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

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.

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

Journal of Orthopaedic Surgery ◽

10.1177/23094990211002002 ◽

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.

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Varus deformity in the proximal tibia and immediate postoperative varus alignment result in varus progression in limb alignment in the long term after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05841-4 ◽

2020 ◽

Vol 28 (10) ◽

pp. 3287-3293

Author(s):

Yuichi Kuroda ◽

Koji Takayama ◽

Shinya Hayashi ◽

Shingo Hashimoto ◽

Takehiko Matsushita ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Proximal Tibia ◽

Varus Deformity ◽

Varus Alignment ◽

Limb Alignment ◽

Total Knee ◽

Alignment Result

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Distal femoral cut perpendicular to the mechanical axis may induce varus instability in flexion in medial osteoarthritic knees with varus deformity in total knee arthroplasty: a pitfall of the navigation system

Journal of Orthopaedic Science ◽

10.1007/s00776-004-0818-z ◽

2004 ◽

Vol 9 (6) ◽

pp. 555-559 ◽

Cited By ~ 20

Author(s):

Ryuji Nagamine ◽

Keiichi Kondo ◽

Satoshi Ikemura ◽

Atsushi Shiranita ◽

Satoshi Nakashima ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Navigation System ◽

Mechanical Axis ◽

Varus Deformity ◽

Total Knee ◽

Varus Instability

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Comparison of Total Knee Arthroplasty Using Computer-Assisted Navigation versus Conventional Guiding Systems: A Prospective Study

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700209 ◽

2009 ◽

Vol 17 (2) ◽

pp. 170-173 ◽

Cited By ~ 29

Author(s):

CH Pang ◽

WL Chan ◽

CH Yen ◽

SC Cheng ◽

SB Woo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Varus Deformity ◽

Osteoarthritis Of The Knee ◽

Computer Assisted ◽

Assisted Navigation ◽

Alignment Correction ◽

Total Knee ◽

A Prospective Study

Purpose. To compare knee alignments in total knee arthroplasty (TKA) using computer-assisted navigation versus conventional guiding systems. Methods. Five men and 49 women aged 49 to 79 years underwent TKA for primary osteoarthritis of the knee with varus deformity. All valgus knees were associated with inflammatory arthritis and thus excluded. Computer-assisted navigation was used for the first 35 TKAs, whereas conventional extramedullary tibial and intramedullary femoral guiding systems were used for the next 35 TKAs. The mechanical axis, coronal tibial and femoral angles, sagittal tibial and femoral angles in the 2 groups were compared. Results. Sagittal tibial and femoral angles aligned more optimally in TKAs using computer-assisted navigation. In the respective computer-assisted navigation and conventional guiding systems, 33 (94%) and 26 (74%) of the TKAs attained a postoperative mechanical axis of <3° varus/valgus. Conclusion. Computer-assisted navigation gives a more consistent alignment correction and reduces outliers during implant positioning.

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

10.21203/rs.3.rs-138927/v1 ◽

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.

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Preoperative Varus-Valgus Stress Angle Difference Is Valuable for Predicting the Extent of Medial Release in Varus Deformity during Total Knee Arthroplasty

Knee Surgery and Related Research ◽

10.5792/ksrr.18.033 ◽

2019 ◽

Vol 31 (1) ◽

pp. 12-18 ◽

Cited By ~ 2

Author(s):

O-Sung Lee ◽

Ashraf Elazab ◽

Yong Seuk Lee

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Valgus Stress ◽

Angle Difference ◽

Total Knee ◽

Medial Release

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

Advances in Orthopedics ◽

10.1155/2019/4096306 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

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.

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Assessing the Role of Minimal Medial Tissue Release during Navigation-Assisted Varus Total Knee Arthroplasty Based on the Degree of Preoperative Varus Deformity

The Journal of Knee Surgery ◽

10.1055/s-0040-1722658 ◽

2021 ◽

Author(s):

Seikai Toyooka ◽

Hironari Masuda ◽

Nobuhiro Nishihara ◽

Wataru Miyamoto ◽

Takashi Kobayashi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Soft Tissue Release ◽

Neutral Position ◽

Valgus Stress ◽

Total Knee ◽

Neutral Alignment ◽

Medial Release

AbstractWe assessed the impact of a minimal medial soft-tissue release with complete peripheral osteophyte removal on the ability to attain manual preresection deformity correction during navigation-assisted total knee arthroplasty (TKA) for varus osteoarthritis. We included 131 TKAs for 109 patients with medial compartment predominant osteoarthritis. The steps for achieving minimal medial soft-tissue release were performed as follows: (1) elevation of a periosteal sleeve to 5-mm distal to the joint line and (2) complete removal of peripheral osteophytes. The evaluation criteria of this study were as follows: (1) age, (2) height, (3) weight, (4) body mass index (BMI), (5) sex, (6) the preoperative femorotibial mechanical angle in the neutral position before medial release and (7) the mechanical angle in maximum manual valgus stress after the two-step medial-release procedure (measured on the navigation screens). Multiple regression analysis of the criteria was performed to determine the degree of varus deformity that allowed neutral alignment but required extensive medial release. The femorotibial mechanical angle in the neutral position before medial release and sex correlated with the mechanical angle in maximum manual valgus stress on the navigation screen after medial release (r = 0.72, p < 0.001). Based on the regression formula, the maximum degree of preoperative varus deformity that allowed neutral alignment by the minimum medial-release procedure was 5.3 degrees for males and 9.1 degrees for females. The magnitude of deformity which has an impact on the ability to correct varus deformity (by minimal soft-tissue release and complete osteophyte removal) was clarified. If the preoperative degree of varus deformity was within 5.3 degrees for males and 9.1 degrees for females, an extensive medial release was not required to obtain neutral alignment.

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