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Preoperative Planning

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Deformity Correction in Total Knee Arthroplasty

Abstract

Preoperative planning is paramount before undertaking any surgical procedure. This cannot be overemphasised for a procedure like total knee arthroplasty (TKA) where the goals include accurate restoration of limb alignment, optimum soft-tissue balancing and achieving a satisfactory range of motion (ROM). The use of computer navigation during TKA does not diminish the role of preoperative planning. The first important step in preoperative planning is proper selection of the patient and a thorough physical examination. This step gives important clues regarding patient complaints and disability and the expectation which a patient may have from the procedure. Physical examination may reveal clues as to what to expect during surgery in terms of pathoanatomic changes in the arthritic joint and how to be plan for it during surgery. Imaging using plain radiographs helps in confirming the extent of knee arthritis and severity of deformity and is useful for planning the procedure. This chapter elaborates on physical examination and imaging for a patient who is to undergo TKA.

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Author information

Authors and Affiliations

  1. Consultant Joint Replacement Surgeon Department of Orthopaedic Surgery, Breach Candy Hospital, Mumbai, Maharashtra, India

    Arun B. Mullaji FRCS Ed, MCh Orth, MS Orth

  2. Consultant Arthritis Care and Joint Replacement Surgery, Asian Orthopedic Institute Asian Heart Institute and Research Center, Mumbai, Maharashtra, India

    Gautam M. Shetty MS Orth

Authors
  1. Arun B. Mullaji FRCS Ed, MCh Orth, MS Orth
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  2. Gautam M. Shetty MS Orth
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Appendices

Appendix 1

figure a

Appendix 2

figure b

Glossary

Coronal component malalignment 

Components outside the acceptable ±3° range from a neutral alignment of 90° in the coronal and sagittal plane.

Coronal limb malalignment 

Postoperative HKA angle outside the acceptable ±3° range from a neutral alignment of 180°.

Femoral anatomic axis 

Mid-diaphyseal line of the femur passing proximally from the piriformis fossa just medial to the greater trochanter distally just medial to the intercondylar notch of the femur.

Femoral mechanical axis 

Line passing from the centre of the femoral head to the apex of the intercondylar notch on the femoral articular surface.

Femorotibial angle (FTA) 

Medial angle formed by the distal femoral anatomic axis and the proximal tibial anatomic axis.

Hip-knee-ankle (HKA) angle 

Medial angle formed by the mechanical axis of the femur and the tibia and denotes the coronal alignment of the limb.

Joint divergence angle (JDA) 

Angle formed by the proposed distal femoral cut and proximal tibial cut each drawn perpendicular to their respective mechanical axes. This generally equals the HKA angle.

Joint line 

This is the distance between the tip of the fibula and the tangent drawn to the distal end of the femoral condyles on lateral radiographs.

Mechanical axis of the limb 

Line passing from the centre of the femoral head and the centre of the ankle plafond.

Patellar height 

This is the distance between the distal tip of the patellar component and the tangent drawn to the distal part of the femoral component on lateral radiographs. Intraoperatively, this distance is assessed as the gap between the distal tip of the patellar component and the tibial polyethylene insert when the knee is put through an arc of flexion.

Tibial mechanical axis 

Line passing from the midpoint between the tibial spines to the centre of the talar dome.

Valgus correction angle (VCA) 

Angle formed by the mechanical and distal anatomic axes of the femur and denotes the amount of valgus angulation required for the distal femoral cut.

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Mullaji, A.B., Shetty, G.M. (2014). Preoperative Planning. In: Deformity Correction in Total Knee Arthroplasty. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0566-9_1

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  • DOI: https://doi.org/10.1007/978-1-4939-0566-9_1

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0565-2

  • Online ISBN: 978-1-4939-0566-9

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