Standing radiographs underestimate joint widthComparison before and after resection of the joint in 34 total knee arthroplasties

Weidow, Jonas; Mars, Ingvar; Cederlund, Claes–Göran; Kärrholm, Johan

doi:10.1080/00016470410001259

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…This result appears to be comparable to the results of some studies using the conventional technique ( Bathis et al 2004 , Perlick et al 2004 , Yau et al 2008 , Ng et al 2012 ), using CAS ( Kim et al 2007 , Yau et al 2008 ), and using PSPGs (only 1 study) ( Nam et al 2013 ). However, several studies using CAS ( Bathis et al 2004 , Perlick et al 2004 , Nam et al 2013 ) and PSPGs ( Ng et al 2012 , Daniilidis and Tibesku 2014 , Macdessi et al 2014 ) have reported fewer outliers. The preoperative MRI planning does not take into account soft tissue balancing, and some of the malalignments of the HKA angle might be explained by improper soft tissue balancing.…”

Section: Discussionsupporting

confidence: 86%

Comparison of planned and achieved implant position in total knee arthroplasty with patient-specific positioning guides

et al. 2014

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Background and purpose Intraoperatively, patient-specific positioning guides (PSPGs) represent the preoperatively planned alignment. We investigated the degree of correlation between preoperative planning and the alignment achieved postoperatively with the PSPG technique.Patients and methods TKAs performed with the PSPG technique between 2009 and 2011 were included. 39 patients (42 TKAs) volunteered for a postoperative CT scan. 2 independent observers performed the postoperative CT measurements. Preoperative component angles (target angles) in the coronal and axial planes were defined as 0 degrees, and in the sagittal plane on average 2.8 degrees for the femoral component and 3 degrees for the tibial component. A postoperative full-length standing anteroposterior radiograph was carried out in 41 TKAs.Results The femoral component was on average 1.2 (SD 1.5) degrees in varus, 4.4 (SD 4.0) degrees in flexion, and 0.5 (SD 1.4) degrees in external rotation. The tibial component was on average 0.4 (SD 2.5) degrees in varus and 3.7 (SD 2.3) degrees in flexion. A statistically significant difference between the target (preoperative software plan) and postoperative CT measurement was found for the femoral component angle in the frontal plane (p < 0.001; CI: 0.8–1.7), the sagittal plane (p = 0.01; CI –5.6 to –3.1), and the axial plane (p = 0.03; CI: 0.04–0.88). HKA angles were greater than 3 degrees from the neutral axis in 10 of the 41 cases.Interpretation We found our postoperative component alignment angles to be close to the software plan, especially for the tibial component. However, we found outliers in all planes and we cannot therefore conclude that the PSPG technique is a method that reproduces preoperatively planned alignment in a consistent manner.

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Section: Discussionsupporting

confidence: 86%

Comparison of planned and achieved implant position in total knee arthroplasty with patient-specific positioning guides

et al. 2014

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“…Perlick et al 20) inserted the femoral component in slight flexion of 2° to the anterior femoral cortex to avoid notching during navigated TKA. A preoperative radiological evaluation is essential.…”

Section: Discussionmentioning

confidence: 99%

“…The femoral cut should be modified during navigated TKA if remarkable anterior femoral bowing is detected. 20) …”

Section: Discussionmentioning

confidence: 99%

Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

Lee

Wang

2015

Clin Orthop Surg

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BackgroundWe retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system.MethodsWe retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups.ResultsThe prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups.ConclusionsSurgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed.

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“…Buckland-Wright et al found in an arthrography-based study of knees with OA that JSW accurately estimated cartilage thickness in the medial but not in the lateral compartment [9]. In another study, knees obtained at joint replacement surgery for OA were compared with estimations of JSW by pre-surgical standing knee radiographs and significant differences between the radiologic measurement and surgical specimen measurement were observed in both medial and lateral arthrosis; however, lateral JSW measurements had a greater amount of variation of JSW by radiograph than did medial [10, 11]. There is also an acknowledged difference in the angle of the tibial plateau between medial and lateral compartments [12] which thus may make JSW estimates in the lateral compartment less accurate when read in radiographs optimized for assessment of the medial compartment.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging lesions are more severe and cartilage T2 relaxation time measurements are higher in isolated lateral compartment radiographic knee osteoarthritis than in isolated medial compartment disease – data from the Osteoarthritis Initiative

Niu

Guermazi

Liu

et al. 2017

Osteoarthritis and Cartilage

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Objective-Isolated lateral compartment tibiofemoral radiographic osteoarthritis (IL-ROA) is an understudied form of knee osteoarthritis. The objective of the present study was to characterize MRI abnormalities and MR-T2 relaxation time measurements associated with IL-ROA and with isolated medial compartment ROA (IM-ROA) compared with knees without OA.Method-200 case subjects with IL-ROA (Kellgren/Lawrence (K/L) grade≥2 and joint space narrowing (JSN)>0 in the lateral compartment but JSN=0 in the medial compartment) were randomly selected from the Osteoarthritis Initiative baseline visit. 200 cases with IM-ROA and 200 controls were frequency matched to the IL-ROA cases. Cases and controls were analyzed for odds of having a subregion with >10% cartilage area affected, with ≥25% bone marrow lesions (BML), with meniscal tear or maceration, and for association with cartilage T2 values.Results-IL-ROA was more strongly associated with ipsilateral MRI knee pathologies than IM-ROA (IL-ROA: OR=135.2 for size of cartilage lesion, 95%CI 42.7-427.4; OR= 145.4 for large size bone marrow lesions (BML), 95%CI 41.5-509.5; OR =176 for meniscal tears, 95%CI 59.8-517.7; IM-ROA: OR=28.4 for size of cartilage lesion, 95%CI 14.7-54.7; OR= 38.1 for size of BML, 95%CI 12.7-114; OR =37.0 for meniscal tears, 95%CI 12-113.6). Cartilage T2 values were higher in both tibial and medial femoral compartments in IL-ROA, but in IM-ROA were only significantly different from controls in the medial femur.Conclusion-IL-ROA knees show a greater prevalence and severity of MRI lesions and higher cartilage T2 values than IM-ROA knees compared with controls.

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Standing radiographs underestimate joint widthComparison before and after resection of the joint in 34 total knee arthroplasties

Cited by 5 publications

References 15 publications

Comparison of planned and achieved implant position in total knee arthroplasty with patient-specific positioning guides

Comparison of planned and achieved implant position in total knee arthroplasty with patient-specific positioning guides

Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

Magnetic resonance imaging lesions are more severe and cartilage T2 relaxation time measurements are higher in isolated lateral compartment radiographic knee osteoarthritis than in isolated medial compartment disease – data from the Osteoarthritis Initiative

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