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.

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.

scholarly journals Systematic Review of Accelerometer Based Navigation in Total Knee Arthroplasty: Improved Alignment, Clinical Results, and Patient Reported Outcomes Compared to Conventional Guides?

2020 ◽  
pp. 1-8
Author(s):  
Stephen T. Duncan ◽  
Stephen T. Duncan ◽  
Cale Jacobs ◽  
Lucian Warth ◽  
Syed K. Mehdi
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Mechanical Axis ◽  
Mechanical Alignment ◽  
Estimated Blood Loss ◽  
Patient Reported ◽  
Total Knee

Background: There have been significant advancements to restore knee alignment postoperatively in the TKA population. This includes the use of accelerometer-based portable navigation (ABN). ABN can lead to a more precise restoration of the neutral mechanical axis, improve efficiency and potentially decrease early- and long-term complications. The degree with which ABN can achieve this remains unclear. We performed a systematic review to answer this question. Methods: We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE with an emphasis on studies comparing postoperative outcomes such as mechanical axis alignment, operative time, blood loss, complications and clinical outcome scores in total knee arthroplasty patients using ABN versus conventional intramedullary guides. Results: ABN was associated with significantly fewer outliers in hip-knee-ankle alignment (p = 0.0006), femoral component alignment (p < 0.0001). ABN was associated with significantly less estimated blood loss (p = 0.05) and no difference in operative times (p = 0.21). Finally, there was no difference regarding functional outcomes or DVT. Conclusion: ABN more accurately achieves neutral mechanical alignment with a smaller incidence of outliers. There was not an increase in operative time with using ABN and there were reductions in blood loss as well. We conclude that ABN offers the benefit of improved mechanical alignment.

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.

Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs

The Knee ◽  
2016 ◽  
Vol 23 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Anneka Bowman ◽  
Meenalochani Shunmugam ◽  
Amy R. Watts ◽  
Donald C. Bramwell ◽  
Christopher Wilson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Observer Reliability ◽  
Axis Alignment ◽  
Before And After ◽  
Total Knee ◽  
Long Leg Radiographs

scholarly journals Similar radiological results with accelerometer-based navigation versus conventional technique in total knee arthroplasty

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901877237 ◽  
Author(s):  
Ing How Moo ◽  
Jerry Yong Qiang Chen ◽  
Dickson Hong Him Chau ◽  
See Wei Tan ◽  
Adrian Cheng Kiang Lau ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Conventional Method ◽  
Knee Arthroplasty ◽  
Lower Limb ◽  
Mechanical Axis ◽  
Computer Assisted ◽  
Mechanical Alignment ◽  
Component Placement ◽  
Duration Of Surgery ◽  
Total Knee

Background: The Zimmer iASSIST system is an accelerometer-based, portable navigation device for total knee arthroplasty (TKA) that does not require the use of a large console for alignment feedback as required in computer-assisted surgery. The purpose of this study was to determine the accuracy of the accelerometer-based system in component positioning and overall mechanical alignment. Methods: Two groups of 30 patients each with primary osteoarthritis underwent TKA using either conventional method or Zimmer iASSIST navigation in 2013 was retrospectively studied. Patients were matched according to body mass index (BMI), gender and age. A senior arthroplasty surgeon performed all the operation using the same surgical approach. Perioperative and post-operative regimens were the same. All patients had standardized radiographs performed post-operatively to determine the lower limb mechanical alignment and component placement. Results: There was no difference between the two groups for age, BMI, gender, side of operated knee and preoperative mechanical axis ( p > 0.05). There was no difference in the proportion of outliers for mechanical axis ( p = 0.38), coronal femoral angle ( p = 0.50), coronal tibia angle ( p = 0.11), sagittal femoral angle ( p = 0.28) and sagittal tibia angle ( p = 0.33). The duration of surgery, post-operative drop in haemoglobin level and transfusion incidence did not show statistically significant differences between the two groups ( p > 0.05). Conclusions: Our article showed that iASSIST was safe and remains a useful tool to restore mechanical axis. However, our data demonstrated no difference in lower limb alignment and component placement between the TKA that used accelerometer-based system and those that underwent conventional method.

scholarly journals Comparative study of anterior knee pain after patelloplasty with and without circumferential denervation in a total knee arthroplasty

2019 ◽  
Vol 13 (2) ◽  
pp. 106-110
Author(s):  
Ahmed Latteef Al-Shamari
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Statistical Significance ◽  
Study Groups ◽  
Control Group ◽  
Before And After ◽  
Total Knee ◽  
Anterior Knee

Background: The anterior knee pain is an important chief complaint of the patients with knee osteoarthritis due to patellofemoral pathology. The pain receptors denervation can be achieved by circumferential denervation of the patellar area by a process of electrocautery. Objectives: The aim of current study is to assess the pain after total knee arthroplasty (TKA) by patelloplastywith and without circumferential denervation via electrocautery at a minimum follow up with 1 year separately for each patient. Type of the study:Cross- sectional study. Methods: Thirty five patients,with mean age of about (62.8) years, were enrolled in this prospective, hospital based study that was held at Al-Yarmouk Teaching Hospital in Baghdad from October 2012 to November 2016. These patients were divided into 2 groups, first group was composed of 19 patients who have TKA with patellar circumferential denervation by electrocautery with  patelloplasty  by removing peripheral osteophytes of patella , the second group of 16 patients were undergone TKA without denervation, but only patelloplasty. The second group was considered as the control group. Visual analogue scale (VAS) was used to evaluate pain pre and post operatively. The patient’s functional ability was assessed by knee society score (KSS) also before and after TKA for both groups and pain killer was given according to patients need.   Results: All of the patients were followed for 12 months period. No drugs were used other than occasional use of pain killers in first month after operation for all patients in group one of study. On VAS scale, significant statistical difference in pre and post-operative scales were noticed between both groups of study.  The Knee Society Scale (KSS) was showing a non- significant statistical significance between both study groups before and after TKA. ConclusionA: nterior knee pain can be reduced through the use of patelloplasty with circumferential denervation of patella byelectrocautery, compared with non- denervated procedure. Good clinical outcome was also present.   

scholarly journals Is Robotic TKA Having Added Advantage over Conventional TKA? A Comparative Study of Functional and Radiological Outcome of Robotic versus Conventional Total Knee Arthroplasty

2021 ◽  
Author(s):  
Himanshu Panchal ◽  
Ashwini S. Patel
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Radiological Outcome ◽  
Soft Tissue Management ◽  
Significant Difference ◽  
Total Knee

Abstract Objective Total knee arthroplasty (TKA) is most commonly performed procedure in patients who are not showing improvement in pain, activities of daily living, and quality of life by conservative modalities. Precise component implantation and soft tissue management is required to achieve desired outcome following TKA. 1.3% patients remain disappointed due to persistent pain, 24% due to instability, and 2.5% due to malalignment following TKA. Robotic TKA is associated with the use of customized implants and bone cuts leading to precise component implantation and reduced deviation from mechanical axis in coronal, transverse, and sagittal plane and proper soft tissue management. This study compares conventional against robotic TKA in terms of clinical, functional, and radiological outcome. Materials and Methods  This is a prospective randomized control trial carried over period of 3 years where patients were selected on the basis of inclusion and exclusion criteria and were randomly divided into both groups and compared using their pre- and postoperative radiological and functional outcomes as well as intraoperative and postoperative complications and statistical significance of difference was calculated. Results There was no significant difference in terms of ROM, KOOS (Knee Injury and Osteoarthritis Outcome Score), (Knee Society Score) KSS, Eq. 5D, (Western Ontario and McMaster Universities Osteoarthritis Index) WOMAC, and (visual analog scale) VAS scores while we found significant difference in mechanical axis deviation, femoral and tibial implant alignment in both planes. Discussion Advantages of using robotic TKA are customized preoperative planning, implants, cuts, accuracy of the intraoperative procedure, and radiological superiority with no significant differences in clinical and functional outcomes. In fact, robotic TKA is associated with steep learning curve, increased cost, and operative time. Still there are no added complications caused by it.

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis

2017 ◽  
Vol 31 (01) ◽  
pp. 078-086 ◽  
Author(s):  
Yanhong Li ◽  
Yuliang Wang ◽  
Mingxuan Yang ◽  
Shuanke Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Mechanical Axis ◽  
Meta Analysis ◽  
Mechanical Alignment ◽  
Short Term ◽  
Significant Difference ◽  
Total Knee

AbstractThis meta-analysis was conducted to study whether kinematically aligned total knee arthroplasty (TKA) improves short-term functional outcomes compared with mechanical alignment without changing the hip–knee–ankle angle. Prospective cohort studies were searched from electronic literature databases, including PubMed, Web of Science, Embase (Ovid interface), and Cochrane Library (Ovid interface). Total 1,159 records were identified. Six trials involving 561 patients were eligible for data extraction and meta-analysis. The included studies recorded outcomes in the follow-up range from 6 to 34 months. Primary outcomes were to assess the functional outcomes in follow-up, and KA group achieved better performance on WOMAC score (mean difference [MD] = −18.82, 95% CI: −16.06 to −5.58), knee function score (MD = 7.23, 95% CI: 0.52–13.94), Oxford knee score (MD = 4.76, 95% CI: 0.40–9.12), and knee range of flexion (MD = 4.48, 95% CI: 2.09–6.86), whereas other parameters including Knee Society score, knee range of extension, VAS pain score, and the occurrence of the complications were without significant difference (p > 0.05). Second outcomes evaluated the perioperative clinic indexes. Our meta-analysis showed that KA group had a shorter time of operation (MD = −15.44, 95% CI: −27.47 to −3.71) and a longer walk distance before discharge (MD = 53.24, 95% CI: 21.32–85.15) when compared with the MA group, whereas the change in hemoglobin, incision length, knee range of flexion before discharge, and length of stays were without significant difference (p > 0.05). Third outcomes were used to analyze the alignment data. Our study showed that KA had larger angles of femoral component and mechanical axis of the femur (MD = −1.95,95% CI: −2.77 to −1.13), tibial component and mechanical axis of tibia (MD = 2.06, 95% CI: 1.43–2.70), anatomic knee angle (MD = −0.72, 95% CI: −1.33 to −0.11), and operative limb alignment (MD = −1.97, 95% CI: −2.50 to −1.45,) compared with the MA group, but the hip–knee–ankle angles between the two groups were similar. KA provided better functional outcomes and better flexion following short-term follow-up of TKA. However, longer-term follow-up and larger sample studies are needed to put into research in the future.

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