectively. There was no correlation between age and sFBA (CC = 0.192, p = 0.194) or cFBA (CC = 0.192, p = 0.194); similarly, there was no correlation between age and sFBA (CC = 0.067, p = 0.565) or cFBA (CC = 0.069, p = 0.549). The sFBA was correlated with cFBA and β angle (CC = 0.540, p < 0.01; CC = 0.543, p < 0.01, respectively), and the cFBA was correlated with mTFA (CC = 0.430, p < 0.01). There was no significant difference (p = 0.247) of cFBA between the patients with sFSB and the patients without sFSB. Conclusions The current study showed that the sFBA was correlated with cFBA in the patients undergoing TKA and the patients with sFSB usually presented non-cFSB. We also found that sFSB could affect the femoral component alignment in the sagittal plane and cFSB could affect the femoral component alignment in the coronal plane. The sFBA or cFBA was not correlated with age, BMI, or gender.

Download Full-text

Primary Results of Medial Epicondylar Osteotomy in Patients with Severe Bilateral Varus Knee Candidate for Total Knee Replacement

The Journal of Knee Surgery ◽

10.1055/s-0039-1694047 ◽

2019 ◽

Author(s):

Fardin Mirzatolooei ◽

Ali Tabrizi ◽

Hassan Taleb ◽

Mohammad Khalegi Hashemian ◽

Mir Bahram Safari

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Stress Test ◽

Varus Deformity ◽

Contralateral Side ◽

Significant Difference ◽

Total Knee ◽

The Mean ◽

Medial Release ◽

Varus Angle

Background Total knee arthroplasty is a challenging task in patients with severe varus deformity. In most of these patients, an extensive medial release is needed that may lead to instability. Medial epicondylar osteotomy may be a better substitute for complete medial collateral release. Materials and Methods Fourteen patients with bilateral knee osteoarthritis and severe varus deformity were enrolled in this study. In one side, the patients underwent medial epicondylar osteotomy for mediolateral imbalance if the only option was superficial medial collateral ligament (MCL) release. In contralateral side, the extensive medial release was performed and MCL was released either by pie-crusting technique or by subperiosteally release. The results of the two sides were compared. Patients were followed up for 12 months after the operation. Physical examination, clinical questionnaires, and radiography findings were recorded. Union of the osteotomies fragment and complications was evaluated. Results The mean varus angle before surgery was 21.6 ± 4.7 degrees, which was corrected to 8.6 ± 2.9 degrees after operation with an extensive medial release. The mean varus angle of contralateral side was 22.6 ± 1.7 degrees, which was corrected to 7.5 ± 2.3 degrees following medial femoral epicondyle osteotomy. There was no significant difference in varus correction (p = 0.1). Medial joint line opening in valgus stress test was 2.7 ± 0.4 mm in the osteotomized side and 3.5 ± 0.9 mm in contralateral side. Mean range of motion for the osteotomized side was 97.8 ± 4.3 degrees and 100.7 ± 2.7 degrees for contralateral side (p = 0.6). Nonunion occurred in a case in the osteotomized side and no medial instability was observed in medial release or osteotomies sides. No statistical difference was recorded based on clinical questionnaires (Oxford and WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] scores). Conclusion Medial epicondylar osteotomy is a safe technique with the well-controlled medial extensive release in the patients with severe varus deformity during total knee arthroplasty.

Download Full-text

Correlation Between Asymmetric Resection of Posterior Femoral Condyles and Femoral Component Rotation in Total Knee Arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00140 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0014

Author(s):

Harun Reşit Güngör ◽

Nusret Ök ◽

Kadir Ağladıoğlu ◽

Semih Akkaya ◽

Esat Kıter

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Trochlear Groove ◽

Femoral Component Rotation ◽

Component Rotation ◽

Significant Difference ◽

Total Knee ◽

The Mean ◽

The Asymmetry

Objectives: Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty. Methods: We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured. Results: The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (p<0.0001, r=0.803). Linear regression analyses revealed that 0.8 mm of difference between the anteroposterior dimensions of medial and lateral PCO corresponds to 1 degree of surgical FRA (p<0.0001, R2=0.645). Conclusion: Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.

Download Full-text

Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

Acta Orthopaedica Belgica ◽

10.52628/87.1.22 ◽

2021 ◽

Vol 87 (1) ◽

pp. 175-179

Author(s):

Thibault Dewilde ◽

Sebastiaan Schelfaut ◽

Sven Bamps ◽

Matthias Papen ◽

Pierre Moens

Keyword(s):

Retrospective Study ◽

Case Series ◽

Technical Note ◽

Coronal Alignment ◽

Level Of Evidence ◽

Coronal Balance ◽

Scoliotic Deformity ◽

Significant Difference ◽

The Mean ◽

The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

Download Full-text

Implications of Long-Term Survival in Acute Stem Cell Leukemia of Childhood Treated with Composite Cyclic Therapy

Blood ◽

10.1182/blood.v24.5.477.477 ◽

1964 ◽

Vol 24 (5) ◽

pp. 477-494 ◽

Cited By ~ 98

Author(s):

WOLF W. ZUELZER

Keyword(s):

Stem Cell ◽

Lymphoblastic Leukemia ◽

Current Evidence ◽

White Blood Count ◽

Cell Leukemia ◽

Term Survival ◽

Total Survival ◽

Significant Difference ◽

The Mean ◽

Stem Cell Leukemia

Abstract The results of 9 years’ experience with acute stem cell (lymphoblastic) leukemia treated with a combination of steroids and antimetabolites, designated as "composite cyclic therapy" (CCT), are described and their theoretical implications are discussed. In 175 patients surviving at least one month after diagnosis the per cent survivals were: 17.2 months (50 per cent), 27.5 months (25 per cent), and 45.0 months (10 per cent). Six patients were alive in uninterrupted remission at the close of the study, from 4-9 years after diagnosis. The mean survival of the expired patients was 17.7 months, with a median of 14.5 months. The mean duration of the first remission was 15.2 months with a median of 12.5. The therapeutic response in terms of remission rate and total survival was significantly better in stem cell leukemia, as defined cytologically at the time of original diagnosis, than in other types, suggesting that the effect of steroids on the former is at least in part specific for malignant cells of lymphoid origin. A highly significant difference within the group of stem cell leukemia was observed between patients with initially low as compared to high white blood count, the dividing line being at 20,000 cells/mm.,3 the latter having twice the mean survival of the former. Of the 44 patients achieving survival of 2 years or more only one had an initial white count of more than 20,000. In conjunction with chromosome studies published elsewhere these findings suggest that the initial white count is a parameter, possibly of immunologic nature, indicative of the partial retention or complete loss of control over leukemic mutant cells. The possibility is discussed, on the basis of theoretical considerations and the observed role of long first remissions in the total survival time, that conditions and measures taken in the early stages of therapy may be decisive for the ultimate course. The current evidence for the mutational nature of acute leukemia permits the theoretical distinction between remission as the temporary suppression of a mutant stem line as opposed to a "cure" representing its permanent elimination, and to explain occasional apparent cures, including some observed in the present series, on that basis. Clinically, combined cyclic therapy or CCT appears to be superior to the use of single antimetabolites. The withholding of steroids until these drugs become ineffective does not at present appear justified.

Download Full-text

Outcome of using a modified surgical technique for the repair of complex vesicovaginal fistulas in Nigeria

Urogynaecologia ◽

10.4081/uij.2017.196 ◽

2017 ◽

Vol 30 (1) ◽

Author(s):

Aniefiok J. Umoiyoho ◽

Emmanuel C. Inyang-Etoh

Keyword(s):

Obstetric Fistula ◽

Conventional Technique ◽

Control Group ◽

Study Group ◽

Success Rates ◽

Modified Technique ◽

Repair Technique ◽

Significant Difference ◽

The Mean ◽

Repair Techniques

The relatively low effectiveness of available surgical repair techniques for complex obstetric fistula has justified the need for continued exploration of more effective repair techniques. Subjects who presented at a vesicovaginal fistula referral centre in Nigeria were randomized into the study group (modified technique) and the control group (conventional technique). Success rates between the two groups were compared. The study comprised 29 patients in each arm of the study. The mean age of patients in the study group was 23.9 ± 9.6 years and 24.4 ± 2.1 years among patients in the control group with the vast majority of the patients in the both groups being married, 75.9% and 86.2% respectively. In both groups, the majority were secundipara, 55.2% in the study group and 44.8% in the control group. The majority (41.4% in the study group and 44.8% in the control group) of the patients in both groups had attained primary level of education. The mean duration of the fistulas among patients in the study population was 1.1 ± 0.3 years with over half (50.0% among patients in the study group and 53.5% of patients in the control group) of the patients had their fistula for less than one year. A highly statistically significant difference in success rate between patients in the study group and patients in the control group was obtained (p=0.0004). The modified repair technique presented by this study has proved to produce superior results when compared to the conventional repair technique in the management of complex obstetric fistulas in Nigeria.

Download Full-text

Different Kinematics of Knees with Varus and Valgus Deformities

The Journal of Knee Surgery ◽

10.1055/s-0037-1603340 ◽

2017 ◽

Vol 31 (03) ◽

pp. 264-269 ◽

Cited By ~ 1

Author(s):

A. Benditz ◽

F. Koeck ◽

A. Keshmiri ◽

J. Grifka ◽

G. Maderbacher ◽

...

Keyword(s):

Internal Rotation ◽

External Rotation ◽

Computer Navigation ◽

Movement Pattern ◽

Varus Deformity ◽

Valgus Deformity ◽

Significant Difference ◽

Before And After ◽

Tibiofemoral Kinematics

AbstractFew data exist of kinematics of knees with varus and valgus deformities combined with osteoarthritis. The purpose of this study was to reveal different (1) tibiofemoral kinematics, (2) medial and lateral gaps, and (3) condylar liftoff of osteoarthritic knees with either varus or valgus deformity before and after total knee arthroplasty (TKA). For this purpose, 40 patients for TKA were included in this study, 23 knees with varus deformity and 17 knees with valgus deformity. All patients underwent computer navigation, and kinematics was assessed before making any cuts or releases and after implantation. Osteoarthritic knees with valgus deformity showed a significant difference in tibia rotation relative to the femur with flexion before and after TKA, whereas knees with varus deformity did not. Knees with a valgus deformity showed femoral external rotation in extension and femoral internal rotation in flexion, whereas knees with a varus deformity revealed femoral internal rotation in extension and femoral external rotation in flexion. In both groups, gaps increased after TKA. Condylar liftoff was not observed in the varus deformity group after TKA. In the valgus deformity group, condylar liftoff was detected after TKA at knee flexion of 50 degrees and more. This study revealed significant differences in tibiofemoral kinematics between osteoarthritic knees with a varus or valgus deformity before and after TKA. Valgus deformities showed a paradoxic movement pattern. These in vivo intraoperative results need to be confirmed using fluoroscopic or radiographic three-dimensional matching before and after TKA.

Download Full-text