Optimizing Femoral Component Rotation in Total Knee Arthroplasty

Miller, Mark Carl; Berger, Richard A.; Petrella, Anthony J.; Karmas, Alex; Rubash, Harry E.

doi:10.1097/00003086-200111000-00005

Cited by 267 publications

(207 citation statements)

References 14 publications

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“…Second, the goal for femoral rotation was different in the two groups: in the ROBODOC 1 -assisted group, the femoral component was aligned with the transepicondylar axis, while in the conventional group, it was aligned 3°externally to the posterior condylar axis. According to the literature [14,30], the best rotation alignment for the femoral component has been parallel to the transepicondylar axis. This axis is identifiable on most CT scans but is difficult for surgeons to identify manually during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This axis is identifiable on most CT scans but is difficult for surgeons to identify manually during surgery. Several studies have shown using 3°of external rotation to the posterior condylar axis may accurately estimate the femoral flexion axis only 65% to 80% of the time [20,30,32]. Therefore, using a fixed 3°rotational alignment in the conventional group could have resulted in some of the differences found in this group.…”

Section: Discussionmentioning

confidence: 99%

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Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Song

Seon

Yim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

333

295

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Background Several studies have shown mechanical alignment influences the outcome of TKA. Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment. Questions/purposes We determined whether roboticassisted implantation for TKA (1) improved clinical outcome; (2) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes; (3) improved the balance (flexion and extension gaps); and (4) reduced complications, postoperative drainage, and operative time when compared to conventionally implanted TKA over an intermediate-term (minimum 3-year) followup period. MethodsWe prospectively randomized 100 patients who underwent unilateral TKA into one of two groups: 50 using a robotic-assisted procedure and 50 using conventional manual techniques. Outcome variables considered were postoperative ROM, WOMAC scores, Hospital for Special Surgery (HSS) knee scores, mechanical axis alignment, flexion/extension gap balance, complications, postoperative drainage, and operative time. Minimum followup was 41 months (mean, 65 months; range, 41-81 months). Results There were no differences in postoperative ROM, WOMAC scores, and HSS knee scores. The roboticassisted group resulted in no mechanical axis outliers ([ ± 3°from neutral) compared to 24% in the conventional group. There were fewer robotic-assisted knees

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Song

Seon

Yim

et al. 2013

Clinical Orthopaedics &Amp; Related Research

333

295

View full text Add to dashboard Cite

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“…18 Rotation of the femoral component of 58 from the transepicondylar axis alters tibiofemoral kinematics and patellar tracking. 19 Malrotation of the tibial component will lead to impingement of the polyethylene, which could lead to loss of motion and wear. 20 A study of patients with anterior knee pain found that the average tibial component alignment was 6.28 internal rotation, compared with 0.48 external rotation for patients without pain.…”

mentioning

confidence: 99%

Biomechanical effects of total knee arthroplasty component malrotation: A computational simulation

Thompson

Hast

Granger

et al. 2011

Journal Orthopaedic Research

106

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Modern total knee arthroplasty (TKA) is an effective procedure to treat pain and disability due to osteoarthritis, but some patients experience quadriceps weakness after surgery and have difficulty performing important activities of daily living. The success of TKA depends on many factors, but malalignment of the prosthetic components is a major cause of postoperative complications. Significant variability is associated with femoral and tibial component rotational alignment, but how this variability translates into functional outcome remains unknown. We used a forward-dynamic computer model of a simulated squatting motion to perform a parametric study of the effects of variations in component rotational alignment in TKA. A cruciate-retaining and posterior-stabilized version of the same TKA implant were compared. We found that femoral rotation had a greater effect on quadriceps forces, collateral ligament forces, and varus/valgus kinematics, while tibial rotation had a greater effect on anteroposterior translations. Our findings support the tendency for orthopedic surgeons to bias the femoral component into external rotation and avoid malrotation of the tibial component. ß

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“…In TKA, femoral component rotation is an important factor that affects patellofemoral and tibiofemoral kinematics (6). Several previous studies have associated femoral component malposition to the development of anterior knee pain and patellar position (2,20,21).…”

Section: Discussionmentioning

confidence: 99%

“…Analyzing TKA kinematics can be important in the assessment of numerous factors affecting the outcome of TKA. Various analytical methods, in vivo or in vitro, have been proposed to determine knee kinematics with and without TKA, including cadaveric evaluations (1,2), gait laboratory motion analysis systems (3,4), radiography (5,6), roentgen stereophotogrammetric analyses (7,8), and video fluoroscopy (9).…”

mentioning

confidence: 99%

Magnetic resonance imaging of in vivo kinematics after total knee arthroplasty

Lee

Slavinsky

Ries

et al. 2005

Magnetic Resonance Imaging

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Purpose:To improve the quality of magnetic resonance imaging (MRI) on knees after total knee arthroplasty (TKA) by minimizing image artifacts caused by metallic implants, and to establish a method determining in vivo kinematics of TKA knees using MRI. Materials and Methods:Two knee implants made of cobaltchrome and oxidized zirconium were tested with different pulse sequences and imaging parameters. Then, in vivo kinematic MRI was performed on five well-functioning TKAs under simulated weight-bearing conditions. Kinematic measurements were made and a linear correlation test was run between the tibio-and patellofemoral measurements. Results:The best images with minimum metallic artifacts were observed using oxidized zirconium implants, a fast spin echo sequence (FSE), thin slice thickness, and high readout gradient. TKA kinematics exhibited a large deviation from the normal kinematics and considerable patientto-patient variability. However, significant linear correlations between tibiofemoral and patellofemoral kinematics were observed (R ϭ -0.96, 0.92, 0.88). Conclusion:Metallic artifacts due to orthopedic implants can be reduced in MR images for some materials, appropriate pulse sequence, and imaging parameters selection, enabling MR quantification of knee kinematics. Tibiofemoral kinematics appears to affect patellofemoral position after total knee arthroplasty.

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Optimizing Femoral Component Rotation in Total Knee Arthroplasty

Cited by 267 publications

References 14 publications

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA

Biomechanical effects of total knee arthroplasty component malrotation: A computational simulation

Magnetic resonance imaging of in vivo kinematics after total knee arthroplasty

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