Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

Saibaba, Balaji; Dhillon, Mandeep Singh; Chouhan, Devendra Kumar; Kanojia, Ravi Prakash; Prakash, Mahesh; Bachhal, Vikas

doi:10.5792/ksrr.2015.27.3.173

Cited by 21 publications

(14 citation statements)

References 24 publications

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“…The MA technique for primary TKA leads to improved implant durability and patient function because it has good radiographic alignment and few axis outliers. [ 20 , 21 ] However, a study of clinical and radiographic outcomes in 280 patients who underwent primary TKA reported that placement of the prosthesis within 3° of varus or valgus did not improve the Kaplan-Meier 15-year survivorship estimates compared with placement of the prosthesis outside of this range. [ 22 ] Theoretically, the KA technique should provide better clinical results than the MA technique in primary TKA because the KA technique reproduces the obliquity and location of the pre-arthritic joint line, which may lead to improvements in clinical outcomes, greater flexion ROM, and increased patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty

Yoon¹,

Han

Jee³

et al. 2017

Medicine

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Background:This meta-analysis compared clinical and radiographic outcomes and complications of kinematic alignment (KA) and mechanical alignment (MA) techniques in primary total knee arthroplasty (TKA).Methods:All studies comparing the operation time, change in hemoglobin, length of hospital stay, postoperative complications, and clinical and radiographic outcomes as assessed with various measurement tools, from direct interview to imaging methods, in patients who underwent primary TKA through the KA or MA technique were included.Results:Six studies were included in the meta-analysis. The proportion of patients who developed postoperative complications (OR: 1.10, 95% CI: 0.49–2.46; P = .69) did not differ significantly between the KA and MA techniques. The 2 groups were also similar in terms of change in hemoglobin (95% CI: −0.38 to 0.34; P = .91), length of hospital stay (95% CI: −0.04 to 0.55; P = .10), hip-knee-ankle angle (95% CI: −1.76 to 0.75; P = .43), joint line orientation angle (95% CI: −4.27 to 4.23; P = .99), tibial component slope (95% CI: −0.53 to 3.56; P = .15), and femoral component flexion (95% CI: −2.61 to 7.57; P = .34). In contrast, operation time (95% CI: −27.16 to −3.71; P = .01), overall functional outcome (95% CI: 6.59–11.51; P < .0001), knee anatomical axis (95% CI: −1.38 to −0.01; P = .05), femoral component relative to the mechanical axis (95% CI: −2.47 to −1.40; P < .0001), and tibial component relative to the mechanical axis (95% CI: 1.56–2.95; P < .0001) were significantly different between the 2 groups.Conclusions:There were no significant differences in postoperative complications, change in hemoglobin, length of hospital stay, hip-knee-ankle angle, joint line orientation angle, tibial component slope, or femoral component flexion between the KA and MA techniques for primary TKA. However, the KA technique resulted in a significantly shorter operation time and better overall functional outcome than the MA technique, even though the femoral component was placed in a slightly more valgus position relative to the mechanical axis and the tibial component in a slightly more varus position with the KA technique.

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Section: Discussionmentioning

confidence: 99%

Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty

Yoon¹,

Han

Jee³

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

“…[20,21] However, a study of clinical and radiographic outcomes in 280 patients who underwent primary TKA reported that placement of the prosthesis within 3°o f varus or valgus did not improve the Kaplan-Meier 15-year survivorship estimates compared with placement of the prosthesis outside of this range. [22] Theoretically, the KA technique should provide better clinical results than the MA technique in primary TKA because the KA technique reproduces the obliquity and location of the pre-arthritic joint line, which may lead to improvements in clinical outcomes, greater flexion ROM, and increased patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Yoon

Shin

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…23 A postoperative HKA that deviates more than 3 from neutral correlates with worse functional outcome and prosthesis survival. 24 Saibaba et al 6 have reported that extraarticular tibia vara measured by MDA is associated with abnormal postoperative HKA (beyond 180 + 3 ) when MDA is above 4 with a sensitivity of 78.1%, specificity of 62.5%, and p value of 0.03. This was why our study divided MDA by 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Because Saibaba et al have reported that MDA above 4 was associated with abnormal postoperative HKA. 6 Preoperative and postoperative alignment were assessed by measuring HKA in preoperative and postoperative standing lower extremity view, respectively. HKA was defined as the angle created between the mechanical axis of the femur and the mechanical axis of the tibia (Figure 2 There were positive correlations between preoperative HKA and postoperative HKA in overall cases (p ¼ 0.001, r ¼ 0.187; Table 3).…”

mentioning

confidence: 99%

Postoperative radiologic outcome comparison between conventional and computer-assisted navigation total knee arthroplasty in extra-articular tibia vara

Cho

Shin

Kim

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Total knee arthroplasty (TKA) is the definite treatment for osteoarthritis. Meanwhile, significant inherent extra-articular varus angulation is associated with abnormal postoperative hip–knee–ankle (HKA) angle. Computer-assisted navigation TKA (CAS-TKA) used in patients who have severe varus deformity. The purpose of this study was to compare postoperative radiologic outcome between CAS-TKA and conventional TKA for extra-articular tibia vara. Methods: A retrospective review of postoperative HKA on standing lower extremity views was conducted in patients who underwent TKA by a single surgeon from 2010 to 2018, including knee with conventional TKA ( n = 83) and CAS-TKA ( n = 246). Extra-articular tibia vara was assessed by measuring the metaphyseal–diaphyseal angle (MDA) of the tibia in preoperative standing lower extremity view. Postoperative alignment was assessed by measuring the HKA in postoperative standing lower extremity view. Results: There was no significant difference in age ( p = 0.063), gender ( p = 0.628), body mass index ( p = 0.426), preoperative range of motion ( p = 0.524), preoperative HKA ( p = 0.306), preoperative MDA ( p = 0.523), or postoperative HKA ( p = 0.416) between the two groups (conventional TKA and CAS-TKA). There was no significant difference in postoperative alignment for cases with MDA ≤4° ( p = 0.351) or MDA >4° ( p = 0.866) in each group. There was a positive correlation between preoperative HKA and postoperative HKA in the CAS-TKA group ( p < 0.001, r = 0.243). However, there was no significant correlation between preoperative HKA and postoperative HKA in the conventional TKA group ( p = 0.732). Conclusions: There was no significant difference in postoperative alignment between conventional TKA and CAS-TKA in extra-articular tibial vara even for cases with MDA >4°.

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Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

Cited by 21 publications

References 24 publications

Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty

Comparison of kinematic and mechanical alignment techniques in primary total knee arthroplasty

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Postoperative radiologic outcome comparison between conventional and computer-assisted navigation total knee arthroplasty in extra-articular tibia vara

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