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Radiographic and Navigation Measurements of TKA Limb Alignment Do Not Correlate

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Precise pre- and postoperative anatomic measurements are necessary to plan, perform, and evaluate total knee arthroplasty (TKA). We evaluated the relationship between radiographic and navigation alignment measurements, identified sources of error in radiographic and navigated alignment assessment, and determined the differences between desired and clinically accepted alignment. Fifty-eight computer-assisted TKAs were performed and limb alignment measurements were recorded both pre- and postoperatively with standard radiographs and with an intraoperative navigation system. Intraoperative navigation produced consistent navigation-generated alignment results that were within 1° of the desired alignment. The difference between preoperative radiographic and navigation measurements varied by as much as 12° and the difference between postoperative radiographic and navigation measurements varied by as much as 8°. This discrepancy depended on the degree of limb deformity. Postoperative radiographic measurements have inherent limitations. Navigation can generate precise, accurate, and reproducible alignment measurements. This technology can function as an effective tool for assessing pre- and postoperative limb alignment and relating intraoperative alignment measurements to clinical and functional outcomes.

Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Bathis H, Perlick L, Tingart M, Luring C, Perlick C, Grifka J. Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty. Int Orthop. 2004;28:87–90.

    Article  PubMed  CAS  Google Scholar 

  2. Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004;86:682–687.

    Article  PubMed  CAS  Google Scholar 

  3. Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am. 2007;89:261–269.

    Article  PubMed  Google Scholar 

  4. Brouwer RW, Jakma TS, Brouwer KH, Verhaar JA. Pitfalls in determining knee alignment: a radiographic cadaver study. J Knee Surg. 2007;20:210–215.

    PubMed  CAS  Google Scholar 

  5. Chauhan SK, Scott RG, Breidahl W, Beaver RJ. Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br. 2004;86:372–377.

    Article  PubMed  CAS  Google Scholar 

  6. Chin PL, Yang KY, Yeo SJ, Lo NN. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty. 2005;20:618–626.

    Article  PubMed  Google Scholar 

  7. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P. Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis Cartilage. 1997;5:39–47.

    Article  PubMed  CAS  Google Scholar 

  8. Cooke TD, Scudamore RA, Bryant JT, Sorbie C, Siu D, Fisher B. A quantitative approach to radiography of the lower limb. Principles and applications. J Bone Joint Surg Br. 1991;73:715–720.

    PubMed  CAS  Google Scholar 

  9. Cooke TD, Sled EA, Scudamore RA. Frontal plane knee alignment: a call for standardized measurement. J Rheumatol. 2007;34:1796–1801.

    PubMed  Google Scholar 

  10. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty. 2005;20:282–288.

    Article  PubMed  Google Scholar 

  11. Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res. 1998;354:49–56.

    Article  PubMed  Google Scholar 

  12. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.

    PubMed  Google Scholar 

  13. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res. 2005;433:152–159.

    Article  PubMed  Google Scholar 

  14. Hauser R. Computer-aided 3D-navigation systems: a plea for an error model. HNO. 2000;2:71–74.

    Article  Google Scholar 

  15. Hunt MA, Fowler PJ, Birmingham TB, Jenkyn TR, Giffin JR. Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg. 2006;49:401–406.

    PubMed  Google Scholar 

  16. Jenny JY, Boeri C. Computer-assisted implantation of a total knee arthroplasty: a case-controlled study in comparison with classical instrumentation [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2001;87:645–652.

    PubMed  CAS  Google Scholar 

  17. Jenny JY, Boeri C, Picard F, Leitner F. Reproducibility of intra-operative measurement of the mechanical axes of the lower limb during total knee replacement with a non-image-based navigation system. Comput Aided Surg. 2004;9:161–165.

    Article  PubMed  Google Scholar 

  18. Kendoff D, Board TN, Citak M, Gardner MJ, Hankemeier S, Ostermeier S, Krettek C, Hufner T. Navigated lower limb axis measurements: influence of mechanical weight-bearing simulation. J Orthop Res. 2008;26:553–561.

    Article  PubMed  Google Scholar 

  19. Laskin R. Alignment in total knee components. Orthopedics. 1984;7:62–72.

    Google Scholar 

  20. Lonner JH, Laird MT, Stuchin SA. Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res. 1996;331:102–106.

    Article  PubMed  Google Scholar 

  21. Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW. The effect of surgeon experience on component positioning in 673 press fit condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty. 2001;16:635–640.

    Article  PubMed  CAS  Google Scholar 

  22. McGrory JE, Trousdale RT, Pagnano MW, Nigbur M. Preoperative hip to ankle radiographs in total knee arthroplasty. Clin Orthop Relat Res. 2002;404:196–202.

    Article  PubMed  Google Scholar 

  23. Oberst M, Bertsch C, Lahm A, Wuerstlin S, Holz U. Regression and correlation analysis of preoperative versus intraoperative assessment of axes during navigated total knee arthroplasty. Comput Aided Surg. 2006;11:87–91.

    Article  PubMed  Google Scholar 

  24. Perlick L, Bathis H, Perlick C, Luring C, Tingart M, Grifka J. Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique. Knee Surg Sports Traumatol Arthrosc. 2005;13:167–173.

    Article  PubMed  Google Scholar 

  25. Picard F, Gregori A, Leitner F. Computer Assisted Total Knee Arthroplasty: Validation of the Image Free Concept. Berlin, Germany: Pro Business; 2007.

    Google Scholar 

  26. Pitto RP, Graydon AJ, Bradley L, Malak SF, Walker CG, Anderson IA. Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br. 2006;88:601–605.

    Article  PubMed  CAS  Google Scholar 

  27. Prakash U, Wigderowitz CA, McGurty DW, Rowley DI. Computerised measurement of tibiofemoral alignment. J Bone Joint Surg Br. 2001;83:819–824.

    Article  PubMed  CAS  Google Scholar 

  28. Rauh MA, Boyle J, Mihalko WM, Phillips MJ, Bayers-Thering M, Krackow KA. Reliability of measuring long-standing lower extremity radiographs. Orthopedics. 2007;30:299–303.

    PubMed  Google Scholar 

  29. Siu D, Cooke TD, Broekhoven LD, Lam M, Fisher B, Saunders G, Challis TW. A standardized technique for lower limb radiography. Practice, applications, and error analysis. Invest Radiol. 1991;26:71–77.

    Article  PubMed  CAS  Google Scholar 

  30. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br. 2003;85:830–835.

    PubMed  CAS  Google Scholar 

  31. Specogna AV, Birmingham TB, DaSilva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR. Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg. 2004;17:203–210.

    PubMed  Google Scholar 

  32. Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR. Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load. Am J Sports Med. 2007;35:65–70.

    Article  PubMed  Google Scholar 

  33. Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res. 2004;426:180–186.

    Article  PubMed  Google Scholar 

  34. Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am. 2002;84(Suppl 2):90–98.

    PubMed  Google Scholar 

  35. Stulberg SD, Yaffe MA, Koo SS. Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am. 2006;88(Suppl 4):47–54.

    Article  PubMed  Google Scholar 

  36. Stulberg SD, Yaffe MA, Koo SS. Navigation improves accuracy and reproducibility of soft tissue balance in TKA. Poster presentation: International Society for Computer Assisted Orthopedic Surgery 7th Annual Meeting. Heidelberg, Germany, June 20–23, 2007. http://www.caos-international.org/2007/FinalProgram.pdf.

  37. Wright JG, Treble N, Feinstein AR. Measurement of lower limb alignment using long radiographs. J Bone Joint Surg Br. 1991;73:721–723.

    PubMed  CAS  Google Scholar 

  38. Yau WP, Leung A, Chiu KY, Tang WM, Ng TP. Intraobserver errors in obtaining visually selected anatomic landmarks during registration process in nonimage-based navigation-assisted total knee arthroplasty: a cadaveric experiment. J Arthroplasty. 2005;20:591–601.

    Article  PubMed  CAS  Google Scholar 

  39. Yau WP, Leung A, Liu KG, Yan CH, Wong LL, Chiu KY. Interobserver and intra-observer errors in obtaining visually selected anatomical landmarks during registration process in non-image-based navigation-assisted total knee arthroplasty. J Arthroplasty. 2007;22:1150–1161.

    Article  PubMed  CAS  Google Scholar 

  40. Yoshioka Y, Siu DW, Scudamore RA, Cooke TD. Tibial anatomy and functional axes. J Orthop Res. 1989;7:132–137.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Joseph Feinglass, PhD, Steven Gondek, MD, and Emily Martin, MD, for their valued contributions to this study.

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Authors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Mark A. Yaffe MD, Samuel S. Koo MD & S. David Stulberg MD

  2. Joint Reconstruction & Implant Service, Northwestern Memorial Hospital, 680 North Lake Shore Drive, Suite 1028, Chicago, IL, 60610, USA

    S. David Stulberg MD

Authors
  1. Mark A. Yaffe MD
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  2. Samuel S. Koo MD
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  3. S. David Stulberg MD
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Corresponding author

Correspondence to S. David Stulberg MD.

Additional information

One or more of the authors (SDS) has received funding from Aesculap.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Yaffe, M.A., Koo, S.S. & Stulberg, S.D. Radiographic and Navigation Measurements of TKA Limb Alignment Do Not Correlate. Clin Orthop Relat Res 466, 2736–2744 (2008). https://doi.org/10.1007/s11999-008-0427-9

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  • DOI: https://doi.org/10.1007/s11999-008-0427-9

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