Intramedullary control of distal femoral resection results in precise coronal alignment in TKA

Pfitzner, Tilman; Roth, Philipp von; Perka, Carsten; Matziolis, Georg

doi:10.1007/s00402-014-1934-7

Cited by 11 publications

(6 citation statements)

References 35 publications

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“…Das Ziel der vorliegenden Studie war es zu untersuchen, ob die relevanten Kniegelenkswinkel, die anatomische Achse und eine approximierte mechanische Achse nach Knie-TEP-Implantation anhand einer a.-p.-Röntgenaufnahme des Kniegelenkes valide messbar sind und reproduzierbare Ergebnisse liefern.In dieser Studie wurden digitale postoperative Ganzbeinstandaufnahmen im a.-p.-Strahlengang nach Implantation einer primären nichtnavigierten Knie-TEP von 100 Patienten untersucht. Die intraoperative Komponentenausrichtung erfolgte tibial extramedullär senkrecht zur mechanischen Achse und femoral intramedullär nach Maßgabe des individuellen mechanisch-anatomischen Femurwinkels gemäß der präoperativen Planung[18]. Es wurden nur Aufnahmen mit Abbildung des Hüftkopfes, des Sprunggelenkes und mit zentral ausgerichteter Patella in die Analyse eingeschlossen.…”

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Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig?

Dargel

Pennig

Schnurr³

et al. 2016

Orthopäde

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Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig?

Dargel

Pennig

Schnurr³

et al. 2016

Orthopäde

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“…The standard practice to determine distal cutting angle referenced off the femoral intramedullary guide was usually to measure the angle between the anatomical and mechanical femoral axis on preoperative radiographs [ 12 ]. The position of TKA implant significantly affects the outcome of joint replacement in the coronal plane [ 33 – 35 ]. Although femoral component alignment has been thoroughly studied, the importance of femoral sagittal bowing in TKA has not been widely studied [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Zhang

Wang

et al. 2021

J Orthop Surg Res

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Background The aim of the present study was to investigate the influence of sagittal femoral bowing on sagittal femoral component alignment, and whether there was correlation between sagittal femoral component alignment and coronal femoral component alignment. Methods We retrospectively reviewed 77 knees in 71 patients who had undergone primary TKA for advanced osteoarthritis. All surgeries were performed by using a standard medial parapatellar approach. The osteotomy was performed with a conventional technique using an intramedullary rod for the femur and a mechanical extramedullary guiding system for the tibia. All patients enrolled in the study were evaluated with full-length lower extremity load-bearing standing scanograms, and the patients had preoperative and postoperative radiographs of the knees. Coronal femoral bowing angle (cFBA), sagittal femoral bowing angle (sFBA), and postoperatively, mechanical tibiofemoral angle of the knee (mTFA), β angle (femoral component flexion angle) were measured. The radiographic results of both groups were compared using Student's t test. A two-sided Pearson correlation coefficient was obtained to identify the correlations between FBA in the coronal and sagittal planes, as well as FBA and age or BMI, sFBA and β angle, cFBA and mTFA. Comparison of FSB incidence between different genders was made using Chi-square test. The p value < 0.05 indicates a statistically significant difference. Results The mean sFBA, cFBA, β angle, mTFA were 9.34° ± 3.56°(range 1°–16°), 3.25° ± 3.79°(range − 7° to −17°), 3.91° ± 3.15°(range − 1° to −13°), 0.60° ± 1.95°(range − 3° to −6°), respectively. There was no correlation between age and sFBA (CC = 0.192, p = 0.194) or cFBA (CC = 0.192, p = 0.194); similarly, there was no correlation between age and sFBA (CC = 0.067, p = 0.565) or cFBA (CC = 0.069, p = 0.549). The sFBA was correlated with cFBA and β angle (CC = 0.540, p < 0.01; CC = 0.543, p < 0.01, respectively), and the cFBA was correlated with mTFA (CC = 0.430, p < 0.01). There was no significant difference (p = 0.247) of cFBA between the patients with sFSB and the patients without sFSB. Conclusions The current study showed that the sFBA was correlated with cFBA in the patients undergoing TKA and the patients with sFSB usually presented non-cFSB. We also found that sFSB could affect the femoral component alignment in the sagittal plane and cFSB could affect the femoral component alignment in the coronal plane. The sFBA or cFBA was not correlated with age, BMI, or gender.

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“…Many risk factors, such as the female sex, age, alcohol use, smoking, pre‐existing psychiatric illness and the African‐American race, are associated with increased persistent pain and increased patient dissatisfaction after TKA 22,23 . Among these risk factors, precise bone resection and accurate component positioning are important for preventing the malalignment of TKA 24,25 . Inadequate bone resection may cause suboptimal component positioning, thus leading to malalignment, which can result in an increased rate of revision arthroplasty and polyethylene wear 26 .…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Among these risk factors, precise bone resection and accurate component positioning are important for preventing the malalignment of TKA. 24,25 Inadequate bone resection may cause suboptimal component positioning, thus leading to malalignment, which can result in an increased rate of revision arthroplasty and polyethylene wear. 26 More than 6% of these patients who have undergone primary TKA may need revision surgery within five years, based on a large primary surgery meta-analysis.…”

Section: F I G U R E 4 Typical Picture Of Sawbones After Bone Resection: (A) Femoral; (B) Tibialmentioning

confidence: 99%

Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study

Chen

Zhang

et al. 2021

Robotics Computer Surgery

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Background The purpose of this study was to compare the accuracy of this new HURWA robotic‐assisted total knee arthroplasty (TKA) technique to the accuracy of the conventional technique in a sawbone model. Methods The HURWA robotic‐assisted TKA system was applied in the robotic group. After bone resection, all of these sawbones were scanned by the use of a structured light scanning system. Measurements of bone resections, femoral coronal and sagittal measurements, and tibial coronal and sagittal measurements were recorded. Results Compared to the conventional technique, the HURWA robotic‐assisted system significantly improved the accuracy of the bone resection levels and angles. In the robotic group, the accuracy of all of the bone resection levels was below 0.6 mm (with standard deviation [SD] below 0.6 mm), and all of the bone resection angles were below 0.6° (with SD below 0.4°). Conclusion Our data suggest that this novel HURWA robotic‐assisted system can significantly improve the accuracy of bone resection levels and angles.

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Intramedullary control of distal femoral resection results in precise coronal alignment in TKA

Cited by 11 publications

References 35 publications

Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig?

Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig?

Is the femoral component flexion affected by the sagittal femoral shaft bowing in conventional intramedullary guided TKA?

Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study

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