Computed navigated total knee arthroplasty compared to computed tomography scans

Batash, Ron; Rubin, Guy; Lerner, Alexander; Shehade, Hussein; Rozen, Nimrod; Rothem, David E.

doi:10.1016/j.knee.2017.03.006

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…The current study attempted to identify the effect of rotation on measurements of alignment in the lower extremities. The results suggest that knee surgeons should be careful and opt for more sensitive investigations when diagnosing and planning treatment options in certain groups of patients [23,24]. The significance threshold for one-way analysis of variance (ANOVA) was set at P < 0:05.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Position on Radiographic Angle Measurements of the Lower Extremities

Chung

Lee

Han

et al. 2022

BioMed Research International

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Purpose. Accurately measuring an angle on a lower extremity X-ray is essential for the diagnosis and treatment of knee osteoarthritis (KOA). However, the angle is often affected by position, especially with flexion contracture and rotation. To date, there have been no quantitative analyses examining the relationship between lower extremity angle and patient position and no studies targeting patients with deformities. The aim of this study is to quantify the effect of position on angle measurements in lower extremity X-rays and to compare the effect in patients with different deformities. Methods. Computed tomography (CT) data of 131 patients with knee pain were retrospectively analyzed. The subjects were categorized into the following groups: neutral (hip-knee-ankle angle (HKAA) between 175 and 185°), varus (HKAA less than 175°), valgus (HKAA more than 185°), and flexion (flexion contracture more than 10°). CT images were digitally reconstructed to anterior-posterior X-ray images using an average intensity projection algorithm. The process was then repeated while rotating the reconstruction plane from internal 9° to external 9°. In this manner, X-ray images were reconstructed in different rotational states. The following angles were measured from reconstructed X-ray images: HKAA, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and femoral valgus angle (FVA). The measurements were then compared according to the degree of rotation. Results. FVA significantly differed according to rotation in all groups ( P < 0.001 ), with a difference of 1.3° (±0.4°). HKAA significantly changed only in the flexion contracture group ( P < 0.001 ), which showed a difference of 1.0° (±0.7°). However, HKAA in the other groups, LDFA, and MPTA did not significantly differ depending on rotation. Conclusions. Radiographic measurement of FVA is subject to change according to rotation. HKAA significantly changed only in the flexion contracture group, so more care should be taken while obtaining X-rays of patients with flexion contracture.

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Section: Discussionmentioning

confidence: 99%

The Effect of Position on Radiographic Angle Measurements of the Lower Extremities

Chung

Lee

Han

et al. 2022

BioMed Research International

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“…Technology-assisted approach encompasses several possibilities, including robotic arm-assisted procedure, computer navigation and patient-specific instrumentation (PSI) 10 11. Most technologies offer a three-dimensional preoperative planning, which tremendously contributes to the intraoperative readiness in these complex cases 12.…”

Section: Discussionmentioning

confidence: 99%

Multiple trauma-induced, secondary osteoarthritis, knee Arthroplasty and technology: Conventional approach to an unconventional scenario

et al. 2022

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A 49-year-old man was involved in a high-energy motor vehicle accident. Haemodynamic instability with multiple long bone fractures of lower limbs was the hallmarks of the injury. Closed fragmented fracture of left femur shaft and open displaced supracondylar fracture of the contralateral femur. Closed comminuted high-grade fracture of the Tibia plateau (Schatzker VI) was diagnosed bilaterally. ‘Orthopaedic damage control’ was initiated with bilateral ‘cross knee’ external fixation, followed by conversion to open reduction internal fixation of all fracture sits at 8 days later. The patient underwent nine subsequent hospitalisations, of which eight involved operative treatment. The interval from admission to last documented surgery was 7 years. The endpoint was total knee arthroplasty (TKA) with mega prosthesis of the left knee and a primary-type TKA in the right knee. Both arthroplasties were non-assisted, conventional procedures. Postoperative Western Onterio and McMaster Universities Arthritis Index (WOMAC) score was 85 at 9-year follow-up from the injury incurred.

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“…In fact, the percentage of patients lost to follow-up is consistent with other studies with similar follow-up time. 31 The radiological measurement of coronal deformity before TKA is potentially imprecise, 27,32 but computed tomography 28,33 or EOS technique 29,34 is not common practice. The multicentric nature of the study involves the use of different implants and variable surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Navigation Improves the Survival Rate of Mobile-Bearing Total Knee Arthroplasty by Severe Preoperative Coronal Deformity: A Propensity Matched Case–Control Comparative Study

Jenny

Saragaglia²,

Bercovy

et al. 2020

J Knee Surg

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The primary hypothesis of this study was that the survival rate over 10 years of total knee arthroplasties (TKAs) implanted with a navigation system was superior to that of TKAs implanted with a conventional technique. The secondary hypothesis was that the severity of the initial coronal deformity had a negative influence on the survival rate. A national, multicentric, retrospective study was performed in France, including eight university or private centers with high volumes in knee surgery. Cases operated on with either a conventional (control group) or a navigated (study group) technique were matched after calculating the propensity score using the logistic regression technique. All patients were contacted after 10 years or more to determine the survival of the TKA. The need for date and cause of revision were noted. The primary end point of the study was the occurrence of a revision for any mechanical reason. Survival curves were calculated using the Kaplan–Meier's technique, with the primary criterion as end point. The influence of the implantation technique was analyzed by a log-rank test at a 5% level of significance. The influence of severity of the preoperative coronal deformity was analyzed using the same technique. A total of 513 cases were included in each group. The survival rates after 13 years were 96.5% in the study group and 92.9% in the control group (not significant). There was no significant difference between both groups for the survival rates after 13 years for small deformity (96.0 vs. 97.0%), but the difference was significant for large deformity (97.0 vs. 89.0%, p = 0.04). The results suggest that the use of a navigation system, allowing a more consistent correction of the preoperative coronal deformity, thus allows a better long-term prosthetic survival in cases with a large initial coronal deformity. A navigation system should be routinely used in cases of initial coronal deformity greater than or equal to 10 degrees, as conventional techniques do not routinely provide satisfactory axial correction in these difficult cases.

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Computed navigated total knee arthroplasty compared to computed tomography scans

Cited by 11 publications

References 15 publications

The Effect of Position on Radiographic Angle Measurements of the Lower Extremities

The Effect of Position on Radiographic Angle Measurements of the Lower Extremities

Multiple trauma-induced, secondary osteoarthritis, knee Arthroplasty and technology: Conventional approach to an unconventional scenario

Navigation Improves the Survival Rate of Mobile-Bearing Total Knee Arthroplasty by Severe Preoperative Coronal Deformity: A Propensity Matched Case–Control Comparative Study

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