Two-dimensional measurement misidentifies alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements

Ueyama, Hideki; Minoda, Yukihide; Sugama, Ryo; Ohta, Yoshiji; Yamamura, Kazumasa; Nakamura, Suguru; Takemura, Susumu; Nakamura, Hiroaki

doi:10.1007/s00167-018-5175-0

Cited by 30 publications

(31 citation statements)

References 27 publications

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“…The medial and lateral joint surfaces of the knee joint were also used for the tibia. The present study showed that 3DCT measurement had excellent intra-and interclass reliability [14,15,18,29].…”

Section: Tablesupporting

confidence: 57%

“…The postoperative femorotibial angle (FTA) was also measured as the leg axis between the anatomical axis of the femur and tibia in the coronal plane defined by the coordinate systems. The postoperative 3DCT images of the femur and tibia were superimposed onto those of the preoperative 3DCT plan using ZedView software (Figure 3) [14,15,18,19].…”

Section: Pre-and Postoperative Three-dimensional Computed Tomography Imagesmentioning

confidence: 99%

“…1) Outliers for FTA and prosthetic alignment were defined as an alignment error greater than ± 3°from baseline [14,15] (goal alignment: FTA: 176°). 2) The absolute values in the prosthetic alignment between postoperative 3DCT image and goal alignment were measured using six parameters: coronal, sagittal, and axial alignment of the femoral and tibial prostheses.…”

Section: Pre-and Postoperative Three-dimensional Computed Tomography Imagesmentioning

confidence: 99%

“…The goal alignments were as follows: femoral component-coronal 96°, sagittal 3°flexion from the femoral anterior surface [20], axial 3°external rotation from the posterior condyle axis; tibial component-coronal 90°, sagittal 85°in a tibial posterior tilt, axial 0°in parallel of anteroposterior (AP) axis [16]. 3) Cases where the prosthetic alignment difference between the preoperative 3DCT plan and postoperative 3DCT image was greater than 3°were defined as outliers [14,15,21]. The degrees of component alignment were measured to two decimal places with the software.…”

Section: Pre-and Postoperative Three-dimensional Computed Tomography Imagesmentioning

confidence: 99%

“…These reports demonstrate the accuracy of robotic-assisted procedure using two-dimensional (2D) radiographic measurements. Moreover, previous reports show that three-dimensional computed tomography (3DCT) measurements are more reliable for the investigation of prosthetic alignment after TKA [10][11][12][13][14][15]. Hence, it is suggested that the use of 3DCT is preferred over 2D radiographic measurement to evaluate the true accuracy of a robotic-assisted technique to analyze pre-and postoperative images.…”

Section: Introductionmentioning

confidence: 99%

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Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

et al. 2021

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Background:The aim of the present study was to compare the accuracy of prosthetic alignment with three-dimensional computed tomography (3DCT) measurements following total knee arthroplasty (TKA) performed using a robotic-assisted surgical technique versus a conventional TKA. Methods: 41 TKAs were performed with a handheld robotic-assisted surgical procedure (Robot group) between 2019 and 2020. Another 41 patients underwent TKA with a conventional manual surgical procedure (Manual group) using the same prosthesis. The operation durations between both groups were investigated. 3DCT scans of the entire lower extremities were taken before and after the surgery and femoral and tibial alignments in the coronal, sagittal, and axial planes were measured using computer software. The differences in prosthetic alignment and translation between the preoperative 3DCT plan and postoperative 3DCT image were also measured. Results: There were no statistically significant differences in the post-operative outliers of the femorotibial angle between the groups. In the tibial-axial plane, the mean of prosthetic alignment in the anteroposterior plane was 4.0°in the Robot group and 6.7°in the Manual group (p < 0.01). The rate of outliers for tibial-axial alignment in the Robot group was significantly less than in the Manual group (p < 0.01). There were no statistically significant differences in prosthetic translation in the proximal-distal, anterior-posterior and medial-lateral orientations between the groups. Conclusions: In a radiologic study using 3DCT, robotic-assisted TKA reduced the outliers for rotational alignment of the tibial prosthesis in comparison to conventional TKA, which can lead to improved tracking of the femoral-tibial bearing surfaces.

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Section: Tablesupporting

confidence: 57%

Section: Pre-and Postoperative Three-dimensional Computed Tomography Imagesmentioning

confidence: 99%

Section: Pre-and Postoperative Three-dimensional Computed Tomography Imagesmentioning

confidence: 99%

Section: Pre-and Postoperative Three-dimensional Computed Tomography Imagesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

et al. 2021

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Large multiplanar changes to native alignment have no apparent impact on clinical outcomes following total knee arthroplasty

Tarassoli,

Warnock,

Lim

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study sought to examine if achieved postoperative alignment when compared to the native anatomy would lead to a difference in Patient Reported Outcome Measures (PROMs), and whether the achieved alignment could be broadly categorised by an accepted alignment strategy.MethodsA retrospective cohort study of prospectively collected data on patients undergoing single primary or bilateral simultaneous total knee arthroplasty (TKA) was carried out. CT scans were used to determine the mean change (“delta values”) between the pre and postoperative; hip‐knee‐ankle angle, lateral distal femoral angle, medial proximal tibial angle and femoral implant rotation. Femoral implant flexion and tibial implant slope were measured postoperatively. The primary outcome was the relationship of the variables to the change in KOOS pain subscale after one year. The secondary outcome was the number of knees which could be categorised postoperatively to an alignment strategy, and the mean PROMs in each cohort.ResultsA total of 296 knees in 261 patients were available for analysis. With regards to the primary outcome, the delta values for each variable did not demonstrate any association with the change in knee injury and osteoarthritis outcome score (KOOS) pain score. Approximately 46% of knees could not be categorised to an alignment strategy based on postoperatively measured alignment, with no significant difference between each cohort with regards to the change in KOOS Pain score.ConclusionAchieved alignment does not consistently match accepted alignment strategies, and appears to confer no benefit to clinical outcomes when the native anatomy is most closely approximated, nor results in poorer outcomes in outliers. This study highlights the importance of routine three dimensional pre and postoperative imaging in clinical practice and for the valid analysis of outcomes in studies on alignment.Level of EvidenceLevel III, retrospective cohort study.

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Two‐ and three‐dimensional measurements following robotic‐assisted total knee arthroplasty

Hasegawa

Tone

Naito

et al. 2022

Robotics Computer Surgery

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Background The purpose of this study was to compare component alignment using two‐dimensional (2D) and three‐dimensional (3D) measurements following total knee arthroplasty (TKA) with a new robotic system. Methods A total of 38 patients underwent TKA with the robotic system. Cutting errors were measured. Errors in 2D and 3D component alignments from the planned angle, validated cutting angle, and validated implantation angle were calculated. These errors were compared with 2D and 3D measurements. Results Cutting errors were below 0.6°, except for femoral sagittal angle (1.0°). Errors in component alignment from the planned and cutting angles were significantly higher in 3D measurements than that in 2D measurements, in the femoral coronal and sagittal planes and tibial coronal planes. Errors in component alignments from implantation showed no differences between the measurements. Conclusion The accuracies of component alignment from the planned and cutting angles were better in 3D measurements.

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Two-dimensional measurement misidentifies alignment outliers in total knee arthroplasty: a comparison of two- and three-dimensional measurements

Cited by 30 publications

References 27 publications

Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

Large multiplanar changes to native alignment have no apparent impact on clinical outcomes following total knee arthroplasty

Two‐ and three‐dimensional measurements following robotic‐assisted total knee arthroplasty

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