Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty

Novotny, John E.; Gonzalez, Mark H.; Amirouche, Farid; Li, Y.C.

doi:10.1054/arth.2001.23714

Cited by 66 publications

(57 citation statements)

References 4 publications

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“…This may have been attributable to the limited surgical exposure. Although there are adequate data to corroborate the importance of accurate femoral component alignment in the coronal plane [9,31,32,38], we are not aware of equally strong evidence concerning sagittal orientation of the femoral component. We found prolonged tourniquet and operating times for MIS TKAs, which is in agreement with other publications [11,24,25,27,37].…”

Section: Discussionmentioning

confidence: 80%

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Liebensteiner

Krismer

Koller³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Less invasive dissection of the extensor apparatus, one of the aspects of minimally invasive surgical (MIS) TKA, might result in less reduction of postoperative quadriceps strength. However, it is unclear whether MIS is associated with less strength reduction. Questions/purposes We asked whether knee strength (extensor or flexor torque) would be greater in patients having a MIS TKA compared with patients having a standard TKA and whether knee scores, alignment, ROM, tourniquet and operating times, and hospital length of stay were improved. Methods We prospectively recruited 52 patients awaiting MIS or standard TKA, matched for age, weight, height, BMI, sex, and surgically treated side, but not randomized. Isokinetic tests were performed preoperatively and postoperatively to obtain peak values of extensor and flexor torque. Postoperative-to-preoperative ratios and the extensor-flexor torque ratio also were calculated. Results Mean baseline extensor torques were 57 Nm and 53 Nm for MIS and standard TKAs, respectively. At 8 weeks postoperatively, absolute values of the mean postoperative knee extensor torque also were similar: 47 and 45 Nm for patients with MIS and standard TKAs, respectively. The postoperative-to-preoperative ratios were 0.8 for extensor and flexor torque in both groups. The extensor-flexor torque ratios were similar between groups. Conclusions Our data suggest a less invasive dissection of the extensor apparatus involved in MIS TKA does not enhance postoperative quadriceps strength. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 80%

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Liebensteiner

Krismer

Koller³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…The principal limitation was the lack of a control group in which a standard technique using intra-operative radiographs and EM jigs were used when femoral IM instrumentation was contraindicated. Another restraint included the limited accuracy in measuring angles on plain radiographs according to inherent measurement errors [24]. Finally, another important limitation was the relatively small number of patients treated and the retrospective nature of the study.…”

Section: Discussionmentioning

confidence: 99%

Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity

Tigani

Masetti²,

Sabbioni

et al. 2012

International Orthopaedics (SICOT)

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Purpose The use of traditional cutting guides during knee arthroplasty in some cases could be extremely difficult, if not impossible, because of angular deformities, IM sclerosis, long-stemmed hip implants, or hardware within the femoral canal that cannot be removed. In these difficult cases navigation-assisted knee arthroplasty should be considered as an effective and appealing option. Methods We present 14 cases in which ideal mechanical and prosthetic alignment was achieved with different image-free, computer-assisted navigation systems, because of an extra-articular deformity (group A, nine patients) or because of a retained implant or hardware (group B, five patients).Results After a mean follow-up of 28 months (range 12-53 months), the average knee score increased overall from a mean of 33 points (range 12-63) to 78 points (range 63-90). The average functional score improved from a mean of 32 points (range 10-65) to 72 points (range 40-90). The postoperative mechanical axis ranged between 3°of varus and 3°of valgus. There was an implant revision in one patient who had a traumatic rupture of medial collateral ligament, which occurred 27 months after the index procedure.Conclusions Based on our results we think that the navigationassisted technique provides an alternative approach to the traditional instrumentation for treating these difficult patients in an effective and less invasive manner.

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“…They found an alignment of more than ±3°varus/valgus in 25% of cases, independent of the surgeon's experience. Although various guiding tools for alignment have been designed to improve accuracy, several limitations of these instruments have been reported [11][12][13][14]. Errors may be due to variations in the bony anatomy, visual misjudgement by the surgeon or limitations of the technique.…”

Section: Introductionmentioning

confidence: 99%

A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters

Lüring

Kauper

Bäthis

et al. 2011

International Orthopaedics (SICOT)

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Purpose Computer-assisted knee surgery has become established in routine clinical practice. Still, there is no study investigating midterm clinical outcome after five to seven years postoperatively. We aimed to test the hypothesis that there is no difference either for subjective [Western Ontario and McMaster Universities (WOMAC) scores] or for objective (Knee Society Score, degree of flexion) criteria between computer-assisted total knee replacement (TKR) and freehand TKR after 5.6-7.3 years. Methods We performed a matched-pair analysis; 100 patients who received a primary TKR were investigated after a median follow-up of 6.25 years. Group A was operated on with the support of a computer system, while surgery on patients in group B was performed with the freehand technique. We determined WOMAC Score, Knee Society Score and degree of flexion.

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Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty

Cited by 66 publications

References 4 publications

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Computer-assisted surgery as indication of choice: total knee arthroplasty in case of retained hardware or extra-articular deformity

A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters

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