Under-correction of preoperative varus alignment does not lead to a difference in in-vivo bone loading in 3D-SPECT/CT compared to neutral alignment

Zimmermann, Moritz; Moser, Lukas B.; Moret, C.; Iordache, Edna; Amsler, Felix; Rasch, Helmut; Hügli, Rolf; Hirschmann, Michael T.

doi:10.1016/j.knee.2022.01.005

Cited by 3 publications

(1 citation statement)

References 56 publications

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“…Howell et al and others, however, could demonstrate that these factors do not correlate clinically and midterm survival is not negatively influenced [14, 31]. Recent investigation could prove, that under correction of varus alignment does not significantly change bone‐loads [37].…”

Section: Discussionmentioning

confidence: 99%

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Graichen

Luderer

Strauch

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modiication of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and ( 2) in what percentage non-anatomical cuts are needed to achieve these goals. Methods Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle < 178°; n = 680) were included. All surgeries were performed as computer assisted surgery (CAS) in AMA technique. CAS data at the end of surgery were analysed with respect to HKA and gap-sizes. All bone cuts were quantiied. Depending on the amount of deformity, a subgroup analysis was performed. It was analysed whether the amount of deformity inluences the non-anatomical cuts by correlation analysis. Results AMA reached the goals for postoperative HKA (3° corridor) in 636 cases (93.5%). While extension and lexion gap balance were achieved in more than 653 cases (96%), lexion and extension gap size were equalled in 615 knees (90.4%). The resections of the lateral tibia plateau and distal and posterior medial femoral condyle were anatomical (Tibia: 7.0 ± 1.7 mm; medial condyle distal: 7.8 ± 1.4 mm; medial posterior: 8.2 ± 1.8 mm). The number of non-anatomical resections for those cuts were low; 67 (9.9%); 24 (3.5%); 32 (4.7%). For the medial tibia plateau and the lateral posterior condyle, the cuts were non-anatomical in a high percentage of cases; Tibia: 606 (89.1%), lateral posterior condyle: 398 (58.5%). Moderate but signiicant correlations were found between resection diferences and amount of deformity (medio-lateral: tibia: 0.399; distal femur: 0.310; posterior femur: 0.167). No correlations were found between resection diferences and gap values. Conclusion AMA reaches the intended target for HKA and gap balance in over 612 (90%) of cases and maintains the medial femoral condyle anatomically. Non-anatomical tibial resection causes increased external rotation of the femoral component and by that non-anatomical cut of the posterior lateral condyle. Nonanatomical resections of AMA might be one reason for the persisting high rate of unsatisied patients after TKA. Anatomical and individual alignment philosophies might help to reduce this rate of dissatisfaction.

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Section: Discussionmentioning

confidence: 99%

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Graichen

Luderer

Strauch

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Tibia‐first, gap‐balanced patient‐specific alignment technique achieves well‐balanced gaps in 90% of cases by rebuilding bony anatomy within boundaries

Strauch,

Kaufmann,

Graichen

2024

Knee surg. sports traumatol. arthrosc.

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PurposePatient‐specific alignment (PSA) technique tries to achieve balanced gaps and simultaneously rebuild the individual bony phenotype. The hypothesis was: PSA technique achieves balanced knees in a high percentage with more anatomical resections than adjusted mechanical alignment (AMA).MethodsThree hundred sixty‐seven patients underwent navigated total knee arthroplasty (TKA) with a tibia‐first gap‐balanced PSA technique. Resection boundaries for medial proximal tibia angle (MPTA) of 86–92°, mechanical lateral distal femoral angle (mLDFA) of 86–92°, and hip‐knee‐ankle angle (HKA) of 175–185° were defined. Preoperative and intraoperative parameters of HKA, MPTA, mLDFA, and gap widths were recorded. Depending on the coronal deformity, the patients were divided into three groups: varus HKA < 178°; straight 178–182° and valgus HKA > 182°. The stability was analysed by assessing the difference between medial and lateral extension and flexion gaps as well as between flexion and extension gaps. All PSA measurements were compared with data from a previously published AMA series.ResultsPSA achieved balanced gaps in extension, flexion and between flexion/extension in over 90% of cases, being similar to AMA. In PSA, MPTA and mLDFA were restored within 1°, except in extreme varus (MPTA difference 2°) and valgus knees (mLDFA difference 3°). This was caused by the defined boundaries of the alignment technique. This individualised reconstruction led to significantly more anatomical resections of all tibia and femur resections.ConclusionA tibia‐first, gap‐balanced PSA technique achieves balanced joints in more than 90% of cases. By maintaining preoperative MPTA and mLDFA to a high extent, far more anatomical resections, compared to AMA were performed. Future studies need to be conducted to investigate whether those promising intraoperative results correlate with postoperative patient outcomes and whether patients outside the 5° corridor have higher failure rates.Level of EvidenceLevel III, retrospective cohort study.

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Fixation options for total knee arthroplasty: a comprehensive literature review

Moya-Angeler,

Akkaya,

Innocenti

et al. 2024

J Orthop Surg Res

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Total knee arthroplasty is a consistently successful, cost-efficient, and highly effective surgical procedure for treating severe knee osteoarthritis. The success and longevity of total knee arthroplasty depend significantly on the fixation method used to secure the prosthetic components. This comprehensive review examines the primary fixation methods (cemented, cementless, and hybrid fixation), analysing their biomechanics, clinical outcomes, advantages, and disadvantages, focusing on recent advances and trends in total knee arthroplasty fixation.

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Under-correction of preoperative varus alignment does not lead to a difference in in-vivo bone loading in 3D-SPECT/CT compared to neutral alignment

Cited by 3 publications

References 56 publications

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Tibia‐first, gap‐balanced patient‐specific alignment technique achieves well‐balanced gaps in 90% of cases by rebuilding bony anatomy within boundaries

Fixation options for total knee arthroplasty: a comprehensive literature review

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