Preoperative Malalignment Increases Risk of Failure After Total Knee Arthroplasty

Ritter, Merrill A.; Davis, Kenneth; Davis, Peter; Farris, Alex; Malinzak, Robert A.; Berend, Michael E.; Meding, John B.

doi:10.2106/jbjs.k.00607

Cited by 112 publications

(88 citation statements)

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“…However they found failure rates only increased if there was greater than 7.4°of valgus malalignment. This study demonstrated a relatively narrow range of alignment outcomes, well below the limits set by Ritter et al [32], which may in part be due to the single surgeon series, but failed to demonstrate any advantage in CATKR. Although the followup period was short we were unable to show any improvement in implant survival with CATKR compared to JATKR.…”

Section: Discussioncontrasting

confidence: 67%

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Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

Allen

Hooper

Oram

et al. 2013

International Orthopaedics (SICOT)

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Purpose There remains controversy as to whether computernavigated total knee replacement (TKR) improves the overall prosthesis alignment and patient function. The aim of this study was to determine whether computer-assisted total knee arthroplasty provides superior prosthesis positioning when compared to a conventional jig-assisted total knee replacement and whether this affected the functional outcome. Methods This prospective, randomised controlled study compared computer navigated and conventional jig-assisted total knee replacement in 37 patients who underwent bilateral TKR. A quantitative assessment of the spatial positioning of the implant in the 74 total knee replacements was determined using a low-dose dual-beam CT scanning technique. This resulted in six parameters of alignment that were compared. Functional outcomes using the high activity arthroplasty score and Knee Society score were assessed pre-operatively, postoperatively, at three years and at five years. Patients also indicated which knee they felt was subjectively the best. Results There was no statistically significant difference in the prosthesis alignment between both groups and the number of outliers was not decreased with navigation. All function scores improved from pre-operative to postoperative but there was no statistically significant difference between the groups at five years. At five years, 40.6 % of patients thought their jigassisted knee was the better knee compared with 21.9 % their computer assisted knee and 37.5 % of patients who felt they were the same. Conclusion Computer-assisted implantation of total knee replacements does not offer a significant advantage in prosthesis alignment. There was no difference in functional outcome or subjective "best knee" between the computer-assisted or jig-assisted knee.

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Section: Discussioncontrasting

confidence: 67%

“…Ritter et al [32] reviewed implant survival in relation to pre-operative and postoperative alignment and showed the importance of correct alignment in reducing the risk of implant failure. However they found failure rates only increased if there was greater than 7.4°of valgus malalignment.…”

Section: Discussionmentioning

confidence: 99%

Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

Allen

Hooper

Oram

et al. 2013

International Orthopaedics (SICOT)

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“…Excessive pre-operative malalignment predisposes to a greater risk of failure compared to well-aligned knees. For this reason it is important to correct the deformity during surgery even if it does not completely eliminate the increased risk of failure (1.9 vs 0.5 %) [3]. The valgus deformity is sustained by anatomical variations divided into bone tissue remodelling and soft tissue contraction/elongation.…”

Section: Introductionmentioning

confidence: 99%

Total knee arthroplasty in the valgus knee

Rossi¹,

Rosso

Cottino

et al. 2013

International Orthopaedics (SICOT)

136

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Valgus knee deformity is a challenge in total knee arthroplasty (TKA) and it is observed in nearly 10 % of patients undergoing TKA. The valgus deformity is sustained by anatomical variations divided into bone remodelling and soft tissue contraction/elongation. Bone tissue variations consist of lateral cartilage erosion, lateral condylar hypoplasia and metaphyseal femur and tibial plateau remodelling. Soft tissue variations are represented by tightening of lateral structures: lateral collateral ligament, posterolateral capsule, popliteus tendon, hamstring tendons, the lateral head of the gastrocnemius and iliotibial band. Complete pre-operative planning and clinical examination are mandatory to manage bone deformities and soft tissue contractions/elongations and to decide if a higher constrained prosthesis is necessary. Two different approaches have been described to perform TKA in a valgus knee: the anteromedial approach and the anterolateral one. In valgus knee deformity bone cuts can be performed differently in order to correct low-grade deformities and reduce great deformities. There is still debate in the literature on the sequence of lateral soft tissue release to achieve the best alignment without any instability. The aim of this article is to review the anatomical variations underlying a valgus knee, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. We will also review the main approaches and surgical techniques both for bone cuts and soft tissue management. Finally, we will report on our experience and technique.

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“…Dr. Cross: The main advantage of using a neutrally aligned technique is the proven long-term success and survivorship when a neutral (or near neutral) mechanical axis is achieved. In a retrospective study of more than 5000 TKAs by Ritter et al [16], achieving a neutral mechanical alignment of ''anatomic'' valgus had a lower failure rate (0.74%) than patients outside the neutral mechanical axis (failure rate = 1.7%). However, the effect of achieving neutral mechanical alignment (0 ± 3°) has been recently called in to question.…”

Section: Dr Abdelmentioning

confidence: 96%

“…Regardless of the softtissue envelope, preoperative alignment, and age, a mechanically aligned TKA can always be performed. That said, large preoperative varus (> 8°) and valgus (> 11°) deformities have a higher failure rate [16]. Additionally, with an incompetent medial collateral ligament or lateral collateral ligament, additional constraint may be needed after the cuts are performed, despite achieving a neutral mechanical alignment.…”

Section: Dr Abdelmentioning

confidence: 99%

Clinical Faceoff: Neutrally Versus Kinematically Aligned TKA

Abdel

2015

Clinical Orthopaedics &Amp; Related Research

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Preoperative Malalignment Increases Risk of Failure After Total Knee Arthroplasty

Cited by 112 publications

References 1 publication

Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

Total knee arthroplasty in the valgus knee

Clinical Faceoff: Neutrally Versus Kinematically Aligned TKA

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