Skip to main content
SpringerLink
Log in

Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique

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

Abstract

Accurate reconstruction of leg alignment is one important factor for long-term survival in total knee arthroplasty (TKA). Recent developments in computer-assisted surgery focused on systems improving TKA. The aim of the study is to compare the results of computer-assisted revision TKA with the conventional technique. We hypothize that a significantly better leg alignment and component orientation is achieved when using a navigation system for revision TKA. In a prospective study, two groups of 25 revision TKAs each were operated on using either a CT-free navigation system or the classical surgeon-controlled technique. The postoperative leg alignment was analysed on long-leg coronal and lateral X-rays. The mechanical limb axis was significantly better in the navigation-based group. Twenty-three patients (92%) in the computer-assisted group had a postoperative leg axis between 3° varus/valgus deviation, while 19 patients (76%) in the conventional group had a comparable result (p<0.05). Further, significant differences were seen for the coronal orientation of the femoral component. Computer-assisted revision TKA leads to a superior restoration of leg alignment compared with the conventional technique. Particularly the real-time presentation of the actual leg axis and the flexion and extension gaps is useful in revision TKA. Potential benefits in long-term outcome and functional improvement require additional investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Laskin RS (1976) Modular total knee-replacement arthroplasty: a review of eighty-nine patients. J Bone Joint Surg Am 58:766–773

    CAS  PubMed  Google Scholar 

  2. Riley LH, Hungerford DS (1978) Geometric total knee replacement for treatment of the rheumatoid knee. J Bone Joint Surg Am 60:523–527

    PubMed  Google Scholar 

  3. Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70:1163–1173

    CAS  PubMed  Google Scholar 

  4. Bourne RB, Crawford HA (1998) Principles of revision total knee arthroplasty. Orthop Clin North Am 29:331–337

    CAS  PubMed  Google Scholar 

  5. Gofton WT, Tsigaras H, Butler RA, Patterson JJ, Barrack RL, Rorabeck CH (2002) Revision total knee arthroplasty: fixation with modular stems. Clin Orthop 404:158–168

    PubMed  Google Scholar 

  6. Dorr LD, Boiardo RA (1986) Technical considerations in total knee arthroplasty. Clin Orthop 205:5–11

    PubMed  Google Scholar 

  7. Hofmann AA, Bachus KN, Wyatt RW (1991) Effect of the tibial cut on subsidence following total knee arthroplasty. Clin Orthop 269:63–69

    PubMed  Google Scholar 

  8. Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59:77–79

    CAS  PubMed  Google Scholar 

  9. Ritter MA, Montgomery TJ, Zhou H, Keating ME, Faris PM, Meding JB (1999) The clinical significance of proximal tibial resection level in total knee arthroplasty. Clin Orthop 360:174–181

    Article  PubMed  Google Scholar 

  10. Dorr LD (2002) Session V: revision total knee replacement: an overview. Clin Orthop 404:143–144

    PubMed  Google Scholar 

  11. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall award paper. Why are total knee arthroplasties failing today? Clin Orthop 404:7–13

    PubMed  Google Scholar 

  12. Figgie HE, Goldberg VM, Heiple KG, Moller HS, Gordon NH (1986) The influence of tibial-patellofemoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68:1035–1040

    PubMed  Google Scholar 

  13. Laskin RS (2002) Joint line position restoration during revision total knee replacement. Clin Orthop 404:169–171

    PubMed  Google Scholar 

  14. Partington PF, Sawhney J, Rorabeck CH, Barrack RL, Moore J (1999) Joint line restoration after revision total knee arthroplasty. Clin Orthop 367:165–171

    Article  PubMed  Google Scholar 

  15. Jenny JY, Boeri C (2001) Navigated implantation of total knee endoprostheses: a comparative study with conventional instrumentation. Z Orthop Ihre Grenzgeb 139:117–119

    Article  CAS  PubMed  Google Scholar 

  16. Mielke RK, Clemens U, Jens JH, Kershally S (2001) Navigation in knee endoprosthesis implantation: preliminary experiences and prospective comparative study with conventional implantation technique. Z Orthop Ihre Grenzgeb 139:109–116

    Article  CAS  PubMed  Google Scholar 

  17. 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 

  18. Engh GA, Ammeen DJ (1999) Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 48:167–175

    CAS  PubMed  Google Scholar 

  19. Buechel FF, Pappas MJ (1986) The New Jersey low-contact-stress knee replacement system: biomechanical rationale and review of the first 123 cemented cases. Arch Orthop Trauma Surg 105:197–204

    CAS  PubMed  Google Scholar 

  20. 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

    Google Scholar 

  21. Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop 232:168–173

    PubMed  Google Scholar 

  22. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714

    CAS  PubMed  Google Scholar 

  23. Hvid I, Nielsen S (1984) Total condylar knee arthroplasty. Prosthetic component positioning and radiolucent lines. Acta Orthop Scand 55:160–165

    CAS  PubMed  Google Scholar 

  24. Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement: its effect on survival. Clin Orthop 309:153–156

    Google Scholar 

  25. Petersen TL, Engh GA (1988) Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty 3:67–72

    Google Scholar 

  26. Jenny JY, Mielke RK, Kohler S, Kiefer H, Konermann K, Boeri C, Clemens U, Ratayski H (2003) Total knee prosthesis implantation with a non image based navigation system: a multicentric analysis. In: Proceedings of the 70th annual meeting AAOS, American Academy of Orthopedic Surgeons, New Orleans, p 96

  27. Plaskos C, Hodgson AJ, Inkpen K, McGraw RW (2002) Bone cutting errors in total knee arthroplasty. J Arthroplasty 17:698–705

    Google Scholar 

  28. Rand JA (1998) Modular augments in revision total knee arthroplasty. Orthop Clin North Am 29:347–353

    CAS  PubMed  Google Scholar 

  29. Noda T, Yasuda S, Nagano K, Takahara Y, Namba Y, Inoue H (2000) Clinico-radiological study of total knee arthroplasty after high tibial osteotomy. J Orthop Sci 5:25–36

    Article  CAS  PubMed  Google Scholar 

  30. Griffin FM, Math K, Scuderi GR, Insall JN, Poilvache PL (2000) Anatomy of the epicondyles of the distal femur: MRI analysis of normal knees. J Arthroplasty 15:354–359

    Google Scholar 

  31. Stiehl JB, Abbott BD (1995) Morphology of the transepicondylar axis and its application in primary and revision total knee arthroplasty. J Arthroplasty 10:785–789

    CAS  PubMed  Google Scholar 

  32. Scuderi GR, Insall JN (1992) Total knee arthroplasty: current clinical perspectives. Clin Orthop 276:26–32

    PubMed  Google Scholar 

  33. Insall JN, Lachiewicz PF, Burstein AH (1982) The posterior stabilized condylar prosthesis: a modification of the total condylar design. Two to four-year clinical experience. J Bone Joint Surg Am 64:1317–1323

    CAS  PubMed  Google Scholar 

  34. Cope MR, O’Brien BS, Nanu AM (2002) The influence of the posterior cruciate ligament in the maintenance of joint line in primary total knee arthroplasty: a radiologic study. J Arthroplasty 17:206–208

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Postbox 100662, 93042, Regensburg, Germany

    Lars Perlick, Holger Bäthis, Christian Lüring, Markus Tingart & Joachim Grifka

  2. Department of Orthopaedics, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansensgade 2, 8000, Aarhus C, Denmark

    Carsten Perlick

Authors
  1. Lars Perlick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Holger Bäthis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carsten Perlick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Lüring
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Markus Tingart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joachim Grifka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Perlick.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Perlick, L., Bäthis, H., Perlick, C. et al. Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique. Knee Surg Sports Traumatol Arthrosc 13, 167–173 (2005). https://doi.org/10.1007/s00167-004-0507-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-004-0507-7

Keywords

Search

Navigation