Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

Kanna, Raj; Ravichandran, Chandramohan; Shetty, Gautam M.

doi:10.1186/s43019-021-00129-9

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…[8] Most surgeons recommend to align it either perpendicular or in slight flexion (3-5°) to sagittal mechanical axis of femur. [14] However, studies have shown that the risk of anterior femoral notching is high if the femoral component positioning is planned perpendicular to sagittal mechanical axis of femur in navigated TKA. [8,15] In our study, significantly higher anterior femoral notching occurred more frequently in navigated TKA than in conventional TKA.…”

Section: Discussionmentioning

confidence: 99%

Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis

2022

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To compare femoral sagittal axis between navigated total knee arthroplasty (TKA) and conventional TKA.A total of 136 cases were assigned to group 1 (navigated TKA) and 77 cases were assigned to group 2 (conventional TKA). Specifically, this study targeted patients with degenerative osteoarthritis. Only patients with primary TKA were analyzed. Hip knee ankle angle and lateral femoral bowing were measured using preoperative scanogram. Anterior femoral bowing was measured using preoperative femoral lateral X rays. The presence of anterior femoral notching and the insertion angle of the femoral implant with respect to the anatomical sagittal plane of the distal femur were checked using postoperative lateral knee X rays. Student t-test was used to compare the difference in the position of the sagittal plane of the femoral implant between the navigated TKA group and the conventional TKA group.When comparing the 2 groups, the sagittal axis of the femoral implant was more extended than the anatomical sagittal plane axis of the distal femur in group 1 than in group 2 (P = .01). There was a significant negative correlation between the value of anterior femoral bowing and the degree of flexion to the sagittal plane of the femoral implant in group 1 (correlation coefficient: -0.40, P = .01). The occurrence of anterior femoral notching was significantly higher in group 1 than in group 2.During navigated TKA, imageless navigation does not consider the anatomical variation of the femoral shaft. Therefore, surgeons should take into consideration that when performing navigated TKA, a femoral implant could be inserted more extended for the anatomical sagittal axis of the distal femur than for the conventional TKA. Also, surgeon should know that the degree of extension insertion of the femoral implant increases as femoral anterior bowing increases.

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Section: Discussionmentioning

confidence: 99%

Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis

2022

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“…For sagittal plane positioning of the femoral component, anterior referencing was used, and the component was positioned perpendicular to the distal femur anterior cortex axis, using navigation, to avoid anterior femoral notching (AFN). 15 Tibial component rotation was based on self-centering of the trial tibial implant during trial reduction if the orientation was (a) in line with the medial and middle third junction of the tibial tuberosity (neutral rotational alignment), (b) in ER, or (c) in internal rotation (IR) with proper patella tracking. 8 However, if the orientation was in IR and the patella tracking was improper, neutral rotational alignment was established.…”

Section: Methodsmentioning

confidence: 99%

“…This could be because, for the sagittal plane positioning of the femoral component, (a) we used the anterior referencing method and (b) we opted to position the component perpendicular to the distal femur anterior cortex axis rather than perpendicular to the sagittal mechanical axis of the femur using navigation. 15 …”

Section: Implications Of the Gap Balancing Techniquementioning

confidence: 99%

Influence of Preoperative Deformity on Flexion Gap Asymmetry in Measured Resection Technique: A Theoretical Study in Navigated Gap Balancing Total Knee Arthroplasties, Done for Varus Knee Osteoarthritis

Kanna,

Kumar,

Karthikeyan

et al. 2024

JAAOS Glob Res Rev

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Introduction: Disagreement exists on (a) achieving a symmetrical flexion gap and (b) the influence of varus deformity on the flexion gap asymmetry (FGA) in measured resection (MR) total knee arthroplasty (TKA). We aimed to determine the FGA and influence of preoperative deformity on the FGA, based on the MR technique, in varus knee osteoarthritis. Methods: In 321 navigated TKAs, we released the soft tissues in extension. In 90° flexion, with the tensioner in situ, we calculated the FGA, the angle between the posterior femoral cut (planned 3° external rotation to the posterior condylar line, parallel to the surgical transepicondylar axis, or perpendicular to the Whiteside line) and the proximal tibial resection plane. Results: The FGA values varied widely, and the risk of >2° and >3° FGA was present in at least 60% and 40% knees, respectively. These risks were high in knees with moderate and severe varus deformity. Conclusions: In varus knee osteoarthritis, the risk of FGA (based on the MR technique) was high, especially when the deformity was moderate to severe. Caution is required in MR TKA, and surgeons must consider safer alternatives (gap balancing or hybrid technique) to achieve a symmetrical flexion gap in these knees.

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“…[ 1 , 2 ] In the case of manual TKA, a rod is typically inserted intramedullary into the femur for bone preparation. [ 3 ] However, in computer-assisted surgery (CAS) using navigation or robotic systems, bone preparation can be achieved without intramedullary rod insertion. [ 4 ] This approach offers advantages over manual TKA, such as reduced blood loss [ 5 , 6 ] and less surgical trauma.…”

Section: Introductionmentioning

confidence: 99%

The degree of C-reactive protein elevation after total knee arthroplasty is related to bone and medullary injury rather than soft tissue

Bum Kwon,

Woo Bae,

Jin Bae

et al. 2023

Medicine

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First, we want to find out whether computer-assisted surgery (CAS) for total knee arthroplasty (TKA), which does not require opening the femoral medullary canal, results in a lesser C-reactive protein (CRP) level increase postoperatively compared to manual TKA. Second, they seek to examine whether the CRP reduction in CAS TKA and manual TKA follows a similar pattern within the first 2 weeks after surgery. Third, the study aims to compare and analyze the CRP levels in 3 different groups: CRP levels in CAS TKA with surgeons who started TKA surgery by CAS, CRP levels in manual TKA by surgeons with little experience, and CRP levels in skillful manual TKA performed after conducting over 200 cases. The 3 patient groups were as follows. Group 1: Patients who underwent non expertized surgeon CAS TKA (N = 63). Group 2: Patients who underwent manual TKA after surgeon CAS TKA experience (N = 108). Group 3: Patients who underwent manual TKA after surgeon 200 cases or more of either CAS TKA or manual TKA experience (more skillful manual TKA) (N = 66). CRP levels were analyzed using electronic medical records for 3 time points: within 3 months before surgery, 5 days after surgery, and 11 days after surgery. There were no statistically significant differences in pre operative CRP values among the 3 groups. At 5 days after surgery, the CRP level were 48.59 ± 32.75 for CAS TKA, 69.82 ± 42.76 for early manual TKA, and 67.73 ± 44.00 for skillful manual TKA, indicating a statistically significant lower CRP level in the CAS TKA group compared to the manual TKA groups (P = .01). At 11 days after surgery, there were no statistically significant differences in CRP level among the 3 groups, with was 12.12 ± 9.74 for CAS TKA, 14.07 ± 13.18 for early manual TKA, and 11.43 ± 11.45 for skillful manual TKA. The degree of CRP elevation after TKA is related to bone and medullary injury rather than soft tissue.

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Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

Cited by 8 publications

References 32 publications

Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis

Comparison of femoral sagittal axis between navigated total knee arthroplasty and conventional total knee arthroplasty in patients with knee osteoarthritis

Influence of Preoperative Deformity on Flexion Gap Asymmetry in Measured Resection Technique: A Theoretical Study in Navigated Gap Balancing Total Knee Arthroplasties, Done for Varus Knee Osteoarthritis

The degree of C-reactive protein elevation after total knee arthroplasty is related to bone and medullary injury rather than soft tissue

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