Computer-assisted surgery improves rotational positioning of the femoral component but not the tibial component in total knee arthroplasty

Hernández-Vaquero, Daniel; Noriega-Fernandez, Alfonso; Fernández-Carreira, José Manuel; Fernandez-Simon, Jose Manuel; Rios, Jimena Llorens de los

doi:10.1007/s00167-014-3233-9

Cited by 36 publications

(40 citation statements)

References 38 publications

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“…Recovery of the correct coronal limb alignment and femoral prosthesis rotation alignment are essential for good postoperative function. Poor coronary limb alignment can lead to residual deformities and accelerated wear of the prosthesis, while poor rotational alignment of the femoral prosthesis can cause imbalance of the flexion gap and poor patellar tracking, which will eventually affect knee function [1,12]. In this study we found that although there was no significant difference in the mFTA, the femoral prothesis was more internally rotated in group B patients.…”

Section: Discussionmentioning

confidence: 63%

Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

Liu¹,

Dong²,

Xu³

et al. 2020

Preprint

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Purpose: We hypothesized that patellar positioning during minimally invasive total knee arthroplasty (MIS-TKA) would affect soft tissue balance and postoperative outcome.Methods: From December 2018 to February 2019, 55 patients receiving primary MIS-TKA were enrolled. The gap-balance technique was used, with patients randomly assigned to undergo osteotomy and balance of soft tissue with the patella reduced (group A; n = 27) or with the patella subluxated (group B; n = 28). The soft tissue balance achieved with the patella reduced and subluxated were compared. Femoral prosthesis rotation, mechanical femoral axis–to–tibial axis angle, Knee Society Score (KSS), pain score, and range of flexion were compared between the groups. Follow-up was for 6 months.Results: The flexion gap and the varus angle were significantly greater after patella reduction than before reduction, but the extension joint gap and varus angle were comparable before and after patella reduction. The femoral prosthesis tended to be internally rotated in group B. Range of flexion was better in the group A than in group B at 1 month after surgery, but the differences were not significant at 3 and 6 months. KSS and pain score were comparable between the groups after surgery.Conclusion: During MIS-TKA, as far as possible, soft tissue balance should be achieved with the patella reduced; otherwise, the femoral prosthesis may be installed more internally and, after patella reduction, the flexion gap and varus would increase.

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Section: Discussionmentioning

confidence: 63%

Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

Liu¹,

Dong²,

Xu³

et al. 2020

Preprint

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“…Previous studies have investigated and compared the accuracy of tibial cuts achieved with various alignment techniques, including extramedullary guides, computer-assisted navigation, patient-specific jigs, and hand-held surgical navigation. [3456] Chiu et al . [7] reported 59 tibial components (78.7%) that had a tibial cut within 3° of perpendicular to the mechanical axis when using an extramedullary guide.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, many studies have been reported using computer-assisted navigation systems and patient-specific cutting guides to decrease the number of alignment outliers. [345] However, owing to longer procedure times, increased cost, and highly sensitive instruments, most surgeons still choose conventional mechanical alignment guides when performing TKA. These conventional alignment devices can result in unacceptable intraoperative alignment distortions in clinical practice, due to difficulty in accurately identifying the landmarks around the ankle, tibial torsion, abnormal tibial bowing, and ankle joint deformities.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Measurement of Tibial Resection in Total Knee Arthroplasty Improves Accuracy of Postoperative Limb Alignment Restoration

Zhang

Fang

Zhong

et al. 2016

Chinese Medical Journal

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Background:Accuracy of implant placement in total knee arthroplasty (TKA) is crucial. Traditional extramedullary alignment instruments are fairly effective for achieving the desired mean tibial component coronal alignment. We modified the traditional tibial plateau resection technique and evaluated its effect on alignment restoration.Methods:Two hundred and eighty-two primary TKAs in our hospital between January 2013 and December 2014 were enrolled in this retrospective study. Group A consisted of 128 primary TKAs performed by one senior surgeon. Preoperative measurement of the tibial resection was conducted on radiographs, and the measured thicknesses of the lateral and medial plateau resection were used to place the tibial alignment guide. Group B consisted of 154 primary TKAs performed by the other senior surgeon, using a traditional tibial plateau resection technique. In all patients, an extramedullary guide was used for tibial resection, and preoperative and postoperative full-leg standing radiographs were used to assess the hip-knee-ankle angle (HKA), femoral component alignment angle (FA), and tibial component alignment angle (TA). A deviation ≥3° was considered unsatisfactory. Data were analyzed by unpaired Student's t-test.Results:The mean postoperative HKA and TA angles were significantly different between Groups A and B (178.2 ± 3.2° vs. 177.0 ± 3.0°, t = 2.54, P = 0.01; 89.3 ± 1.8° vs. 88.3 ± 2.0°, t = 3.75, P = 0.00, respectively). The mean postoperative FA was 88.9 ± 2.5° in Group A and 88.9 ± 2.6° in Group B, and no significant difference was detected (t = 0.10, P = 0.92). There were 90 (70.3%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 38 (29.7%) outliers (>3° deviation) in Group A, whereas there were 89 (57.8%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 65 (42.2%) outliers (>3° deviation) in Group B. The severity of the preoperative alignment deformity was a strong predictor for postoperative alignment.Conclusions:Using conventional surgical instruments, preoperative measurement of resection thickness of the tibial plateau on radiographs could improve the accuracy of conventional surgical techniques.

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“…Patients were randomly assigned to each group by means of a random number table. The study methodology of our cases has already been published in a previous paper (19). The angulation obtained was taken to be the mean of the values recorded by the two observers.…”

Section: Methodsmentioning

confidence: 99%

“…The introduction of computer-assisted surgery (CAS) has improved TKR positioning in the frontal axis, avoiding outliers, and has demonstrated its usefulness particularly in major varus-valgus deformities (17,18). However, it has not been demonstrated that CAS improves tibial tray placement in the transverse axis (19).…”

Section: Introductionmentioning

confidence: 99%

Total knee replacement modifies the preoperative tibial torsion angle—similar results between computer-assisted and standard technique

et al. 2018

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Computer-assisted surgery improves rotational positioning of the femoral component but not the tibial component in total knee arthroplasty

Cited by 36 publications

References 38 publications

Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

Does Patella Position Influence Soft Tissue Balance and Clinical Outcome in Minimally Invasive Total Knee Arthroplasty?

Preoperative Measurement of Tibial Resection in Total Knee Arthroplasty Improves Accuracy of Postoperative Limb Alignment Restoration

Total knee replacement modifies the preoperative tibial torsion angle—similar results between computer-assisted and standard technique

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