The difficult primary total knee arthroplasty

Baldini, Andrea; Castellani, Lorenzo; Traverso, F.; Balatri, Amerigo; Balato, Giovanni; Franceschini, Vincenzo

doi:10.1302/0301-620x.97b10.36920

Cited by 61 publications

(49 citation statements)

References 71 publications

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“…An associated sagittal deformity (either flexion or hyperextension) is frequently seen in arthritic knees undergoing TKA5,6). However, the effect of sagittal knee deformity on coronal mechanical alignment measurements in patients undergoing TKA has not been previously studied.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

Shetty

Mullaji

Khalifa

et al. 2017

Knee Surg Relat Res

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PurposeThe purpose of this prospective study was to determine correlation between coronal mechanical alignment measured on preoperative standing full-length radiographs and navigation during total knee arthroplasty (TKA) in the presence of an associated sagittal deformity (hyperextension and flexion deformity).Materials and MethodsCoronal mechanical alignment measured on preoperative, standing, full-length, hip-to-ankle anteroposterior radiographs was compared with intraoperative measurements recorded with computer navigation in 200 primary navigated TKAs.ResultsThe mean difference in mechanical alignment between the two techniques was significantly greater (p=0.001) in patients with an associated flexion deformity >10° when compared to knees with associated flexion deformity ≤10°; 48% of knees with a flexion deformity >10° had a difference of ≥3° between the full-length radiograph and navigation alignment measurements. There was a strong correlation between the radiographic and navigation measurement techniques.ConclusionsThe mean difference in coronal mechanical alignment between the two techniques was significantly higher in patients with an associated flexion deformity >10°. Hence, surgeons should take caution when relying on preoperative full-length radiographs for determining coronal mechanical alignment in patients with an associated flexion deformity >10° where using navigation may be more reliable.

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Section: Introductionmentioning

confidence: 99%

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

Shetty

Mullaji

Khalifa

et al. 2017

Knee Surg Relat Res

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“…19 A possible suggestion for this result may be because the patients who had navigated TKA had better planned cuts using the assistance of the navigation program. 2 Therefore, understanding how knees with pre-existing deformity behave can help the surgeon plan the TKR.…”

Section: Discussionmentioning

confidence: 99%

Review of the Relationship Between Knee Alignment and Fixed Flexion Deformity and How This Can Influence Total Knee Arthroplasty: A Retrospective Cohort Study

Sajid

Kuiper

Davis

2017

J. Musculoskelet. Res.

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Total knee arthroplasty relies on accurate balancing of soft tissues and knee alignment to prevent postoperative pain and early loosening. Pre-existing fixed flexion deformity (FFD) and varus and valgus deformity add to the challenge of ligament balancing. This observational retrospective cohort study reviewed the relationship between FFD and valgus/varus knee. Data from computer-assisted knee replacement was collected and analyzed. The FFD and knee alignment were noted before making bone cuts. The results showed that as the valgus deformity increases, there is a trend for FFD to decrease but this relationship is not significant (correlation is À0.19, p ¼ 0:19). As varus deformity increases, there is a significant increase in FFD (correlation is 0.36, p < 0:0001). Varus knees have a positive correlation with FFD and may be more challenging to treat, as the surgeon is more likely to need to address alignment deformity in both coronal and sagittal planes. Understanding the relationship between FFD and valgus/varus knee alignment and recognizing the pre-existing deformity the patient exhibits can help surgeons with pre-operative planning and be useful in guiding intra-operative bony cuts and soft tissue releases.

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“…There are two schools of thoughts to achieve this. a) One to initially restore the anatomical axis with corrective osteotomy and then to perform routine arthroplasty [1] . b) While the second group votes to leave the deformity as such and align the knee to the mechanical axis there by nullifying the abnormal force acting on the joint.…”

Section: Mechanical Axismentioning

confidence: 99%

“…b) While the second group votes to leave the deformity as such and align the knee to the mechanical axis there by nullifying the abnormal force acting on the joint. This can be achieved either by computer aided navigation or patient specific instrumentation [1] . While restoring mechanical axis much importance given to coronal plane whereas mechanical axis in sagittal plan given least importance in literature.…”

Section: Mechanical Axismentioning

confidence: 99%

“…In many case studies TKA shows excellent results with minimal complication rate. But in situations like pre-existing deformity of bone or soft tissue pathology can lead to raise the complication rate from 5% to 41% [1] . Aiming to improve the result of total knee arthroplasty in special situation clinical researches and technological researches are being made throughout the world.…”

Section: Introductionmentioning

confidence: 99%

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Total knee arthroplasty in patients with extra-Articular deformity: A critical analysis

Gokulakrishnan¹,

Balaji²,

Ashraf³

2018

Int. J. Orthop. Sci.

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Total knee arthroplasty is the standard of care for the patients with severe degenerative joint disease. There are still controversies among surgeons about restoring alignment in knee with Extra Articular Deformity. Some author reports corrective osteotomy to align anatomical axis there by restoring mechanical axis indirectly, while others restores mechanical axis directly using special instruments. We conduct a qualitative analysis of outcome in restoring mechanical axis directly and indirectly by, Post op alignment, Perioperative morbidity, Advantages and disadvantages of devises used for osteotomy fixation, Merits and demerits of navigation and Period of rehabilitation. Twenty five articles have been identified with Extra Articular Deformity. Twelve are evaluating outcome of single stage corrective osteotomy coupled with Total Knee Arthroplasty, two studies about dual stage Corrective osteotomy with Total Knee Arthroplasty. Seven are restoring mechanical axis by intra articular correction using computer assisting navigation, and three achieving Mechanical axis by intra articular correction using Patient Specific Instrumentation, and remaining one is a comparative study between intra articular correction with Extra Articular Deformity. Our review shows that average preoperative deformity is slightly higher (>20* in coronal plane) in Extra articular correction group than Intra articular correction. But restoration of mechanical axis is superior with intra articular correction than with corrective osteotomy, more over complications like delay in rehabilitation, non-union, delayed union, and infections at osteotomy site are reported in extra articular correction which are not there with deformities corrected intra-articularly. Considering overall outcome, extra-articular deformity corrected by intra-articular resection carries good postoperative alignment with less complication rate. But not sufficient studies are available to support intra articular correction in knee with higher degree of extra articular deformity. As most of the studies with intra articular correction of extra articular deformity provides encouraging results not much studies supporting it with higher extra articular deformity.Keywords: Knee arthroplasty, Deformity correction knee arthroplasty, intra articular correction, Extra articular correction IntroductionThe incidence of knee osteoarthritis are increasing in trend, with view to upgrade quality of mobility and restore function patient with symptomatic OA often require total knee arthroplasty. In many case studies TKA shows excellent results with minimal complication rate. But in situations like pre-existing deformity of bone or soft tissue pathology can lead to raise the complication rate from 5% to 41% [1] . Aiming to improve the result of total knee arthroplasty in special situation clinical researches and technological researches are being made throughout the world. Success of total knee arthroplasty depends on number of factors starts with a) Patient selection, b) Appropriate p...

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The difficult primary total knee arthroplasty

Cited by 61 publications

References 71 publications

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

The Effect of Sagittal Knee Deformity on Preoperative Measurement of Coronal Mechanical Alignment during Total Knee Arthroplasty

Review of the Relationship Between Knee Alignment and Fixed Flexion Deformity and How This Can Influence Total Knee Arthroplasty: A Retrospective Cohort Study

Total knee arthroplasty in patients with extra-Articular deformity: A critical analysis

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