Alignment Deviation Between Bone Resection and Final Implant Positioning in Computer-Navigated Total Knee Arthroplasty

Catani, Fabio; Biasca, Nicola; Ensini, Andrea; Leardini, Alberto; Bianchi, Luca; Digennaro, Vitantonio; Giannini, Sandro

doi:10.2106/jbjs.g.00293

Cited by 94 publications

(73 citation statements)

References 13 publications

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“…Our results were comparable to previous studies when evaluating cutting error [1,10,12,14] (Table 1), implanting error [9] (Table 2) and radiographic error [15,16] (Table 3). Our study is the first to evaluate all types of errors (cutting, implanting and radiographic error).…”

Section: Discussionsupporting

confidence: 90%

“…However, the frontal femoral and tibial alignments were measured by the instrumented probe of the navigation system positioned onto the relevant bone cuts after a final cut of the femur or tibia without implanting the components in this study. Our study and the study by Catani et al [9] checked the component alignment after component implantation. Previous studies evaluated the standard TKA except the study by Kim et al [12] who used the MIS technique.…”

Section: Discussionmentioning

confidence: 66%

“…The use of computer-assisted surgery has also reduced the risk of malalignment associated with minimally invasive surgery (MIS) [5,6], which has potential issues with component malpositioning arising from the limited surgical view [7]. However, there were still errors in component alignment with computer-navigated TKA associated with the jig cutting setting, bone cutting and component implantation [8][9][10][11]. Navigation systems recommend checking for alignment of the bone cutting surface just after cutting the bone.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, they recommend checking for the lower limb alignment only after the trial or final components are introduced. The importance of the final positioning of the femoral and tibial components seems to be particularly underestimated [9]. However, we can use the navigation system at the time of the final tibial and femoral component implantation.…”

Section: Introductionmentioning

confidence: 99%

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Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Hasegawa

Yoshida

Wakabayashi

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the accuracy of bone cutting and implantation in minimally invasive total knee arthroplasty with image-free navigation. Methods The alignment of the tibial and femoral bone resection was measured in 40 knees during surgery. The alignment measurement was repeated after cementing the tibial and femoral components. We evaluated the cutting error and the implanting error. Results The mean tibial cutting errors were 0.5 and 0.7°in the frontal and sagittal planes, respectively. The mean femoral cutting errors were 0.5 and 0.9°in the frontal and sagittal planes, respectively. The mean tibial implanting errors were 1.0 and 0.9°in the frontal and sagittal planes, respectively. The mean femoral implanting error was 0.7°in the frontal plane. Conclusions Computer-assisted navigation was useful in checking the alignment of both bone cut and cementation.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Hasegawa

Yoshida

Wakabayashi

et al. 2012

International Orthopaedics (SICOT)

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“…This could be due to improper cementation and impaction of the components intraoperatively. Catani et al [4] reported alignment deviations of more than 1°can occur in 20% of limbs for femoral component position in the coronal plane. Malaligned knees where both components were placed accurately were probably the result of mediolateral soft tissue imbalance.…”

Section: Discussionmentioning

confidence: 99%

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

Mullaji

Shetty

Lingaraju

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Computer navigation has improved accuracy and reduced the percentage of alignment outliers in TKA. However, the characteristics of outliers and the risk factors for limb malalignment after TKA are still unclear. Questions/Purposes We therefore addressed the following questions: (1) What is the incidence and characteristics of outliers for postoperative limb mechanical axis (hip-knee-ankle [HKA] angle outside the conventional 180°± 3°range) and component alignment in TKA? And (2) what are the preoperative clinical or radiographic risk factors for limb mechanical axis malalignment in TKA? Methods We retrospectively reviewed the clinical and radiographic records of 1500 computer-assisted TKAs to identify outliers for postoperative HKA axis and component alignment and determined risk factors for malalignment. Full-length hip-to-ankle and knee radiographs were used to measure preoperative HKA angle, femoral coronal bowing, joint divergence angle, tibial subluxation, and tibial bone loss and postoperative HKA angle and femoral and tibial component angle. Results The incidence of outliers for postoperative limb mechanical axis, femoral component alignment, and tibial component alignment was 7% (112 of 1500 TKAs), 7%, and 8%, respectively, with 70% of limbs placed in excessive varus and 30% in excessive valgus. Preoperative varus deformity of more than 20°and femoral bowing of more than 5°were associated with increased risk of placing the limb mechanical axis outside the acceptable ± 3°range after computer-assisted TKA. Conclusions The presence of preoperative radiographic risk factors should alert the surgeon to increased chance of malalignment and every measure should be undertaken in such at-risk knees to ensure proper limb and component alignment and soft tissue balance.

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In vivo kinematics and kinetics of a bi‐cruciate substituting total knee arthroplasty: A combined fluoroscopic and gait analysis study

Catani

Ensini

Belvedere

et al. 2009

Journal Orthopaedic Research

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After total knee arthroplasty, changes in articular surface geometry, soft tissue treatment, and component alignment can alter normal lower limb function. The guided motion bi-cruciate substituting prosthesis was designed specifically to restore physiological knee joint motion. We determined whether this design could in vivo normal kinematics and kinetics, not only at the replaced knee, but also throughout both lower limbs. Sixteen patients (4 male, 12 female, mean age of 68.2 years with a range from 58 to 79 years) with primary knee osteoarthritis were implanted with the bi-cruciate substituting prosthesis. At 6-month follow-up, knee joint kinematics was assessed by video-fluoroscopy during stair-climbing, chair-rising/sitting, and step-up/down. Lower limb overall function was also assessed on the same day by standard gait analysis with simultaneous electromyography during level walking. By video-fluoroscopy, mean anteroposterior translations between femoral and tibial components during the three motor tasks were 9.7 AE 3.0, 10 AE 2.6, and 6.9 AE 3.5 mm on the medial compartment, and 14.3 AE 3.5, 18.5 AE 3.0, and 13.9 AE 3.8 mm on the lateral compartment, respectively. Axial rotation ranged from 5.68 to 26.28. Gait analysis revealed restoration of nearly normal walking patterns in most patients. This rare combination of measurements, i.e., accurate rotation-translation at the replaced knee and complete locomotion patterns at both lower limb joints, suggested that bi-cruciate substituting arthroplasty can restore physiological knee motion and normal overall function. ß

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Alignment Deviation Between Bone Resection and Final Implant Positioning in Computer-Navigated Total Knee Arthroplasty

Cited by 94 publications

References 13 publications

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Which Factors Increase Risk of Malalignment of the Hip-Knee-Ankle Axis in TKA?

In vivo kinematics and kinetics of a bi‐cruciate substituting total knee arthroplasty: A combined fluoroscopic and gait analysis study

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