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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2013 | Knee

Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty?

Authors: Dae Kyung Bae, Sang Jun Song, Dong Beom Heo, Dae Hyun Tak

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2013

Abstract

Purpose

The postoperative alignment was compared according to the severity of preoperative varus deformity in computer-assisted and conventional total knee arthroplasty (CAS-TKA).

Methods

The study reviewed 127 consecutive CAS-TKA and 236 conventional TKA, retrospectively. In CAS-TKA, 77 knees with a varus deformity ≤15.0° were classified in group CAS-A and 50 knees with a varus deformity >15.0° were classified in group CAS-B. In conventional groups, 204 knees with a varus deformity ≤15.0 were classified in group Conventional-A and 32 knees with a varus deformity >15.0° were classified in group Conventional-B. The postoperative mechanical axis (MA) was compared among groups CAS-A, CAS-B, Conventional-A and Conventional-B.

Results

The average postoperative MA was 0.7° varus in group CAS-A, 2.8° varus in group CAS-B, 1.1° varus in group Conventional-A and 3.2° varus in group Conventional-B (p < 0.001). The postoperative MA was within 3° in 81.8, 62.0, 58.8 and 37.5 % of group CAS-A, CAS-B, Conventional-A and Conventional-B, respectively.

Conclusions

The severity of preoperative varus deformity influences postoperative alignment despite using CAS. More careful correction of the alignment is required, especially in TKA performed on patients with a greater varus deformity.

Level of evidence

III.

Ajwani SH, Jones M, Jarratt JW, Shepard GJ, Ryan WG (2012) Computer assisted versus conventional total knee replacement: a comparison of tourniquet time, blood loss and length of stay. Knee 19:606–610PubMedCrossRef

Bae DK, Song SJ, Yoon KH, Shin SM (2010) The position of the tibial component affecting the postoperative mechanical axis in total knee arthroplasty. J Arthroplast 25:1131–1136CrossRef

Catani F, Digennaro V, Ensini A, Leardini A, Giannini S (2012) Navigation-assisted total knee arthroplasty in knees with osteoarthritis due to extra-articular deformity. Knee Surg Sports Traumatol Arthrosc 20:546–551PubMedCrossRef

Chung BJ, Dileep I, Chang CB, Kang YG, Park YB, Kim TK (2010) Novel approach to reducing discrepancies in radiographic and navigational limb alignments in computer-assisted TKA. Orthopedics 33:62–67PubMedCrossRef

Ewald FC (1989) The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 248:9–12PubMed

Green WT, Wyatt GM, Anderson M (1946) Orthoroentgenography as a method of measuring the bones of the lower extremities. J Bone Joint Surg Am 28:60–65PubMed

Guenoun B, Zadegan F, Aim F, Hannouche D, Nizard R (2012) Reliability of a new method for lower-extremity measurements based on stereoradiographic three-dimensional reconstruction. Orthop Traumatol Surg Res 98:506–513PubMedCrossRef

Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159PubMedCrossRef

Hauschild O, Konstantinidis L, Baumann T, Niemeyer P, Suedkamp NP, Helwig P (2010) Correlation of radiographic and navigated measurements of TKA limb alignment: a matter of time? Knee Surg Sports Traumatol Arthrosc 18:1317–1322PubMedCrossRef

10.

Hernandez-Vaquero D, Suarez-Vazquez A, Sandoval-Garcia MA, Noriega-Fernandez A (2010) Computer assistance increases precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res 468:1237–1241PubMedCrossRef

11.

Hsu WH, Hsu RW, Weng YJ (2010) Effect of preoperative deformity on postoperative leg axis in total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 18:1323–1327PubMedCrossRef

12.

Huang TW, Hsu WH, Peng KT, Hsu RW, Weng YJ, Shen WJ (2011) Total knee arthroplasty with use of computer-assisted navigation compared with conventional guiding systems in the same patient: radiographic results in Asian patients. J Bone Joint Surg Am 93:1197–1202PubMedCrossRef

13.

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed

14.

Ishida K, Matsumoto T, Tsumura N, Kubo S, Kitagawa A, Chin T, Iguchi T, Kurosaka M, Kuroda R Mid-term outcomes of computer-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1107–1112

15.

Kamat YD, Aurakzai KM, Adhikari AR, Matthews D, Kalairajah Y, Field RE (2009) Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up? Int Orthop 33:1567–1570PubMedCrossRef

16.

Laskin RS, Beksac B (2006) Computer-assisted navigation in TKA: where we are and where we are going. Clin Orthop Relat Res 452:127–131PubMedCrossRef

17.

Lazennec JY, Rousseau MA, Rangel A, Gorin M, Belicourt C, Brusson A, Catonne Y (2011) Pelvis and total hip arthroplasty acetabular component orientations in sitting and standing positions: measurements reproducibility with EOS imaging system versus conventional radiographies. Orthop Traumatol Surg Res 97:373–380PubMedCrossRef

18.

Lee BS, Lee SJ, Kim JM, Lee DH, Cha EJ, Bin SI (2011) No impact of severe varus deformity on clinical outcome after posterior stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:960–966PubMedCrossRef

19.

Luring C, Kauper M, Bathis H, Perlick L, Beckmann J, Grifka J, Tingart M, Rath B (2012) A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters. Int Orthop 36:553–558PubMedCrossRef

20.

Macule-Beneyto F, Hernandez-Vaquero D, Segur-Vilalta JM, Colomina-Rodriguez R, Hinarejos-Gomez P, Garcia-Forcada I, Seral-Garcia B (2006) Navigation in total knee arthroplasty. A multicent study. Int Orthop 30:536–540CrossRef

21.

Matsuda S, Mizu-uchi H, Miura H, Nagamine R, Urabe K, Iwamoto Y (2003) Tibial shaft axis does not always serve as a correct coronal landmark in total knee arthroplasty for varus knees. J Arthroplast 18:56–62CrossRef

22.

Molfetta L, Caldo D (2008) Computer navigation versus conventional implantation for varus knee total arthroplasty: a case-control study at 5 years follow-up. Knee 15:75–79PubMedCrossRef

23.

Mullaji A, Kanna R, Marawar S, Kohli A, Sharma A (2007) Comparison of limb and component alignment using computer-assisted navigation versus image intensifier-guided conventional total knee arthroplasty: a prospective, randomized, single-surgeon study of 467 knees. J Arthroplast 22:953–959CrossRef

24.

Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92:2143–2149PubMedCrossRef

25.

Picard F, Deakin AH, Clarke JV, Dillon JM, Gregori A (2007) Using navigation intraoperative measurements narrows range of outcomes in TKA. Clin Orthop Relat Res 463:50–57PubMed

26.

Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2007) Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load. Am J Sports Med 35:65–70PubMedCrossRef

27.

Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ (2007) Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 89:477–480PubMed

28.

Takasaki M, Matsuda S, Fukagawa S, Mitsuyasu H, Miura H, Iwamoto Y (2010) Accuracy of image-free navigation for severely deformed knees. Knee Surg Sports Traumatol Arthrosc 18:763–768PubMedCrossRef

29.

Teeny SM, Krackow KA, Hungerford DS, Jones M (1991) Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res 273:19–31PubMed

30.

Uslu MM, Ozsar B, Cirpar M, Kara S, Eksioglu F, Cetik O (2007) Computerized tomography scout view for determining distal femoral resection angle in intramedullary instrumentation of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 15:78–82PubMedCrossRef

31.

Yaffe MA, Koo SS, Stulberg SD (2008) Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 466:2736–2744PubMedCrossRef

32.

Yau WP, Chiu KY, Tang WM, Ng TP (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong) 15:32–36

33.

Yau WP, Chiu KY, Zuo JL, Tang WM, Ng TP (2008) Computer navigation did not improve alignment in a lower-volume total knee practice. Clin Orthop Relat Res 466:935–945PubMedCrossRef

Title: Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty?
Authors: Dae Kyung Bae
Sang Jun Song
Dong Beom Heo
Dae Hyun Tak
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2263-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty?

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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