Radiographic and Navigation Measurements of TKA Limb Alignment Do Not Correlate

Yaffe, Mark; Koo, Samuel; Stulberg, S. David

doi:10.1007/s11999-008-0427-9

Cited by 86 publications

(84 citation statements)

References 28 publications

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“…Our results were comparable to previous studies when evaluating cutting error [1,10,12,14] (Table 1), implanting error [9] (Table 2) and radiographic error [15,16] (Table 3). Our study is the first to evaluate all types of errors (cutting, implanting and radiographic error).…”

Section: Discussionsupporting

confidence: 90%

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Hasegawa

Yoshida

Wakabayashi

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the accuracy of bone cutting and implantation in minimally invasive total knee arthroplasty with image-free navigation. Methods The alignment of the tibial and femoral bone resection was measured in 40 knees during surgery. The alignment measurement was repeated after cementing the tibial and femoral components. We evaluated the cutting error and the implanting error. Results The mean tibial cutting errors were 0.5 and 0.7°in the frontal and sagittal planes, respectively. The mean femoral cutting errors were 0.5 and 0.9°in the frontal and sagittal planes, respectively. The mean tibial implanting errors were 1.0 and 0.9°in the frontal and sagittal planes, respectively. The mean femoral implanting error was 0.7°in the frontal plane. Conclusions Computer-assisted navigation was useful in checking the alignment of both bone cut and cementation.

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Section: Discussionsupporting

confidence: 90%

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Hasegawa

Yoshida

Wakabayashi

et al. 2012

International Orthopaedics (SICOT)

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“…Patients with large intraarticular deformities might be easier to correct to neutral alignment than those with large degrees of varus in the tibia, potentially affecting outcome. Fifth, manual goniometer measurements of limb alignment reportedly are accurate to between 2°and 3° [7,29]. The use of digital radiography and computers for angle measurements might improve the accuracy of these measurements [26].…”

Section: Discussionmentioning

confidence: 99%

Residual Varus Alignment does not Compromise Results of TKAs in Patients with Preoperative Varus

Magnussen

Weppe

Demey

et al. 2011

Clinical Orthopaedics &Amp; Related Research

162

136

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BackgroundPostoperative varus alignment has been associated with lower IKS scores and increased failure rates. Appropriate positioning of TKA components therefore is a key concern of surgeons. However, obtaining neutral alignment can be challenging in patients with substantial preoperative varus deformity and it is unclear whether residual deformity influences revision rates. Questions/purposes We asked: (1) in patients with preoperative varus deformities, does residual postoperative varus limb alignment lead to increased revision rates or lower IKS scores compared with correction to neutral alignment, (2) does placing the tibial component in varus alignment lead to increased revision rates and lower IKS scores, (3) does femoral component alignment affect revision rates and IKS scores, and (4) do these findings change in patients with at least 10°varus alignment preoperatively?Patients and Methods From a prospective database, we identified 553 patients undergoing TKAs for varus osteoarthritis. Patients were divided into those with residual postoperative varus and those with neutral postoperative alignment. Revision rates and International Knee Society (IKS) scores were compared between the two groups and assessed based on postoperative component alignment. Survival analysis was conducted with revision as the endpoint. The analysis was repeated in a subgroup of patients with at least 10°preoperative varus. Minimum followup was 2 years (median, 4.7 years; range, 2-19.8 years). Results The two groups had similar survival rates to 10 years and similar IKS scores. Varus tibial component alignment and valgus femoral component alignment were associated with lower mean scores. Revision rates and scores were similar in a subgroup of patients with substantial preoperative varus. Conclusions Our data suggest residual postoperative varus deformity after TKA does not increase survival rates at medium-term in patients with preoperative varus deformities, providing tibial component varus is avoided. Tibial component varus negatively influences IKS score. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…It could therefore be inferred that repeatable measurements are also accurate, as in order for measurements to be repeatable, soft tissue artefacts must be minimal. In addition, it could be argued that the acknowledged long-leg radiographic gold standard has more potential variation [14] than the IR system, and that disagreement between measurements may not reflect true inaccuracies [36]. Although several obese subjects were enrolled in the study, none were morbidly obese and no subject reported discomfort when performing the necessary kinematic maneuvers.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive computer-assisted measurement of knee alignment

Clarke

Riches

Picard

et al. 2011

Computer Aided Surgery

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The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1 larger than for the rigid model with statistically similar variance ( p ¼ 0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost AE1, with up to AE0.5 loss of repeatability for coronal alignment measured before and after stress maneuvers, and a AE0.2 loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were AE1.6 and AE2.3 , respectively. Varus and valgus stress measurements agreed to within AE1.3 and AE1.1 , respectively. Agreement limits for standing MFT angles were AE2.9(coronal) and AE5.0 (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs.

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Radiographic and Navigation Measurements of TKA Limb Alignment Do Not Correlate

Cited by 86 publications

References 28 publications

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Cutting and implanting errors in minimally invasive total knee arthroplasty using a navigation system

Residual Varus Alignment does not Compromise Results of TKAs in Patients with Preoperative Varus

Non-invasive computer-assisted measurement of knee alignment

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