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Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The objective of this study was to calculate bone resection thicknesses and resulting gap sizes, simulating a measured resection mechanical alignment (MA) technique for total knee arthroplasty (TKA).

Methods

MA bone resections were simulated on 1000 consecutive lower limb CT scans from patients undergoing TKA. Femoral rotation was aligned with either the surgical trans-epicondylar axis (TEA) or with 3° of external rotation to the posterior condyles (PC). Imbalances in the extension space, flexion space, medial compartment and lateral compartment were calculated.

Results

Extension space imbalances (≥ 3 mm) occurred in 25% of varus and 54% of valgus knees and severe imbalances (≥ 5 mm) were present in up to 8% of varus and 19% of valgus knees. Higher flexion space imbalance rates were created with TEA versus PC (p < 0.001). Using TEA, only 49% of varus and 18% of valgus knees had < 3 mm of imbalance throughout the extension and flexion spaces, and medial and lateral compartments.

Conclusion

A systematic use of the simulated measured resection MA technique for TKA leads to many cases with imbalance. Some imbalances may not be correctable surgically and may result in TKA instability. Modified versions of the MA technique or other alignment methods that better reproduce knee anatomies should be explored.

Level of evidence

2.

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Funding

No funding was received to perform this study.

Author information

Authors and Affiliations

  1. Department of Surgery, CIUSSS-de-L’Est-de-L’Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l’Assomption, Montréal, QC, H1T 2M4, Canada

    William Blakeney, Yann Beaulieu, Benjamin Puliero, Marc-Olivier Kiss & Pascal-André Vendittoli

  2. Department of Surgery, Albany Health Campus, Albany, Australia

    William Blakeney

  3. Department of Surgery, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada

    Marc-Olivier Kiss & Pascal-André Vendittoli

Authors
  1. William Blakeney
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  2. Yann Beaulieu
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  3. Benjamin Puliero
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  4. Marc-Olivier Kiss
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  5. Pascal-André Vendittoli
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Corresponding author

Correspondence to Pascal-André Vendittoli.

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The authors declared that they have no conflict of interest.

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This article used anonymous data from an existing collection of CT scans and does not contain any studies with human participants performed by any of the authors.

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Blakeney, W., Beaulieu, Y., Puliero, B. et al. Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances. Knee Surg Sports Traumatol Arthrosc 28, 1532–1541 (2020). https://doi.org/10.1007/s00167-019-05562-8

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  • DOI: https://doi.org/10.1007/s00167-019-05562-8

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