Comparison of Standard Anteroposterior Knee and Hip-to-Ankle Radiographs in Determining the Lower Limb and Implant Alignment after Total Knee Arthroplasty

Skyttä, Eerik; Lohman, Martina; Tallroth, Kaj; Remes, Ville

doi:10.1177/145749690909800411

Cited by 68 publications

(65 citation statements)

References 18 publications

(4 reference statements)

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“…Second, we used only one conventional instrumentation system (Genesis II) and only one navigation system (Orthopilot), and different systems of standard instrument or navigation may produce different findings. Third, we used standing whole-limb AP radiographs for radiographic measurements, and although this radiographic view is known to have satisfactory accuracy and reliability [5,35] and have been frequently used in previous studies with similar purposes [11,26,29,30,36,40], it may be affected by several factors such as degree of rotation. To maintain the quality of radiographic images, we used a specially designed template to control rotation.…”

Section: Discussionmentioning

confidence: 99%

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

120

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Background Coronal alignment is considered key to the function and longevity of a TKA. However, most studies do not consider femoral and tibial anatomical features such as lateral femoral bowing and the effects of these features and subsequent alignment on function after TKA are unclear. Questions/purposes We therefore determined (1) the prevalence of lateral femoral bowing, varus femoral condylar orientation, and severe tibia plateau inclination in female Koreans undergoing TKA; (2) whether postoperative alignments are affected by these anatomical features and improved by the use of navigation; and (3) whether postoperative coronal alignments are associated with function.Methods We measured alignment in 367 knees that underwent TKA and 60 sex-and age-matched normal knees (control group). We determined patterns and degrees of femoral bowing angle, femoral condylar orientation, and tibial plateau inclination on preoperative full-limb radiographs. Postoperatively, coronal alignment of limbs and of femoral and tibial components was measured. We compared American Knee Society scores, WOMAC scores, and SF-36 scores in aligned knees and outliers (beyond ± 3°o r ± 2°) at 1 year. Results The prevalence of lateral femoral bowing was 88% in the TKA group and 77% in the control group. Mean femoral condylar orientation angle was varus 2.6°in the TKA group and valgus 1.1°in the control group, and mean tibial plateau inclination was varus 8.3°in the TKA group and varus 5.4°in the control group. Femoral lateral bowing and varus femoral condylar orientation were associated with postoperative alignments. Several clinical outcome scales were inferior in the outliers in mechanical tibiofemoral angle, anatomical tibiofemoral angle, and tibial coronal alignment but not in femoral coronal alignment outliers. Conclusions Lateral femoral bowing, varus condylar orientation, and severe varus inclination of the tibia plateau should be considered when performing TKA in Korean patients or patients with otherwise similar anatomical features.

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Section: Discussionmentioning

confidence: 99%

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Lasam

Lee

Chang

et al. 2013

Clinical Orthopaedics &Amp; Related Research

120

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“…At present, the gold standard for assessing the mechanical axis is by using standing radiographs of the entire lower limb (long plate) [33]. The correct acquisition of such images may be difficult, especially in patients qualified for knee arthroplasty, as pain and limitation of motion of the affected joint both before and after surgery may make it difficult to assume an appropriate position for the study.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Kotela

2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare radiological results of total knee arthroplasties (TKAs) performed with patient-specific computed tomography (CT)-based instrumentation and conventional technique. The main study hypothesis was that CT-based patient-specific instrumentation (PSI) increases the accuracy of TKA. Methods A prospective, randomized controlled trial was carried out between January and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients operated on with the aid of the Signature™ CT-based implant positioning system. The control group consisted of 60 patients operated on using conventional instrumentation. The radiographic evaluation of implant positioning and overall coronal alignment was performed 12 months after the surgery by using standing anteroposterior radiographs of the entire lower limb and standard lateral radiographs. Results Of the 112 patients initially enrolled for the study, 95 were included in the subsequent analyses. There were no statistically significant differences between groups in respect to coronal and sagittal component positioning and overall coronal alignment, except for frontal tibial component positioning. For this parameter, better results were obtained in the control group, with borderline statistical significance. Conclusions Our study did not reveal superiority of the CTbased PSI system over conventional instrumentation. Further high-quality investigations of patient-specific systems are absolutely indispensable to assess their utility for TKA. In our opinion, the surgeon applying PSI technology is required to have advanced knowledge and considerable experience with the conventional method.

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“…The position of the camera was always parallel to the floor. As mentioned by Skyttä et al [27], special attention was paid to obtain a true AP projection because even a slight rotation or flexion of the knees can cause distortion of the alignment measurement. The entire leg from the hip to the ankle was visible on the radiograph.…”

Section: Methodsmentioning

confidence: 99%

Constitutional Varus Does Not Affect Joint Line Orientation in the Coronal Plane

Victor

Bassens

Bellemans³

et al. 2014

Clinical Orthopaedics &Amp; Related Research

142

140

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Comparison of Standard Anteroposterior Knee and Hip-to-Ankle Radiographs in Determining the Lower Limb and Implant Alignment after Total Knee Arthroplasty

Cited by 68 publications

References 18 publications

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Femoral Lateral Bowing and Varus Condylar Orientation Are Prevalent and Affect Axial Alignment of TKA in Koreans

Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Constitutional Varus Does Not Affect Joint Line Orientation in the Coronal Plane

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