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Effect of intraoperative weight-bearing simulation on the mechanical axis in total knee arthroplasty

Archives of Orthopaedic and Trauma Surgery volume 134, pages 673–677 (2014)Cite this article

Abstract

Purpose

Successful outcome after total knee arthroplasty (TKA) requires precise realignment of the mechanical axis. The intraoperative assessment of the mechanical axis is difficult. Intraoperatively, the effect of weight bearing on the lower limb mechanical axis is ignored. We developed a custom-made mechanical loading device to simulate weight-bearing conditions intraoperatively and analysed its effect on the mechanical axis during TKA.

Methods

Measurements of the mechanical axis were obtained during 30 consecutive primary TKAs in osteoarthritic patients using image-free knee navigation system. Half body weight was applied intraoperatively using our device to quantify the effect of intraoperative load application on the mechanical axis, thus receiving indirect information about soft tissue balancing. Furthermore, the intraobserver and interobserver reliability of navigated mechanical axis measurement with and without load was determined.

Results

Before TKA, mean mechanical axis was 4.0° ± 4.9° without load. Under loading conditions, the mean change of the mechanical axis was 2.1° ± 2.8°. Repetitive measurements of the senior surgeon and junior surgeon revealed a high intraobserver (ICC 0.997) and interobserver reliability (ICC 0.998). The registration of the mechanical axis without and with application of intraoperative loading demonstrated no significant differences during insertion of the trial components (SD 0.29 ± 0.29) and after the definitive component cementation (SD 0.63 ± 0.44).

Conclusions

Intraoperative quantification and analysis of the mechanical lower limb axis applying defined axial loading by our custom-made loading apparatus is reliable. Ligament stability was unbalanced before TKA and balanced after TKA. For TKA, intraoperative simulation of weight bearing may be helpful to quantify, control and correct knee stability and its influence of mechanical axis.

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Acknowledgments

No professional or private funding was received for this study. All authors are only affiliated with their mentioned trauma/orthopaedic departments in Hannover and belong to the specific medical universities.

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Affiliations

  1. Department of Trauma Surgery and Orthopaedic Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany

    M. Panzica, M. Kenawey, E. Liodakis, J. Brandes, C. Krettek & S. Hankemeier

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  1. M. Panzica
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  2. M. Kenawey
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  3. E. Liodakis
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  4. J. Brandes
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  5. C. Krettek
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  6. S. Hankemeier
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Correspondence to M. Panzica.

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Panzica, M., Kenawey, M., Liodakis, E. et al. Effect of intraoperative weight-bearing simulation on the mechanical axis in total knee arthroplasty. Arch Orthop Trauma Surg 134, 673–677 (2014). https://doi.org/10.1007/s00402-014-1938-3

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  • DOI: https://doi.org/10.1007/s00402-014-1938-3

Keywords

  • Total knee arthroplasty
  • Navigation
  • Ligament balancing
  • Instability
  • Mechanical leg axis
  • Weight bearing