Variability in the Relationship Between the Distal Femoral Mechanical and Anatomical Axes in Patients Undergoing Primary Total Knee Arthroplasty

Nam, Denis; Maher, Patrick; Robles, Alex; McLawhorn, Alexander S.; Mayman, David J.

doi:10.1016/j.arth.2012.09.016

Cited by 38 publications

(39 citation statements)

References 7 publications

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“…The KneeAlign 2 (KA2; OrthAlign Inc., Aliso Viejo, CA) was developed to aid in the distal femoral resection. One study has demonstrated that KA2 is at least as accurate as a largeconsole, imageless CAS system in achieving neutral mechanical axis, and tibial and femoral component alignment, and is associated with a significant reduction in tourniquet time [28].…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, many surgeons target neutral (0°) overall mechanical alignment in the coronal plane [1]. Conventional intramedullary and extramedullary cutting guides do not reliably achieve this goal [23,28]. Recent meta-analyses have shown that computer-assisted surgical (CAS) techniques result in more reliable control of mechanical axis alignment in TKA [6,22], although there are few studies comparing specific CAS techniques [18,30].…”

Section: Introductionmentioning

confidence: 99%

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Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Steinhaus

McLawhorn

Richardson

et al. 2016

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. Questions/Purposes: The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). Methods: After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests. Results: Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1°of neutral for both groups, although statistically different (p = 0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) (p = 0.004); PSI resulted in significantly more outliers (>6°; p = 0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p = 0.023). Conclusion: NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patientreported outcomes and TKA survivorship is controversial and should be the focus of future research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Steinhaus

McLawhorn

Richardson

et al. 2016

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

Self Cite

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“…[21] It is known that the angle between the femoral mechanical axis and anatomical axis is highly variable and affected by the patient's age, gender, body height, neck-shaft angle, and femoral offset. [15,28,29] However, we are aware of little data reported on the preoperative demographic and radiographic variables specific for ethnic Asians in the literature. The aim of this study was to determine the variability of the distal femoral valgus resection angle in ethnic Asians patients with end-stage osteoarthritis and genu varum deformity.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Variability of distal femoral valgus resection angle in patients with end-stage osteoarthritis and genu varum deformity: Radiographic study in an ethnic Asian population

Lee¹,

Huang²,

Peng³

et al. 2015

Biomed J

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Background: When performing a total knee arthroplasty, most surgeons use the intramedullary alignment guide with a fixed distal femoral valgus resection angle. In this study, we assessed the variability of the distal femoral valgus resection angle in ethnic Asian patients by reviewing our arthroplasty database. Methods:Between January 2004 and December 2012, the patients with end-stage osteoarthritis with genu varum deformity who underwent total knee arthroplasty were enrolled in this retrospective review. Clinical and radiographic data were collected and analyzed. Results:Nine hundred and fifty-two knees met the inclusion criteria. Three hundred and four (31.9%) knees had a distal femoral valgus resection angle value outside the range of 5° ±2° (range, 4°-14°). There were significant differences in the mean distal femoral valgus resection angle between males and females (p < 0.001) and between non-bowed femur and bowed femur (p < 0.001) cohorts. With regard to the correlation coefficients between the distal femoral valgus resection angle and the usual radiographic measurements, only the coronal femoral bowing angle demonstrated a good correlation (r = 0.72). Conclusions: 32% of Asian patients present with a distal femoral valgus resection angle that is outside the range of 5° ±2°. Taking a long-leg weight-bearing split scanogram may provide information that allows the surgeon to determine the true distal femoral valgus resection angle and adjust the cut accordingly. Level ofTherapeutic level III. Evidence: (Biomed J 2015;38:350-355)

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“…Full-length radiographs are useful for understanding and correcting failure, especially in cases of wear, loosening, and coronal plane instability. Curved femurs [9], asymmetric tibiae, and even femoral neck offset all contribute to how a knee may be loaded. Deformity is not so much a problem of the knee joint, as of the entire lower limb.…”

Section: Introductionmentioning

confidence: 98%

Correction of deformity—The implant is never enough!

Vince

2014

Seminars in Arthroplasty

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Variability in the Relationship Between the Distal Femoral Mechanical and Anatomical Axes in Patients Undergoing Primary Total Knee Arthroplasty

Cited by 38 publications

References 7 publications

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: A Retrospective Matched Cohort Study

Variability of distal femoral valgus resection angle in patients with end-stage osteoarthritis and genu varum deformity: Radiographic study in an ethnic Asian population

Correction of deformity—The implant is never enough!

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