Is adapted measured resection superior to gap-balancing in determining femoral component rotation in total knee replacement?

2012 ◽  
Vol 94-B (9) ◽  
pp. 1271-1276 ◽  
Author(s):  
T. Luyckx ◽  
T. Peeters ◽  
H. Vandenneucker ◽  
J. Victor ◽  
J. Bellemans
Keyword(s):  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Gap Balancing ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
Measured Resection ◽  
Total Knee

The Effects of Resection Technique on Implant Migration in Single Radius Posterior-Stabilized Total Knee Replacement

2018 ◽  
Vol 33 (01) ◽  
pp. 078-083
Author(s):  
Matthew G. Teeter ◽  
Kevin Perry ◽  
Xunhua Yuan ◽  
James L. Howard ◽  
Brent A. Lanting
Keyword(s):  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Tibial Component ◽  
Posterior Stabilized ◽  
Gap Balancing ◽  
Measured Resection ◽  
Total Knee ◽  
Single Radius ◽  
Component Migration

AbstractThe purpose of the present study was to measure the effects of gap balancing and resection techniques on migration of a single total knee replacement implant design. A total of 23 patients (24 knees) were recruited on referral to either a surgeon performing gap balancing or a surgeon performing measured resection and followed prospectively. All patients received a fixed bearing, posterior stabilized total knee replacement implant of a single radius femoral component design with cement fixation, and all aspects of care outside of resection technique were identical. Patients underwent radiostereometric analysis (RSA) at 2 weeks (baseline), 6 weeks, 3 months, 6 months, 1 year, and 2 years. Migration of the tibial and femoral components was compared between groups. Tibial component migration was greater at 2 years in the gap balancing group (mean difference = 0.336 mm, p = 0.036), but there was no difference at 1 year. One measured resection and three gap balancing tibial components demonstrated continuous migration > 0.2 mm between years 1 and 2. There was no difference in femoral component migration. Small differences in tibial component migration were found between the gap balancing and measured resection techniques. However, comparing the migration to established predictive thresholds for long-term loosening risk, implants performed with both techniques were found to have equally low revision risk.

scholarly journals Computed tomography is not necessary to assess rotation of the femoral component in navigation-assisted total knee replacement

2016 ◽  
Vol 44 (6) ◽  
pp. 1314-1322 ◽  
Author(s):  
Daniel Hernández-Vaquero ◽  
Alfonso Noriega-Fernandez ◽  
Ivan Perez-Coto ◽  
Manuel A. Sandoval García ◽  
Andres A. Sierra-Pereira ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Total Knee Replacement ◽  
Femoral Component ◽  
Knee Replacement ◽  
Transepicondylar Axis ◽  
Component Rotation ◽  
Preoperative Ct ◽  
Total Knee ◽  
The Mean ◽  
Ct Data

Objective To demonstrate that postoperative computed tomography (CT) is not needed if navigation is used to determine the rotational position of the femoral component during total knee replacement (TKR). Methods Preoperative CT, navigational, and postoperative CT data of 70 TKR procedures were analysed. The correlation between the rotational angulation of the femur measured by CT and that measured by perioperative navigation was examined. The correlation between the femoral component rotation determined by navigation and that determined by CT was also assessed. Results The mean femoral rotation determined by navigation was 2.64° ± 4.34°, while that shown by CT was 6.43° ± 1.65°. Postoperative rotation of the femoral component shown by CT was 3.09° ± 2.71°, which was closely correlated with the angle obtained through the intraoperative transepicondylar axis by navigation (Pearson’s R = 0.930). Conclusions Navigation can be used to collect the preoperative, intraoperative, and postoperative data and final position of the TKR. The rotation of the femoral component can be determined using navigation without the need for CT.

The Effects of Surgical Technique in Total Knee Arthroplasty for Varus Osteoarthritic Knee on the Rotational Alignment of Femoral Component: Gap Balancing Technique versus Measured Resection Technique

2019 ◽  
Vol 33 (02) ◽  
pp. 144-151 ◽  
Author(s):  
Chang-Wan Kim ◽  
Chang-Rack Lee ◽  
Heui-Chul Gwak ◽  
Jung-Han Kim ◽  
Yong-Uk Kwon ◽  
...  
Keyword(s):  
Femoral Component ◽  
Gap Balancing ◽  
Femoral Component Rotation ◽  
Component Rotation ◽  
Measured Resection ◽  
Patient Reported ◽  
Patellofemoral Alignment ◽  
Preoperative Ct ◽  
The Difference ◽  
Group 2

AbstractFew studies have compared the accuracy of femoral component rotation in the measured resection technique according to the preoperative computed tomography (CT) and gap balancing technique. The aim of this study was to evaluate whether there is a difference in accuracy and outlier incidence of femoral component rotation between gap balancing and measured resection techniques with or without preoperative CT and to evaluate the difference in patellofemoral alignment on simple radiographs and clinical outcomes. In this retrospective study, we evaluated femoral component rotation angle on the clinical and surgical transepicondylar axis (FCRA-cTEA and FCRA-sTEA, respectively), patellar tilt angle, lateral patellar displacement, and patient-reported outcomes in the gap balancing technique (Group 1) and in the measured resection technique without (Group 2) and with (Group 3) preoperative CT. A total of 163 total knee arthoplasty (TKA) replacements were included in this study. Average FCRA-cTEA was −3.4 ± 2.6, −2.8 ± 2.1, and −1.8 ± 2.3 degrees in groups 1 to 3, respectively (p = 0.002). Average FCRA-sTEA was −0.2 ± 2.7, 0.5 ± 2.4, and 1.5 ± 2.1 degrees, respectively (p = 0.001). In an outlier analysis that evaluated femoral component rotation using cTEA as reference, no significant difference was observed between the three groups (40.8, 37.3, and 23.7%, respectively, p = 0.133). When sTEA was used as a reference, groups 1 and 3 showed an outlier incidence of 8.2 and 8.5%, respectively, whereas this incidence was as high as 23.5% in group 2 (p = 0.030). No statistically significant group difference in patellofemoral alignment and patient-reported outcome was observed. In the measured resection technique with preoperative CT, the femoral component was externally rotated approximately 1 degree more than in the gap balancing or measured resection technique without preoperative CT. However, the difference in FCRA among the three techniques was not linked to the difference in patellofemoral alignment or patient-reported outcomes.

The Effect of Patellar Positioning on Femoral Component Rotation when Performing Flexion Gap Balancing Using a Tensioning Device for Total Knee Arthroplasty

2020 ◽  
Author(s):  
Lukas Ernstbrunner ◽  
Octavian Andronic ◽  
Florian Grubhofer ◽  
Michèle Jundt-Ecker ◽  
Sandro F. Fucentese
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Lateral Ligament ◽  
Consecutive Series ◽  
Gap Balancing ◽  
Femoral Component Rotation ◽  
Flexion Gap ◽  
Component Rotation ◽  
Total Knee

AbstractThere is an increasing interest in new devices such as tensiometers for flexion gap balancing during total knee arthroplasty (TKA). The purpose of this study was to determine the influence of patella positioning during flexion gap balancing on femoral component rotation. We prospectively evaluated 32 consecutive knees in 31 patients who underwent primary TKA for degenerative osteoarthritis and where soft tissue balancing was performed using the same tensiometer. Preoperative measurements included valgus/varus deformation, mechanical axis, epicondylar axis, and tibial slope. Intraoperatively, measurement of femoral component rotation in 90 degrees of knee flexion was conducted in three different positions of the patella: (1) patella reduced, (2) patella dislocated but not everted, and (3) patella dislocated and everted. The femoral component had significantly higher rotation when the patella was reduced compared with a dislocated patella (4.9 ± 2.1 degrees vs. 4.2 ± 2.2 degrees; p = 0.006) and compared with a dislocated and everted patella (4.9 ± 2.1 degrees vs. 4.1 ± 2.3 degrees; p = 0.006). Varus knees (n = 22) demonstrated significantly increased femoral component rotation if the patella was reduced (5.3 ± 2.2 degrees) compared with dislocated patella without eversion (4.7 ± 2.3 degrees; p = 0.037) and with eversion (4.4 ± 2.5 degrees; p = 0.019). As such, the measurement of the mediolateral flexion gap stability with a laterally dislocated patella leads to a statistically significant overestimation of the lateral ligament stability and an underestimation of the external rotation positioning of the femoral component of approximately 1 degree, which is aggravated in varus knees. This is a Level II, prospective consecutive series study.

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