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Measuring long radiographs affects the positioning of femoral components in total knee arthroplasty: a randomized controlled trial

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to investigate if preoperative measurements of the femoral valgus angle (FVA) affected the mechanical alignment, individual component positions and clinical outcome in total knee arthroplasty (TKA).

Methods

120 patients were randomized into two groups. In one group (control), a fixed FVA for the intramedullary femoral guide was set at 7°, whereas in the other group (measured) FVA was measured preoperatively on long hip–knee–ankle radiographs, and the angle for the distal femoral cut was set accordingly. Preoperatively and 1 year after TKA, range of motion (ROM) and Knee Society Score (KSS) were assessed. Postoperatively, the coronal alignments of the components and the mechanical alignment were measured comparing the rate of outliers which deviated more than 3° from the neutral mechanical axis.

Results

104 patients remained for the radiological analysis (52 in each group). There were no significant differences either in the mean preoperative or postoperative mechanical alignment, or femoral or tibial component alignment; also, there were no differences in the number of postoperative mechanical axis or tibial component alignment outliers. However, the number of femoral component alignment outliers was significantly higher in the control group. 97 patients were available for clinical outcome analysis. Preoperatively, the groups did not differ significantly with respect to KSS or ROM. The postoperative ROM and KSS functional subscale scores were similar between the groups. However, there was slightly but significantly better postoperative KSS objective subscale score in the measured group.

Conclusions

Preoperative FVA measurement and following femoral distal cut adjustments did not affect overall leg alignment postoperatively, while positioning of femoral component was improved together with minor improvements in objective KSS subscale scores.

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Acknowledgments

We acknowledge with gratitude the work done by the radiology department. This research was funded by a Grant (No. MIP-11202) from the Research Council of Lithuania.

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Authors and Affiliations

  1. Department of Orthopaedics, Lithuanian University of Health Sciences, Eiveniu 2, 50009, Kaunas, Lithuania

    Justinas Stucinskas, Aleksej Lebedev, Alfredas Smailys & Sarunas Tarasevicius

  2. Department of Clinical Sciences, Lund University, Lund, Sweden

    Otto Robertsson & Hans Wingstrand

  3. Department of Orthopaedics, Lund University and Lund University Hospital, Lund, Sweden

    Otto Robertsson & Hans Wingstrand

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  1. Justinas Stucinskas
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  2. Otto Robertsson
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Correspondence to Justinas Stucinskas.

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Stucinskas, J., Robertsson, O., Lebedev, A. et al. Measuring long radiographs affects the positioning of femoral components in total knee arthroplasty: a randomized controlled trial. Arch Orthop Trauma Surg 136, 693–700 (2016). https://doi.org/10.1007/s00402-016-2434-8

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  • DOI: https://doi.org/10.1007/s00402-016-2434-8

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