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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

Abstract

Purpose

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°.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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.

Notes

Acknowledgments

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.

References

  1. 1.
    Bjorgul K, Novicoff WM, Saleh KJ (2010) Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol 11:203–209PubMedCrossRefGoogle Scholar
  2. 2.
    Collier MB, Engh CA Jr, McAuley JP, Engh GA (2007) Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 89-A:1306–1314CrossRefGoogle Scholar
  3. 3.
    Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13PubMedCrossRefGoogle Scholar
  4. 4.
    Sikorski JM (2008) Alignment in total knee replacement. J Bone Joint Surg Br 90:1121–1127PubMedGoogle Scholar
  5. 5.
    Srivastava A, Lee GY, Steklov N, Colwell CW Jr, Ezzet KA, D’Lima DD (2011) Effect of tibial component varus on wear in total knee arthroplasty. Knee [Epub ahead of print]Google Scholar
  6. 6.
    Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38:349–355PubMedCrossRefGoogle Scholar
  7. 7.
    Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714PubMedGoogle Scholar
  8. 8.
    Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156PubMedGoogle Scholar
  9. 9.
    Stulberg SD, Loan P, Sarin V (2002) Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 84-A(Suppl 2):90–98PubMedGoogle Scholar
  10. 10.
    Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470:99–107PubMedCrossRefGoogle Scholar
  11. 11.
    Cheng T, Pan XY, Mao X, Zhang GY, Zhang XL (2012) Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up. Knee 19:237–245PubMedCrossRefGoogle Scholar
  12. 12.
    Hafez MA, Chelule KL, Seedhom BB, Sherman KP (2006) Computer-assisted total knee arthroplasty using patient-specific templating. Clin Orthop Relat Res 444:184–192PubMedCrossRefGoogle Scholar
  13. 13.
    Heyse TJ, Tibesku CO (2012) Improved femoral component rotation in TKA using patient-specific instrumentation. Knee. doi: 10.1016/j.knee.2012.10.009.
  14. 14.
    Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop 36:1589–1593PubMedCrossRefGoogle Scholar
  15. 15.
    Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Evaluation of the accuracy of a patient-specific instrumentation by navigation. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-012-2098
  16. 16.
    Noble JW Jr, Moore CA, Liu N (2012) The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplast 27:153–155CrossRefGoogle Scholar
  17. 17.
    Klatt BA, Goyal N, Austin MS, Hozack WJ (2008) Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplast 23:26–29CrossRefGoogle Scholar
  18. 18.
    Spencer BA, Mont MA, McGrath MS, Boyd B, Mitrick MF (2009) Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop 33:1571–1575PubMedCrossRefGoogle Scholar
  19. 19.
    Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL (2012) Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res 470:895–902PubMedCrossRefGoogle Scholar
  20. 20.
    Howell SM, Kuznik K, Hull ML, Siston RA (2008) Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 31:857–863PubMedCrossRefGoogle Scholar
  21. 21.
    Confalonieri N, Chemello C, Cerveri P, Manzotti A (2012) Is computer-assisted total knee replacement for beginners or experts? Prospective study among three groups of patients treated by surgeons with different levels of experience. J Orthop Traumatol [Epub ahead of print]Google Scholar
  22. 22.
    Jenny JY, Miehlke RK, Giurea A (2008) Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee 15:80–84PubMedCrossRefGoogle Scholar
  23. 23.
    Sampath SA, Voon SH, Sangster M, Davies H (2009) The statistical relationship between varus deformity, surgeon’s experience, BMI and tourniquet time for computer assisted total knee replacements. Knee 16:121–124PubMedCrossRefGoogle Scholar

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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