International Orthopaedics

, Volume 37, Issue 1, pp 45–50 | Cite as

Frontal plane alignment after total knee arthroplasty using patient-specific instruments

  • Kiriakos Daniilidis
  • Carsten O. TibeskuEmail author
Original Paper



Although total knee arthroplasty (TKA) is regularly associated with favorable outcomes, considerable research efforts are still underway to improve its ability to achieve a neutral postoperative mechanical axis. Patient-specific instrumentation (PSI) was introduced with this and other goals in mind. The current retrospective study was designed to determine whether PSI would lead to a hip-knee-ankle angle (HKA) within ±3° of the ideal alignment of 180°.


A long-leg x-ray of the knee was performed after an average of 3.5 months (SD, three to four months), following 124 TKAs performed by a single surgeon using PSI technology (VISIONAIRE; Smith & Nephew). In addition to HKA, the zone of the mechanical axis (ZMA; zone of the tibial base plate where the mechanical axis of the limb intersects with the tibial base plate) was analysed, with the ideal intersection occurring centrally.


There were 100 knees (average age, 66.8 years) with follow-up data available. The average HKA changed from 175.5±5.6° preoperatively to 178.5±1.7° postoperatively. The rate of ±3° and ±5° HKA outliers was 11 % and 3 %, respectively. In terms of ZMA, the mechanical axis passed through the central third of the knee in the majority of cases (93 knees, 93 %). There were no intra-operative complications with the use of PSI.


The use of PSI technology was able to achieve a neutral mechanical axis on average in patients undergoing TKA. Further follow-up will be needed to ascertain the long-term impact of these findings.


Total Knee Arthroplasty Mechanical Axis Conventional Instrumentation Tibial Mechanical Axis Femoral Mechanical Axis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors wish to thank the medical assistants Ms. Christina Andrusiak, Ms. Sandra Schaefer, and Ms. Evi Schwarz for the collection of radiographic and patient data.

Conflict of Interest

No benefits in any form have been received or will be received from a commercial party related, directly or indirectly, to the subject of this article. C.O.T is a paid teaching consultant for Smith & Nephew. The authors declare that there are no other potential conflicts of interest in connection with this paper.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryAnnastift Hannover (Medical School Hannover; MHH)HannoverGermany
  2. 2.Sporthopaedicum StraubingStraubingGermany

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