Acquisition of coronal alignment according to the degree of varus deformity in total knee arthroplasty using computer-assisted navigation

Purpose: We have analyzed the surgical outcomes of primary total knee arthroplasty (TKA) using computer-assisted navigation that were performed by a single surgeon in terms of postoperative coronal alignment depending on preoperative varus deformity. Methods: We conducted a retrospective study of patients who have undergone navigated primary TKA from January 2016 through December 2019. Two hundred and fifty-six cases with varus deformity of 10° or less were assigned to group 1, and 216 cases with varus deformity of more than 10° were assigned to group 2. The postoperative mechanical hip–knee–ankle (mHKA) angle was measured from scanograms which were taken preoperatively and 3 months after surgery. The postoperative mHKA angle was targeted to be 0°, and the appropriate range of coronal alignment was set as 0 ± 3°. Results: The Pearson correlation showed a significant correlation with the degree of preoperative varus deformity and with the absolute error of postoperative mHKA ( p = 0.01). Among all patients, 64 cases (13.6%) were detected as outliers (mHKA > 0° ± 3°) at 3 months after surgery. Of the 64 cases, 25 cases (9.8%) were affiliated to group 1 and 39 cases (18.1%) were affiliated to group 2. Group 2 showed significantly higher occurrence of outliers than group 1 ( p = 0.01). Multiple variables logistic regression analysis, which analyzed the difference in the occurrence rate of outliers (mHKA > 0° ± 3°), showed that the occurrence rate of group 2 was 2.04 times higher than group 1. After adjusting for patient’s age, gender, and body mass index, the occurrence rate of outliers in group 2 was 2.01 times higher than group 1. Conclusion: The benefit of computer-assisted navigation during TKA in obtaining coronal alignment within 0 ± 3° may be lessened when the preoperative varus deformity is severely advanced.

Download Full-text

The advantage of navigation for knee with lateral femoral bowing in total knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499020965679 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096567

Author(s):

Jun Ho Nam ◽

Suk-Kyoon Song ◽

Myung-Rae Cho ◽

Dae-Won Kang ◽

Won-Kee Choi

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Occurrence Rate ◽

Computer Assisted ◽

Coronal Alignment ◽

Total Knee ◽

Group 3 ◽

Group 2 ◽

Femoral Bowing ◽

Group 1

Purpose: We have analyzed the surgical outcomes of primary total knee arthroplasty (TKA) using computer-assisted (CA) navigation in terms of postoperative coronal alignment depending on preoperative lateral femoral bowing. Methods: We conducted a retrospective study of patients who have undergone navigated primary TKA from January 2016 through January 2020. Two hundred and ninety-nine cases with lateral femoral bowing of 3° or less were assigned to group 1, 95 cases of lateral femoral bowing between 3° and 5° were assigned to group 2, and 89 cases with lateral femoral bowing of more than 5° were assigned to group 3. The postoperative mechanical hip–knee–ankle (mHKA) angle was measured from scanograms, which were taken 3 months after surgery. The appropriate range of coronal alignment was set as 0 ± 3°. Results: The number of outliers of mHKA occurred was 31 cases (10.4%) in group 1, 17 cases (17.9%) in group 2, and 17 cases (19.1%) in group 3. There was a significant correlation between the degree of lateral femoral bowing and the occurrence rate of mHKA outliers. Multiple variables logistic regression analysis showed occurrence rate of outliers in group 3 to be 2.04 times higher than group 1. After adjusting the patient’s age, sex, body mass index, and preoperative HKA deformity, the occurrence rate of outliers in group 3 was still 1.96 times higher than group 1. Conclusion: The benefit of CA navigation during TKA in obtaining coronal alignment within 0 ± 3° may be lessened when the preoperative lateral femoral bowing is severely advanced.

Download Full-text

Postoperative radiologic outcome comparison between conventional and computer-assisted navigation total knee arthroplasty in extra-articular tibia vara

Journal of Orthopaedic Surgery ◽

10.1177/2309499020905702 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949902090570 ◽

Cited By ~ 1

Author(s):

Yongun Cho ◽

Hun-Kyu Shin ◽

Eugene Kim ◽

Jai Hyung Park ◽

Se-Jin Park ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Lower Extremity ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Computer Assisted ◽

Tibia Vara ◽

Assisted Navigation ◽

Significant Difference ◽

Outcome Comparison ◽

Total Knee

Purpose: Total knee arthroplasty (TKA) is the definite treatment for osteoarthritis. Meanwhile, significant inherent extra-articular varus angulation is associated with abnormal postoperative hip–knee–ankle (HKA) angle. Computer-assisted navigation TKA (CAS-TKA) used in patients who have severe varus deformity. The purpose of this study was to compare postoperative radiologic outcome between CAS-TKA and conventional TKA for extra-articular tibia vara. Methods: A retrospective review of postoperative HKA on standing lower extremity views was conducted in patients who underwent TKA by a single surgeon from 2010 to 2018, including knee with conventional TKA ( n = 83) and CAS-TKA ( n = 246). Extra-articular tibia vara was assessed by measuring the metaphyseal–diaphyseal angle (MDA) of the tibia in preoperative standing lower extremity view. Postoperative alignment was assessed by measuring the HKA in postoperative standing lower extremity view. Results: There was no significant difference in age ( p = 0.063), gender ( p = 0.628), body mass index ( p = 0.426), preoperative range of motion ( p = 0.524), preoperative HKA ( p = 0.306), preoperative MDA ( p = 0.523), or postoperative HKA ( p = 0.416) between the two groups (conventional TKA and CAS-TKA). There was no significant difference in postoperative alignment for cases with MDA ≤4° ( p = 0.351) or MDA >4° ( p = 0.866) in each group. There was a positive correlation between preoperative HKA and postoperative HKA in the CAS-TKA group ( p < 0.001, r = 0.243). However, there was no significant correlation between preoperative HKA and postoperative HKA in the conventional TKA group ( p = 0.732). Conclusions: There was no significant difference in postoperative alignment between conventional TKA and CAS-TKA in extra-articular tibial vara even for cases with MDA >4°.

Download Full-text

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.

Download Full-text

Clinical Efficacy of Preoperative CT-Assisted Planning for Primary Total Knee Arthroplasty: A Pilot Randomized Clinical Trial

The Journal of Knee Surgery ◽

10.1055/s-0041-1723971 ◽

2021 ◽

Author(s):

Ahmed Saeed Younis ◽

Mohammed El Sayed Awad ◽

Tarek M. Samy ◽

Wael Samir Osman ◽

Sherif Mostafa Abdeldayem ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Ct Scan ◽

Knee Arthroplasty ◽

Functional Score ◽

Coronal Alignment ◽

Preoperative Ct ◽

Total Knee ◽

The Mean ◽

Group 2 ◽

Group 1

AbstractThis study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of the included patients showed 5 patients with valgus deformity and 45 patients with varus deformity with the mean coronal alignment of 7.5 degrees. CT scan showed the mean PCA of 3.7 degrees (1.3 degrees). The axial knee postoperative X-ray showed the mean patellar tilt angle of 2.1 degrees (0.5 degrees) and 1.9 degrees (0.5 degrees) in groups 1 and 2, respectively. The congruence angle was 4 degrees (2.6 degrees) in group 1 and 5.5 degrees (3.2 degrees) in group 2. The median Knee Society functional score in group 1 was 85 (12), while it was 84 (7.5) in group 2. The median postoperative Western Ontario and McMaster Universities Arthritis Index score in group 1 was 84 (18.6) whereas 80.2 (13.6) in group 2. The median postoperative Bartlett score in group 1 was 30 (5), while it was 30 (6) in group 2. The use of preoperative CT scan did not improve the patient functional scores after TKA.

Download Full-text

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0040-1721787 ◽

2021 ◽

Author(s):

Mohammadreza Minator Sajjadi ◽

Mohammad Ali Okhovatpour ◽

Yaser Safaei ◽

Behrooz Faramarzi ◽

Reza Zandi

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Soft Tissue Release ◽

Varus Knee ◽

Significant Difference ◽

Leg Alignment ◽

Total Knee ◽

Group 2

AbstractThe aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal–Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.

Download Full-text

Reliability of Imageless Computer-Assisted Navigation for Femoral Rotational Alignment in Total Knee Arthroplasty

Malaysian Orthopaedic Journal ◽

10.5704/moj.2103.012 ◽

2021 ◽

Vol 15 (1) ◽

pp. 79-84

Author(s):

Leelasestaporn C ◽

Thuwapitchayanant M ◽

Sirithanapipat P ◽

Sa-ngasoongsong P ◽

Ruengsilsuwit P

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rotational Alignment ◽

Computer Assisted ◽

Assisted Navigation ◽

Total Knee

Download Full-text

Accuracy of femoral rotational alignment in total knee arthroplasty using computer assisted navigation

Computer Aided Surgery ◽

10.3109/10929080802045640 ◽

2008 ◽

Vol 13 (3) ◽

pp. 167-172 ◽

Cited By ~ 18

Author(s):

Camilo Restrepo ◽

William J. Hozack ◽

Fabio Orozco ◽

Javad Parvizi

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rotational Alignment ◽

Computer Assisted ◽

Assisted Navigation ◽

Total Knee

Download Full-text

Robot-Assisted Navigation versus Computer-Assisted Navigation in Primary Total Knee Arthroplasty: Efficiency and Accuracy

ISRN Orthopedics ◽

10.1155/2013/794827 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Tanner C. Clark ◽

Frank H. Schmidt

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Secondary Outcome ◽

Computer Assisted ◽

Robot Assisted ◽

Tourniquet Time ◽

Assisted Navigation ◽

Total Knee ◽

Primary Total Knee

Background. Since the introduction of robot-assisted navigation in primary total knee arthroplasty (TKA), there has been little research conducted examining the efficiency and accuracy of the system compared to computer-assisted navigation systems. Objective. To compare the efficiency and accuracy of Praxim robot-assisted navigation (RAN) and Stryker computer-assisted navigation (CAN) in primary TKA. Methods. This was a retrospective study consisting of 52 patients who underwent primary TKA utilizing RAN and 29 patients utilizing CAN. The primary outcome measure was navigation time. Secondary outcome measures included intraoperative final mechanical axis alignment, intraoperative robot-assisted bone cut accuracy, tourniquet time, and hospitalization length. Results. RAN navigation times were, on average, 9.0 minutes shorter compared to CAN after adjustment. The average absolute intraoperative malalignment was 0.5° less in the RAN procedures compared to the CAN procedures after adjustment. Patients in the RAN group tended to be discharged 0.6 days earlier compared to patients in the CAN group after adjustment. Conclusions. Among patients undergoing TKA, there was decreased navigation time, decreased final malalignment, and decreased hospitalization length associated with the use of RAN when compared to CAN independent of age, BMI, and pre-replacement alignment.

Download Full-text