scholarly journals Clinical Outcomes of First 100 Navigated Total Knee Arthroplasties at Duke University Medical Center

2014 ◽  
Vol 4 (1) ◽  
pp. 13-18
Author(s):  
Todd E Bertrand
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medical Center ◽  
Coronal Plane ◽  
Computer Assisted ◽  
Coronal Alignment ◽  
Component Alignment ◽  
Duke University ◽  
Total Knee ◽  
Postoperative Knee

ABSTRACT Background Total knee arthroplasty (TKA) is one of the most clinically successful and cost-effective interventions in medicine. Implant malalignment can be a cause of early failure following total knee arthroplasty. Computer-assisted surgery has been employed to improve the precision of component alignment. Questions/purpose: We asked (1) What is the average coronal plane alignment of the first 100 patients undergoing computer-assisted total knee arthroplasty at our institution? (2) How do our clinical and radiographic results compare to those values reported in the literature? (3) Was a ‘learning curve’ present as evidenced by improvements in coronal plane alignment over time? Methods We retrospectively reviewed our first 100 patients undergoing computer navigated total knee arthroplasty. We calculated postoperative knee range of motion (ROM), coronal alignment as well as preoperative and postoperative Knee Society Scores. Minimum follow-up was 4.3 years (0.2-8.25 years). Results Of the 100 patients, average postoperative limb alignment was 0.9° varus compared to the mechanical axis. Seventy-nine percent of patients had coronal plane alignment of ±3°. Knee Society Scores improved on average from 60 preoperatively (52-67) to 85 postoperatively (56-97). Conclusion Computer-assisted total knee arthroplasty is potentially a way to improve component alignment and overall patient satisfaction. In our cohort, average coronal alignment was similar to literature reported values for navigated and conventional total knee arthroplasty. The benefit of this technology remains unproven. Level of evidence Level IV Bertrand TE, Bolognesi MP. Clinical Outcomes of First 100 Navigated Total Knee Arthroplasties at Duke University Medical Center. The Duke Orthop J 2014;4(1):13-18.

Extramedullary Guide Alignment Is not Affected by Obesity in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Jocelyn Compton ◽  
Jessell Owens ◽  
Jesse Otero ◽  
Nicolas Noiseux ◽  
Timothy Brown
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Coronal Plane ◽  
Coronal Alignment ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Valgus Alignment

AbstractCoronal alignment of the tibial implant correlates with survivorship of total knee arthroplasty (TKA), especially in obese patients. The purpose of this study was to determine if obesity affects coronal plane alignment of the tibial component when utilizing standard extramedullary tibial guide instrumentation during primary TKA. A retrospective review from June 2017 to February 2018 identified 142 patients (162 primary TKAs). There were 88 patients (100 knees) with body mass index (BMI) < 35 kg/m2 and 54 patients (62 knees) with BMI ≥ 35.0 kg/m2. The cohorts did not differ in age (p = 0.37), gender (p = 0.61), or Charlson's comorbidity index (p = 0.54). Four independent reviewers measured the angle between the base of the tibial component and the mechanical axis of the tibia on the anteroposterior view of long-leg film at first postoperative clinic visit. Outliers were defined as patients with greater than 5 degrees of varus or valgus alignment (n = 0). Reoperations and complications were recorded to 90 days postoperatively. There was no significant difference in mean tibial coronal alignment between the two groups (control alignment 90.8 ± 1.2 degree versus obese alignment 90.8 ± 1.2 degree, p = 0.91). There was no difference in varus versus valgus alignment (p = 0.19). There was no difference in the number of outliers (two in each group, p = 0.73). There was no difference in rate of reoperation (p = 1.0) or complication (p = 0.51). Obesity did not affect coronal plane alignment of the tibial component when using an extramedullary guide during primary TKA in our population.

scholarly journals Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0004
Author(s):  
Prettysia Suvarly ◽  
Nyoman Aditya Sindunata ◽  
Rio Aditya ◽  
Rusli Muljadi ◽  
John Butarbutar
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Knee Arthroplasty ◽  
Femoral Shaft ◽  
Coronal Plane ◽  
Coronal Alignment ◽  
Geriatric Population ◽  
X Ray ◽  
Cutting Angle ◽  
Total Knee

Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis. Methods: Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24. Results: Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa. Conclusion: Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates. References: Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42

No effect of obesity on limb and component alignment after computer-assisted total knee arthroplasty

The Knee ◽  
2014 ◽  
Vol 21 (4) ◽  
pp. 862-865 ◽  
Author(s):  
Gautam M. Shetty ◽  
Arun B. Mullaji ◽  
Sagar Bhayde ◽  
A.P. Lingaraju
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Computer Assisted ◽  
Component Alignment ◽  
Total Knee

Which Pre- and Postoperative Coronal Plane Laxity Parameters Influence Patient Satisfaction and Function after Primary Total Knee Arthroplasty?

2020 ◽  
Author(s):  
Michael McAuliffe ◽  
Patrick O'Connor ◽  
Lisa Major ◽  
Gautam Garg ◽  
Sarah L. Whitehouse ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Coronal Plane ◽  
Soft Tissue Release ◽  
Computer Assisted ◽  
Soft Tissue Balancing ◽  
Total Knee ◽  
And Function

AbstractSoft tissue balancing, while accepted as crucial to total knee arthroplasty (TKA) outcomes, is incompletely defined as the subject of broad recommendations. We analyzed 120 computer-assisted, posterior stabilized TKA undertaken for osteoarthritis. Coronal plane laxity was measured, in the 91 varus and 29 valgus knees, prior to any bone resection or soft tissue release, and again after implant insertion. Soft tissue laxity parameters were correlated to the American Knee Society Score (2011) at a minimum follow-up of 12 months with a focus on patient function and satisfaction. Thirteen specific laxity parameters showed a significant correlation to satisfaction, one parameter correlated to function, and another to both functional and satisfaction outcomes. Most correlations were weak, the strongest related to postoperative decreases in coronal plane laxity. Greater preoperative varus but not valgus deformity was associated with higher satisfaction scores. Additionally, 30 patients who reported 40 of 40 satisfaction and that their TKA knee felt normal at all times did not have soft tissue balancing parameters distinguishing them from other subjects. Patient satisfaction and function outcomes demonstrated limited correlation to coronal plane soft tissue parameters. It appears that optimizing TKA satisfaction and function is not as simple as producing a narrow range of coronal laxity parameters. The ongoing debate around optimal coronal plane alignment and its subsequent effect on coronal plane soft tissues may not be as independently important as currently argued. Soft tissue balance may need to be considered as a more complex global envelope.

scholarly journals The unicompartmental knee is the preferred side in individuals with both a unicompartmental and total knee arthroplasty

2019 ◽  
Vol 28 (10) ◽  
pp. 3193-3199 ◽  
Author(s):  
Anatole Vilhelm Wiik ◽  
Dinesh Nathwani ◽  
Ahsan Akhtar ◽  
Bilal Al-Obaidi ◽  
Robin Strachan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Femoral Component ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
Coronal Alignment ◽  
Component Alignment ◽  
Posterior Slope ◽  
Knee Oa ◽  
Unicompartmental Knee ◽  
Total Knee

Abstract Purpose To determine the preferred knee in patients with both one total and one unicompartmental knee arthroplasty. Method Patients simply with a unicompartmental (UKA) and total knee arthroplasty (TKA) on contralateral sides were retrospectively screened from three senior knee surgeon’s logs over a 15 year period. Patients safe and free from other diseases to affect gait were approached. A total of 16 patients (mean age 70 ± 8) agreed to ground reaction force testing on an instrumented treadmill at a fair pace and incline. A gender-ratio identical group of 16 healthy control subjects (mean age 67 ± 10) and 16 patients with ipsilateral medial knee OA (mean age 66 ± 7) were analysed to compare. Results Radiographically the mode preoperative Kellgren–Lawrence knee grade for each side was 3. Postoperatively, the TKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 89° with a mean posterior slope of 5° in the sagittal plane. The UKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 86° with a mean posterior slope of 4° in the sagittal plane. In 7 patients, the TKA was the first procedure, while 6 for the UKA and 3 done simultaneously. Gait analysis demonstrated in both walking conditions the UKA limb was the preferred side through all phases of loading (p < 0.05) and nearer to normal than the TKA limb when compared to healthy controls and patients with knee OA. The greatest difference was observed between the transition of weight acceptance and midstance (p = 0.008), when 22% more load was taken by the UKA side. Conclusion By using a dynamic metric of an everyday activity, a distinct gait difference between differing arthroplasty types were established. A more natural loading pattern can be achieved with unicompartmentals as compared to total knees. Level of evidence Retrospective comparative study, Level III.

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