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Joint line is well restored when navigation surgery is performed for total knee arthroplasty

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

Abstract

Purpose

The incorrect restoration of the joint line during TKA can result in joint instability, anterior knee pain, limited range of motion, and joint stiffness. The joint line level is usually measured only on pre- and post-operative radiographs. Current knee navigation systems can now potentially support intra-operatively joint line restoration by controlling the exact amount of the bone-cartilage removed and the corresponding overall thickness of the components implanted. The aim of this study was to assess how well the joint line level is restored and the tibiofemoral overstuffing prevented when standard knee surgical navigation is used carefully also with these purposes. Intra-operative measurements during navigated TKA were taken.

Methods

Sixty-seven primary TKAs were followed prospectively. The variation before and after prosthesis component implantation of the joint line level, both in the femoral and tibial reference, was measured intra-operatively by an instrumented probe. Overstuffing was measured as the difference between the overall craniocaudal thickness of the femoral and tibial prosthesis components inserted and the thickness of the bone-cartilage removed.

Results

A significant elevation in the joint line level after prosthesis implantation was found with respect to the tibial reference (1.9 ± 2.4 mm, mean ± SD), very little to the femoral reference (0.3 ± 2.1 mm), perhaps accounted for the femur-first operative technique utilized. Overstuffing was on the average of 2.2 ± 3.0 mm.

Conclusions

These results suggest that a knee navigation system can also support well a proper restoration of the joint line level and limit the risk of overstuffing when relevant measurements are taken carefully during operation.

Level of evidence

III.

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References

  1. Anderson KC, Buehler KC, Markel DC (2005) Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 20(suppl 3):132–138

    Article  PubMed  Google Scholar 

  2. Bathis H, Perlick L, Tingart M et al (2004) Alignment in total knee arthroplasty: a comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86:682–687

    Article  PubMed  CAS  Google Scholar 

  3. Bäthis H, Perlick L, Tingart M et al (2005) Intraoperative cutting errors in total knee arthroplasty. Arch Orthop Trauma Surg 125:16–20

    Article  PubMed  Google Scholar 

  4. Belvedere C, Catani F, Ensini A et al (2007) Patellar tracking during total knee arthroplasty: an in vitro feasibility study. Knee Surg Sports Traumatol Arthrosc 15:985–993

    Article  PubMed  CAS  Google Scholar 

  5. Biasca N, Wirth S, Bungartz M (2009) Mechanical accuracy of navigated minimally invasive total knee arthroplasty. Knee 16:22–29

    Article  PubMed  Google Scholar 

  6. Bong MR, Di Cesare PE (2004) Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 12:164–171

    PubMed  Google Scholar 

  7. Chauhan SK, Scott RG, Breidahl W et al (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique: a randomised, prospective trial. J Bone Joint Surg Br 86:372–377

    Article  PubMed  CAS  Google Scholar 

  8. 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  PubMed  CAS  Google Scholar 

  9. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP et al (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 

  10. De Ladoucette A (2009) Computer-assisted revision of total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 17:1166–1171

    Article  PubMed  Google Scholar 

  11. Ensini A, Catani F, Leardini A et al (2007) Alignments and clinical results in conventional and navigated TKA. Clin Orthop Relat Res 457:156–162

    PubMed  CAS  Google Scholar 

  12. Figgie HE, Goldberg VM, Heiple KG et al (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. 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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Maeno S, Kondo M, Niki Y et al (2006) Patellar impingement against the tibial component after total knee arthroplasty. Clin Orthop Relat Res 452:265–269

    Article  PubMed  Google Scholar 

  16. Martin JW, Whiteside LA (1990) The influence of joint line position on knee stability after condylar knee arthroplasty. Clin Orthop Relat Res 259:146–156

    PubMed  Google Scholar 

  17. Matsueda M, Gengerke TR, Murphy M et al (1999) Soft tissue release in total knee arthroplasty: cadaver study using knees without deformities. Clin Orthop Relat Res 366:264–273

    Article  PubMed  Google Scholar 

  18. Minoda Y, Kobayashi A, Iwaki H et al (2010) The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:718–722

    Article  PubMed  Google Scholar 

  19. Ryu J, Saito S, Yamamoto K, Sano S et al (1993) Factors influencing the postoperative range of motion in total knee arthroplasty. Bull Hosp Jt Dis 53:35–40

    PubMed  CAS  Google Scholar 

  20. Sato T, Koga Y, Sobue T et al (2007) Quantitative 3-dimensional analysis of preoperative and postoperative joint lines in total knee arthroplasty: a new concept for evaluation of component alignment. J Arthroplasty 22:560–568

    Article  PubMed  Google Scholar 

  21. Scuderi GR (2005) The stiff total knee arthroplasty. J Arthroplasty 20(suppl 2):23–26

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  23. Selvarajah E, Hooper G (2009) Restoration of the joint line in total knee arthroplasty. J Arthroplasty 24:1099–1102

    Article  PubMed  Google Scholar 

  24. Singerman R, Heiple KG, Davy DT et al (1995) Effect of tibial component position on patellar strain following total knee arthroplasty. J Arthroplasty 10:651–656

    Article  PubMed  CAS  Google Scholar 

  25. Sparmann M, Wolke B, Czupalla H et al (2003) Positioning of total knee arthroplasty with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 85:830–835

    PubMed  CAS  Google Scholar 

  26. Stockl B, Nogler M, Rosiek R et al (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186

    Article  PubMed  Google Scholar 

  27. Wyss TF, Schuster AJ, Münger P et al (2006) Does total knee joint replacement with the soft tissue balancing surgical technique maintain the natural joint line? Arch Orthop Trauma Surg 126:480–486

    Article  PubMed  CAS  Google Scholar 

  28. Yoshii I, Witheside LA, White SE et al (1991) Influence of prosthetic joint line position on knee kinematics and patellar position. J Arthroplasty 6:169–177

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy

    A. Ensini & S. Giannini

  2. Clinica Ortopedica e Traumatologica, Azienda Ospedaliera, Universitaria di Modena, Modena, Italy

    F. Catani

  3. Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy

    A. Ensini, C. Belvedere, S. Giannini & A. Leardini

  4. Orthopädische Klinik Luzern St. Anna im Bahnhof, Luzern, Switzerland

    N. Biasca

Authors
  1. A. Ensini
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  2. F. Catani
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  3. N. Biasca
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  4. C. Belvedere
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  5. S. Giannini
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  6. A. Leardini
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Correspondence to A. Ensini.

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Ensini, A., Catani, F., Biasca, N. et al. Joint line is well restored when navigation surgery is performed for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20, 495–502 (2012). https://doi.org/10.1007/s00167-011-1558-1

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  • DOI: https://doi.org/10.1007/s00167-011-1558-1

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