Fixed Distal Femoral Cut of 6° Valgus in Total Knee Arthroplasty: A Radiographic Review of 788 Consecutive Cases

Andrews, Samantha; Beeler, Derek; Parke, Elizabeth A.; Nakasone, Cass K.; Stickley, Christopher D.

doi:10.1016/j.arth.2018.12.013

Cited by 15 publications

(7 citation statements)

References 32 publications

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“…There is still room for debate whether choosing a fixed angle valgus cut (5–7°) of distal femur or applying individualized valgus cut for each patient would be suitable to achieve standard post-operative knee alignment; as there are some reports supporting personalized cutting techniques. Conversely, other reports have noted that fixed angle cuts of distal femur results in favorite alignment in most cases [ 37 – 41 ]; it seems that the simplified fixed angle (e.g., 5°) technique suits for uncomplicated cases once individualized equipment are not accessible, given that final angle cut of distal femur may not affect patients’ functional short-term outcomes[ 21 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty

et al. 2022

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Background Coronal alignment after total knee arthroplasty (TKA) would influence the implant survival. Coronal alignment could be measured on short and full-length X-rays. The goal of the current study was to assess the correlation of short and full-length X-rays to accurate prediction of the true Hip-Knee-Ankle alignment after TKA in the Iranian population. Methods Lateral distal femoral and medial proximal tibial angles, FTA, HKA, in 180 Iranian patients (243 knees without extra-articular deformities) were measured and compared on short and full-length standing X-rays of primary TKA pre/postoperatively. Results The correlation between the preoperative FTA-short and FTA-long, FTA-short and HKA, and FTA-long and HKA values in degrees were fair, good and good (r = 0.64) (r = 0.73), (r = 0.76), respectively. This correlation for postoperative aMPTA and mMPTA (r = 0.73), and FTA-short and HKA (r = 0.76) values were good and significant (P = 0.001). Also, assessing coronal alignment based on short and full-length measurements would result in varying pre/postoperative alignments (varus, neutral and valgus). Conclusion Full length X-rays could not be replaced by short knee X-rays to asses true coronal alignment in TKA; considerable portion of our cases were missorted as varus, neutral or valgus based on the FTA versus the HKA. Intraoperative fixed 5° valgus angle cut of distal femur did not result in postoperative favorable neutral alignment in all cases. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty

et al. 2022

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“…All surgeries were performed with conventional instrumentation including an intramedullary distal femoral cutting guide set at 6-degree valgus and use of an extramedullary tibial cutting guide. 23 The capsule was closed using a barbed suture and the subcutaneous layer was closed with interrupted braided suture. Final wound closure was completed using either staples or a zipper method (ZipLine Medical, Silicon Valley, CA).…”

Section: Methodsmentioning

confidence: 99%

Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty

et al. 2021

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Single-stage bilateral total knee arthroplasty (ssBTKA) can be used for patients presenting with bilateral arthritis and may result in fewer systemic and wound complications compared with two, independent procedures. However, the safety of ssBTKA in the elderly remains controversial. Therefore, the purpose of this study was to compare early complications and transfusion rates following ssBTKA in patients ≤ 70 years old or > 70 years old. This retrospective chart review of 313 consecutive patients undergoing ssBTKA included 174 patients ≤ 70 years old and 139 patients > 70 years old. Perioperative variables and postoperative complications were compared with univariate analyses between age groups. Multivariate analyses were performed to determine risk factors for developing perioperative complications and transfusions. Compared with patients ≤ 70, patients > 70 had significantly lower body mass index (p < 0.001) and were more commonly female (p = 0.024). Although wound (p > 0.12) and systemic complications (p > 0.54) were similar, 23% of patients > 70 required transfusion compared with only 8% of patients ≤ 70 (p < 0.001). Patients with preoperative anemia (p < 0.001), age > 70 (p = 0.002), or diabetes mellitus (p = 0.007) were at 5.7, 3.3, and 2.9 times greater risk for requiring a transfusion, respectively. Patients > 70 undergoing ssBTKA have a similar complication profile to patients ≤ 70 years old, suggesting age should not be an absolute exclusion criterion for ssBTKA. However, the risk of transfusion was significantly higher in those > 70, despite lower tourniquet times. Treatment of preoperative anemia may decrease the risk of transfusion and could provide adequate safety for patients > 70 to undergo ssBTKA by an experienced surgeon.

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“…6° or 7°) is used. [ 5 ] Resulting axis deviations are likely to impair clinical performance[ 6 ] and malalignment of implants contributes to the probability of failure after TKA.…”

Section: Introductionmentioning

confidence: 99%

Influence of the femoral entry point for intramedullary alignment in total knee arthroplasty: A computer-aided design approach

Stotter

Reiter²,

Schretter³

et al. 2022

Jt Dis Relat Surg

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Objectives The aim of this study was to simulate different entry points and investigate potential angulation errors of the intramedullary device and resulting changes in the distal femoral cut using a computer-aided design (CAD) approach. Materials and methods We used a CAD approach to simulate various distal femoral entry points for intramedullary instrumentation. Simulations were performed on (i) a commercially available three-dimensional (3D) CAD model of a human femur (DigitalFemur) and (ii) a digital 3D model of an analogue large femur model produced using a coordinate measuring machine (FaroFemur). Divergent insertion points medial, lateral, anterior and posterior to the ideal position were simulated. Angulation deviations of the resulting positions of the intramedullary rod were measured and changes in the anatomical-mechanical axis angle were calculated. Differences between the two simulation models were quantified. Results The ideal entry point in the FaroFemur was 9.9 mm anterior and 4.3 mm medial to the apex of the intercondylar notch, and 9.2 mm anterior and 3.6 mm medial in the DigitalFemur. A medial entry point increased the angle between the anatomical femoral axis and the alignment rod in the FaroFemur and DigitalFemur (with 5 mm displacement 2.510° and 2.363°, respectively; with 10 mm displacement 3.239° and 3.283°, respectively). In contrast, a lateral entry point decreased the angle between the anatomical femoral axis and the alignment rod (with 5 mm displacement 2.267° and 2.262°, respectively; with 10 mm displacement 3.158° and 3.731°, respectively). An anterior entry point changed the angle between the anatomical femoral axis and the alignment rod towards extension (1.802° in the FaroFemur; 2.142° in the DigitalFemur), while a posterior entry point generated a deviation toward flexion (2.045° in the FaroFemur; 2.055° in the DigitalFemur). The mean difference between the two models was 0.108±0.121° with the highest difference for anterior displacement. Conclusion Minor deviations of the entry point for intramedullary instrumentation during total knee arthroplasty can result in malalignment of several degrees.

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Fixed Distal Femoral Cut of 6° Valgus in Total Knee Arthroplasty: A Radiographic Review of 788 Consecutive Cases

Cited by 15 publications

References 32 publications

Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty

Correlation of short knee and full-length X-rays in evaluating coronal plane alignment in total knee arthroplasty

Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty

Influence of the femoral entry point for intramedullary alignment in total knee arthroplasty: A computer-aided design approach

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