The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty

Abstract

This study examines the association between postoperative coronal tibiofemoral alignment and revision surgery in knee arthroplasty. We retrospectively reviewed the case notes and post-operative long-leg radiographs of 197 Kinemax knee arthroplasty with mean follow-up of 9 years (SD 2.2). They were divided into three groups: neutral, valgus and varus. Revision or decision to revise was used as a hard endpoint. There was no statistical difference among the three groups (p=0.78). We conclude that aseptic failure of a total knee is multifactorial. Coronal tibio-femoral alignment may not be as important a cause of failure as has been previously thought.Résumé Cette étude a pour but d'examiner l'alignement des éléments prothétiques dans la chirurgie de reprise de prothèse totale du genou. Nous avons de façon rétrospec-tive revu en 1997 une série de prothèses de type Kinemax avec un suivi moyen de 9 ans (SD 2.2). La population a été divisée en trois groupes : Neutre, Valgus et Varus. Pour les courbes de survie ont été utilisées comme référence la révision ou la décision de révision. Nous pouvons conclure que le descellement aseptique d'une prothèse totale du genou est multi factorielle. L'alignement tibio fémoral n'est pas une cause importante d'échec comme l'on pouvait le penser auparavant.

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

“…Furthermore, patients with less than good images were excluded. Finally, the clinical value of navigation technology for TKA and whether outliers in the coronal plane are in fact associated with compromised longevity are topics of debate [4,9,14,21,27,32,33], but we convey no information regarding the longevity of prostheses.…”

“…It is well known that the accuracy of femoral bone resection using an intramedullary guiding system can be compromised by femoral anatomical variations and that this could result in incomplete intramedullary rod insertion and subsequently erroneous distal femur resection [25,31,40]. Previous Western [11] and Asian [13,27] authors have also reported that knees with a varus deformity are subject to postoperative varus malalignment. One technical tip that the senior author (TKK) has used is to assure that the cutting block for distal femur resection makes contact with bone as anticipated based on an assessment of femoral condylar orientation.…”

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

“…Additionally, we did not find an association between residual varus alignment and implant revision. Although two recent studies found little correlation between limb alignment and revision rates [21,22], the majority of studies showed increased revision rates with malalignment, particularly in varus [3,8,12,15,23,27] ( Table 4). Several factors likely contribute to the different findings in our study.…”

“…Some authors suggest that despite these efforts, knees with substantial preoperative varus alignment are more likely to have varus alignment postoperatively [9,15]. Additionally, some recent studies have cast doubt on the long-held belief that neutral alignment yields lower revision rates in all patients [21,22].…”

Does Minimally Invasive Surgery Improve Short-term Recovery in Total Knee Arthroplasty?

“…A TKA alleviates pain, restores joint function, and allows patients with severe arthritis to return to varied activities of daily living [29,33,35,49]. However, prolonged postoperative pain and delayed return of function that may contribute to patient dissatisfaction or lengthy recuperative periods are the major concerns with the standard surgical approaches [20].…”