Radiographic assessment of knee alignment after total knee arthroplasty

Petersen, T.; Engh, Gerard A.

doi:10.1016/s0883-5403(88)80054-8

Cited by 260 publications

(138 citation statements)

References 9 publications

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“…This is in accordance with numbers reported by other authors not utilizing navigation [12]. Petersen and Engh reported varus/valgus deviation of the axis of >3°in 26% of their patients [19]. Mahaluxmivala et al presented results of 673 total knee arthroplasties.…”

Section: Discussionsupporting

confidence: 88%

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

Heyse

Decking

Davis

et al. 2009

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Postoperative alignment is a predictor for longterm survival of total knee arthroplasty (TKA). The purpose of this study was to evaluate whether or not preoperative deformities predispose to intraoperative malposition of TKA components. A retrospective radiographic analysis of 53 primary TKA cases was performed. Preoperative AP hip to ankle and lateral knee radiographs were compared with postoperative views to evaluate component positioning. The following angles were measured: the hip-knee-ankle (HKA) angle expressing the mechanical axis of the leg, the mechanical lateral distal femur angle (mLDFA), the medial proximal tibia angle (MPTA), the posterior distal femur angle (PDFA), and the posterior proximal tibia angle (PPTA). Postoperative measurement of the HKA revealed 34.0% of the cases had a deviation of >±3°from neutral alignment. Sixteen knees (30.2%) were in varus and, with one exception, all presented with severe varus gonarthrosis prior to surgery with a mean tibiofemoral angle of 12.4°c ompared with 1.0°of valgus in the optimally aligned group. Patients (93.3%) with preoperative valgus malalignment showed optimal postoperative HKA. Odds ratios for malalignment of TKA for varus knees in comparison with valgus knees were 7

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Section: Discussionsupporting

confidence: 88%

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

Heyse

Decking

Davis

et al. 2009

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…As such, it may underestimate the prevalence of tibial debonding if there are some patients who are asymptomatic or have not returned for routine followup radiographs. We did review the latest available radiographs for all patients and no additional cases of tibial debonding were identified but no patients were specifically contacted as part of this study [13,24]. Second, multiple surgeons with variation in surgical technique, volume, and experience with this specific design were involved.…”

Section: Discussionmentioning

confidence: 99%

Aseptic Tibial Debonding as a Cause of Early Failure in a Modern Total Knee Arthroplasty Design

Arsoy

Pagnano

Lewallen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background We observed isolated tibial component debonding from the cement in one modern primary TKA design (NexGen LPS 3°tibial tray; Zimmer, Warsaw, IN, USA). This failure mechanism is sparsely reported in the literature. Questions/Purposes We (1) assessed survivorship of this tibial tray with special emphasis on debonding; (2) described clinical and radiographic features associated with tibial failure; and (3) compared patient and radiographic features of the failures with a matched cohort. Methods A total of 1337 primary TKAs were performed with a cemented NexGen LPS 3°tibial tray over an 11-year period. Twenty-five knees (1.9%) were revised for tibial debonding. BMI and radiographic alignment in the tibial debonding group were compared with a matched control group. Implant survivorship was assessed using tibial debonding as the end point. Results Survival free of revision from tibial debonding was 100% at 1 year and 97.8% at 5 years. The tibial failures shared a typical radiographic pattern with debonding at the cement-implant interface and subsidence into varus and flexion. We found no link between limb alignment or individual component alignment and failure because 22 of the 25 failures occurred in well-aligned knees. Conclusions Our standardized followup of patients undergoing TKA at routine intervals allowed us to discover a higher rate of revision resulting from tibial debonding. We have discontinued the use of this particular tibial tray for primary TKA and surveillance for patients undergoing TKA continues to be warranted. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…It is thought that a mechanical axis within a range of AE3 varus/valgus is associated with a better long-term outcome [32]. Studies have demonstrated that the post-operative coronal femoro-tibial mechanical angle achieved using navigation systems is significantly better than that obtained using conventional techniques.…”

Section: Alignmentmentioning

confidence: 99%

Computer navigated total knee arthroplasty: The learning curve

Smith

Deakin

Baines

et al. 2010

Computer Aided Surgery

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The learning curve for computer navigated total knee arthroplasty (TKA) is not well defined. We collected data prospectively on a consultant surgeon's first 50 navigated TKAs. Over the same period, matching data was taken from 50 consecutive cases performed by an expert who has performed over 1000 navigated TKAs. From the first case, the novice navigator was able to achieve the same standard as the expert in terms of post-implant mechanical alignment in the coronal and sagittal planes. Equally, at 6 weeks and one year post-surgery there was no significant difference in the mean Oxford score, mechanical axis and range of movement for the two groups of patients. Operative time was significantly longer for the novice surgeon in the first 20 cases (92 versus 73 min, p < 0.001), but by the final 20 cases there was no difference (72 versus 74 min, p ¼ 0.944). This study shows that the learning curve for navigated TKA is approximately 20 cases and that a beginner can reproduce the results of an expert from the outset.

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Radiographic assessment of knee alignment after total knee arthroplasty

Cited by 260 publications

References 9 publications

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

Aseptic Tibial Debonding as a Cause of Early Failure in a Modern Total Knee Arthroplasty Design

Computer navigated total knee arthroplasty: The learning curve

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