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Differences in component and limb alignment between computer-assisted and conventional surgery total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Marked coronal femoral bowing may bear a risk for mal-alignment of femoral component and reconstructed mechanical axis (MA) by using conventional instrumentations. The aim of this study was to investigate the usefulness of computer-assisted surgery–total knee arthroplasty (CAS-TKA) under this circumstance.

Methods

We retrospectively analyzed patients with osteoarthritic knee and marked coronal femoral bowing who underwent TKA at our institution. The CAS-TKA and the conventional techniques were compared by radiographic parameters in coronal and sagittal planes, and rotational alignment of femoral component was assessed by computed tomography (CT) scans. The Hospital for Special Surgery (HSS) and International Knee Society (IKS) scores were obtained for all patients preoperatively and at the last follow-up.

Results

A total of 65 knees were enrolled in this study. Twenty-eight TKAs implanted using a CT-free navigation system, and the remaining 37 TKAs implanted using the conventional technique. CAS-TKAs were more consistent than conventional TKAs in aiding proper postoperative MA and ideal alignments of femoral component in the coronal and sagittal planes. However, CAS-TKA group was not obtained at significantly higher rates of femoral component in axial plane. At a mean follow-up of 43 months, there was no significant difference in HSS and IKS scores between the groups.

Conclusions

Although CAS-TKA did not have superior functional outcomes in the short-term follow-up, proper coronal and sagittal alignment of femoral component and postoperative MA were obtained in patients with marked coronal femoral bowing. The long-term follow-up will be needed to clarify the eventual benefits.

Level of evidence

Retrospective comparative study, Level III.

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References

  1. Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP (2013) Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 21:2206–2212

    Article  CAS  PubMed  Google Scholar 

  2. Cheng T, Zhang G, Zhang X (2011) Imageless navigation system does not improve component rotational alignment in total knee arthroplasty. J Surg Res 171:590–600

    Article  PubMed  Google Scholar 

  3. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20:282–288

    Article  PubMed  Google Scholar 

  4. DeHaan AM, Adams JR, DeHart ML, Huff TW (2014) Patient-specific versus conventional instrumentation for total knee arthroplasty: peri-operative and cost differences. J Arthroplasty. doi:10.1016/j.arth.2014.06.019

    PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  6. Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24(6 Suppl):39–43

    Article  PubMed  Google Scholar 

  7. Fehring TK, Mason JB, Moskal J, Pollock DC, Mann J, Williams VJ (2006) When computer-assisted knee replacement is the best alternative. Clin Orthop Relat Res 452:132–136

    Article  PubMed  Google Scholar 

  8. Fu H, Wang J, Zhou S, Cheng T, Zhang W, Wang Q, Zhang X (2014) No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3115-1

    Google Scholar 

  9. Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 255:215–227

    PubMed  Google Scholar 

  10. 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 18:1323–1327

    Article  PubMed  Google Scholar 

  11. 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 93:1197–1202

    Article  PubMed  Google Scholar 

  12. Huang TW, Hsu WH, Peng KT, Hsu RW (2011) Total knee replacement in patients with significant femoral bowing in the coronal plane: a comparison of conventional and computer-assisted surgery in an Asian population. J Bone Joint Surg Br 93:345–350

    Article  PubMed  Google Scholar 

  13. Insall JN, Ranawat CS, Aglietti P, Shine J (1976) A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg Am 58:754–765

    CAS  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  15. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20:832–839

    Article  PubMed  Google Scholar 

  16. Kawahara S, Okazaki K, Matsuda S, Nakahara H, Okamoto S, Iwamoto Y (2014) Internal rotation of femoral component affects functional activities after tka-survey with the 2011 Knee Society score. J Arthroplasty. doi:10.1016/j.arth.2013.11.017

    Google Scholar 

  17. Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 89:471–476

    Article  PubMed  Google Scholar 

  18. Kim YH, Park JW, Kim JS (2012) Computer-navigated versus conventional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am 94:2017–2024

    Article  PubMed  Google Scholar 

  19. Klein GR, Austin MS, Smith EB, Hozack WJ (2006) Total knee arthroplasty using computer-assisted navigation in patients with deformities of the femur and tibia. J Arthroplasty 21:284–288

    Article  PubMed  Google Scholar 

  20. Konigsberg B, Hess R, Hartman C, Smith L, Garvin KL (2014) Inter- and intraobserver reliability of two-dimensional CT scan for total knee arthroplasty component malrotation. Clin Orthop Relat Res 472:212–217

    Article  PubMed  Google Scholar 

  21. Lasam MP, Lee KJ, Chang CB, Kang YG, Kim TK (2013) Femoral lateral bowing and varus condylar orientation are prevalent and affect axial alignment of TKA in Koreans. Clin Orthop Relat Res 471:1472–1483

    Article  PubMed Central  PubMed  Google Scholar 

  22. Lionberger DR, Crocker CL, Chen V (2014) Patient Specific Instrumentation. J Arthroplasty. doi:10.1016/j.arth.2014.03.019

    PubMed  Google Scholar 

  23. Lizaur-Utrilla A, Sanz-Reig J, Trigueros-Rentero MA (2012) Greater satisfaction in older patients with a mobile-bearing compared with fixed-bearing total knee arthroplasty. J Arthroplasty 27:207–212

    Article  PubMed  Google Scholar 

  24. Lützner J, Dexel J, Kirschner S (2013) No difference between computer-assisted and conventional total knee arthroplasty: five-year results of a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 21:2241–2247

    Article  PubMed  Google Scholar 

  25. Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW (2001) The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate sacrificing total knee arthroplasties. J Arthroplasty 16:635–640

    Article  CAS  PubMed  Google Scholar 

  26. Matziolis G, Adam J, Perka C (2010) Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 130:1487–1491

    Article  PubMed  Google Scholar 

  27. Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y (2008) The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br 90:1025–1031

    Article  CAS  PubMed  Google Scholar 

  28. Mullaji AB, Marawar SV, Mittal V (2009) A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplasty 24:861–867

    Article  PubMed  Google Scholar 

  29. Mullaji A, Shetty GM (2009) Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity. J Arthroplasty 24:1164–1169

    Article  PubMed  Google Scholar 

  30. Mullaji AB, Shetty GM, Lingaraju AP, Bhayde S (2013) Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA? Clin Orthop Relat Res 471:134–141

    Article  PubMed Central  PubMed  Google Scholar 

  31. Nagamine R, Miura H, Bravo CV, Urabe K, Matsuda S, Miyanishi K, Hirata G, Iwamoto Y (2000) Anatomic variations should be considered in total knee arthroplasty. J Orthop Sci 5:232–237

    Article  CAS  PubMed  Google Scholar 

  32. 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 92:2143–2149

    Article  PubMed  Google Scholar 

  33. Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596

    Article  PubMed  Google Scholar 

  34. Rodricks DJ, Patil S, Pulido P, Colwell CW Jr (2007) Press-fit condylar design total knee arthroplasty: fourteen to seventeen-year follow-up. J Bone Joint Surg Am 89:89–95

    Article  PubMed  Google Scholar 

  35. Sassoon A, Nam D, Nunley R, Barrack R (2014) Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res. doi:10.1007/s11999-014-3804-6

    PubMed  Google Scholar 

  36. Scott RD, Chmell MJ (2008) Balancing the posterior cruciate ligament during cruciate-retaining fixed and mobile-bearing total knee arthroplasty: description of the pull-out lift-off and slide-back tests. J Arthroplasty 23:605–608

    Article  PubMed  Google Scholar 

  37. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835

    CAS  PubMed  Google Scholar 

  38. Stronach BM, Pelt CE, Erickson JA, Peters CL (2014) Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment. J Arthroplast. doi:10.1016/j.arth.2014.04.025

    Google Scholar 

  39. Taylor M, Barrett DS (2003) Explicit finite element simulation of eccentric loading in total knee replacement. Clin Orthop Relat Res 414:162–171

    Article  PubMed  Google Scholar 

  40. Thienpont E, Paternostre F, Pietsch M, Hafez M, Howell S (2013) Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity. Knee 20:407–411

    Article  PubMed  Google Scholar 

  41. Thienpont E, Schwab PE, Fennema P (2014) A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Joint J 96:1052–1061

    Article  PubMed  Google Scholar 

  42. Vessely MB, Whaley AL, Harmsen WS, Schleck CD, Berry DJ (2006) Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties. Clin Orthop Relat Res 452:28–34

    Article  PubMed  Google Scholar 

  43. Voleti PB, Hamula MJ, Baldwin KD, Lee GC (2014) Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty. J Arthroplasty. doi:10.1016/j.arth.2014.01.039

    PubMed  Google Scholar 

  44. Wang JW, Wang CJ (2002) Total knee arthroplasty for arthritis of the knee with extra-articular deformity. J Bone Joint Surg Am 84:1769–1774

    Article  PubMed  Google Scholar 

  45. Wang JW, Chen WS, Lin PC, Hsu CS, Wang CJ (2010) Total knee replacement with intra-articular resection of bone after malunion of a femoral fracture: can sagittal angulation be corrected? J Bone Joint Surg Br 92:1392–1396

    Article  PubMed  Google Scholar 

  46. Weng YJ, Hsu RW, Hsu WH (2009) Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty 24:668–673

    Article  PubMed  Google Scholar 

  47. Woolson ST, Harris AH, Wagner DW, Giori NJ (2014) Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 96:366–372

    Article  PubMed  Google Scholar 

  48. 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

    CAS  Google Scholar 

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Acknowledgments

There was no external funding for this study.

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Division of Joint Reconstruction, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, No. 6, West Section, Chia-Pu Road, Putz, 613, Chia-Yi, Taiwan

    Tsan-Wen Huang, Kuo-Ti Peng, Mel S. Lee & Robert Wen-Wei Hsu

  2. Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, 333, Tao-Yuan, Taiwan

    Tsan-Wen Huang, Kuo-Ti Peng, Kuo-Chin Huang, Mel S. Lee & Robert Wen-Wei Hsu

  3. Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital,Chiayi, No 6, West Section, Chia-Pu Road, Putz, 613, Chia-Yi, Taiwan

    Kuo-Chin Huang

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  1. Tsan-Wen Huang
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Correspondence to Robert Wen-Wei Hsu.

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Huang, TW., Peng, KT., Huang, KC. et al. Differences in component and limb alignment between computer-assisted and conventional surgery total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22, 2954–2961 (2014). https://doi.org/10.1007/s00167-014-3331-8

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  • DOI: https://doi.org/10.1007/s00167-014-3331-8

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