scholarly journals Spinal Flexibility Is an Important Factor for Improvement in Spinal and Knee Alignment after Total Knee Arthroplasty: Evaluation Using a Whole Body EOS System

2020 ◽  
Vol 9 (11) ◽  
pp. 3498
Author(s):  
Seong Chan Kim ◽  
Joo Sung Kim ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Joint ◽  
Knee Arthroplasty ◽  
Lower Limb ◽  
Whole Body ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Spinal Flexibility ◽  
Flexion Extension ◽  
Total Knee

The purposes of this study were (1) to evaluate the relationship between lumbosacral flexibility and the effects of total knee arthroplasty (TKA) on whole-body alignment; and (2) to determine the prerequisites of the adjacent joints for successful TKA. A total of 116 patients (156 cases) who had whole-body X-ray and flexion-extension lumbar radiograph available were enrolled. For the sagittal alignment evaluation, hip–knee–ankle (HKA) angle, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and C7 plumb line-sacrum distance (SVA) were evaluated on the whole-body radiographs. Lumbar flexibility (LF) was evaluated using the flexion-extension lumbar radiographs, and pelvic flexibility (PF) was evaluated using the pelvic incidence (PI). The disparities in the knee joint between postoperative passive motion and weight-bearing posture were assessed. LF was significantly correlated with ΔLL and ΔSVA (LL: p = 0.039, SVA: p = 0.040; Pearson correlation coefficient (PCC): −0.206 and 0.205, respectively). There were correlations between PF and ΔSS (p < 0.001, PCC: −0.362), and between the disparity and LF (p = 0.005, PCC = −0.275). Linear regression analysis demonstrated that LF was significantly associated with the presence of disparity (p = 0.005, β = −0.205). LF is an important factor for improved spinal and lower limb alignment after TKA. Additionally, reduced LF may result in knee joint disparity between passive extension and standing extension status. Therefore, surgeons should consider spinopelvic alignment, including lower limb alignment preoperatively, to be able to predict possible changes in whole-body alignment following TKA.

Accuracy of Lower Limb Alignment in Patients with Total Knee Arthroplasty in Fajr Hospital, Tehran, 2008-2013

2014 ◽  
Vol 11 (2) ◽  
pp. 807-813
Author(s):  
M. Shahrezaee ◽  
M. Jabalameli ◽  
A. Noori ◽  
S.R. Sharifzadeh ◽  
M. Setareh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Lower Limb ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Total Knee

scholarly journals Effects of Total Knee Arthroplasty on Coronal and Sagittal Whole-Body Alignments: Serial Assessments Using Whole-Body EOS

2021 ◽  
Vol 10 (15) ◽  
pp. 3242
Author(s):  
Seong-Chan Kim ◽  
Han-Gyeol Choi ◽  
Joo-Sung Kim ◽  
Tae-Woo Kim ◽  
Yong-Seuk Lee
Keyword(s):  
Knee Joint ◽  
Lower Limb ◽  
Weight Bearing ◽  
Whole Body ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Passive Motion ◽  
X Ray ◽  
Spinopelvic Alignment ◽  
Total Knee

Background: The aims of this study were to evaluate the effects of correcting lower limb alignment by total knee arthroplasty (TKA) on the spinopelvic alignment and to identify patients with difference in the knee joint between clinically measured passive motion and the actual standing posture. Methods: In this retrospective study, 101 patients who underwent TKA and whose serial whole-body EOS X-ray were available were included. The relationship of the knee and spinopelvic alignment was analyzed by evaluating the parameters of standing anterior-posterior and lateral whole-body EOS X-ray. The differences between postoperative passive motion and weight-bearing posture in the knee joint were assessed in both coronal and sagittal planes. Furthermore, the causes of such differences were analyzed. Results: Significant correlations between Δpelvic obliquity and coronal ΔHip-Knee-Ankle (HKA)Rt-Lt angle between the preoperative and 3-month and 1-year postoperative data (p < 0.001 and p < 0.005, respectively) and improved with coronal lower limb alignment close to neutral resulted in decreased pelvic obliquity (p < 0.001, ß = 0.085 and p = 0.005, ß = 0.065, respectively) were observed. The correlations between Δpelvic tilt (PT) and Δsacral slope (SS) and sagittal ΔHKARt-Lt angle were statistically significant (PT: p < 0.001 and p < 0.045; SS: p = 0.002 and p < 0.001, respectively). The improved sagittal alignment close to neutral resulted in decreased PT and increased SS. The difference between postoperative passive motion and the weight-bearing posture of the knee joint was correlated with lumbar lordosis and sagittal C7 plumb line-sacrum distance (p = 0.042 and p < 0.001, respectively). Conclusions: The correction of lower limb alignment with TKA affected pelvic parameters dominantly; however, there was little effect on the spinal alignment. Additionally, patients with anterior stooping or lumbar flat back demonstrated difference in extension between passive knee motion and standing. Therefore, rather than only focusing on changes in the knee alignment correction, knee surgeons should also evaluate the spinopelvic alignment before surgery to consider the prognosis of the standing and predict the possible changes in the whole-body alignment. This preoperative assessment may improve the prognosis of TKA.

Posterior cruciate ligament resection in total knee arthroplasty

2019 ◽  
Vol 101-B (10) ◽  
pp. 1230-1237 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Saman Horriat ◽  
Mazin S. Ibrahim ◽  
Fares S. Haddad
Keyword(s):  
Total Knee Arthroplasty ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
Limb Alignment ◽  
Flexion Gap ◽  
Flexion Extension ◽  
Total Knee ◽  
The Mean ◽  
Extension Gap

Aims The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). Patients and Methods This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). Results PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson’s correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). Conclusion PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230–1237

Pitfalls in assessing limb alignment affected by rotation and flexion of the knee after total knee arthroplasty: Analysis using sagittal and coronal whole-body EOS radiography

The Knee ◽  
2020 ◽  
Vol 27 (5) ◽  
pp. 1551-1559
Author(s):  
Hyun Jin Yoo ◽  
Ji Eui Kim ◽  
Sung Chan Kim ◽  
Joo Sung Kim ◽  
Hee Jin Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Whole Body ◽  
Limb Alignment ◽  
Total Knee

scholarly journals One-Stage Femoral Osteotomy and Computer-Assisted Navigation Total Knee Arthroplasty for Osteoarthritis in a Patient with Femoral Subtrochanteric Fracture Malunion

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
C. H. Jason Fan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Subtrochanteric Fracture ◽  
Computer Assisted ◽  
Limb Alignment ◽  
Lower Limb Alignment ◽  
Assisted Navigation ◽  
Osteoarthritis Of Knee ◽  
Femoral Deformity ◽  
Total Knee

Extra-articular femoral deformity in total knee arthroplasty (TKA) is realigned by either intra-articular correction or extra-articular osteotomy. The more distant the deformity is away from knee joint, the more likely it is corrected by the former method. No report described the use of antegrade cephalomedullary femoral nail to fix the osteotomy followed by computer-assisted navigation TKA. This report described the unusual use of this method to manage a 64-year-old man with femoral subtrochanteric fracture malunion and osteoarthritis of knee. He demonstrated a satisfactory functional outcome and good lower limb alignment.

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