Total Knee Arthroplasty after Supracondylar Femoral Osteotomy

Scuderi, Giles R.; Insall, John N.; Bolanos, Alberto A.

doi:10.1007/0-387-21714-2_81

Cited by 2 publications

(7 citation statements)

References 9 publications

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“…Na axiálním snímku pately ve 30 stupních flexe jsme posuzovali její umístění ve femorálním žlábku. (31,32). Tato metoda předpokládá precizní vazivové vyvážení před resekcí .…”

Section: Materiál a Metodikaunclassified

“…V případě příliš volného vnitřního postranního vazu nebo při rigiditě laterálních struktur mohou vzniknout problémy. Poilvache, Scuderi, Hofmann doporučují použít kombinaci dvou metod, a to transepikondylární osy a Whitesideovy linie pro dosažení správné hodnoty rotace femorální komponenty (15,16,29,32). V naší práci zabývající se srovnáním dvou metod měření CTA jsme při peroperačním měření jako referenční hodnotu zvolili kompromis mezi oběma liniemi (transepikondylární a transsulkální) pro stanovení rotace femorální komponenty (21).…”

Section: Materiál a Metodikaunclassified

“…Nejčastěji jsou jako příčiny patelární bolesti uváděny design endoprotézy, operační technika, nesprávné umístění jednotlivých komponent, výběr velikostí, neobnovení fyziologické mechanické osy (reziduální valgózní koleno), nedokonalé vybalancování měkkých tkání a insuficientní opracování čéšky (12,19,31,32,34). Rovněž některá zánětlivá onemocnění (revmatoidní artritis) nebo metabolická (dna, diabetes mellitus), eventuálně vrozené vady (femoropatelární dysplazie, patella nail syndrom, patella baja, patella alta), poúrazové deformity nebo stavy po patelectomii mohou být provázeny bolestí na přední straně kolenního kloubu.…”

Section: Původní Práce Original Paperunclassified

“…Rovněž některá zánětlivá onemocnění (revmatoidní artritis) nebo metabolická (dna, diabetes mellitus), eventuálně vrozené vady (femoropatelární dysplazie, patella nail syndrom, patella baja, patella alta), poúrazové deformity nebo stavy po patelectomii mohou být provázeny bolestí na přední straně kolenního kloubu. Uplatňují se také poruchy svalové rovnováhy, hypotrofie a hypotonie čtyřhlavého svalu, ale i poruchy psychické (31,32). Klademe důraz na důkladné předoperační klinické vyšetření, radiodiagnostické vyšetření, pečlivou operační techniku a individuální přístup.…”

Section: Původní Práce Original Paperunclassified

“…Peroperační měření CTA výrazně sníží počet revizních operací, a proto ho doporučujeme ve shodě s mnohými autory (5,8,18,25,31,32,35). Někteří autoři preferují navigaci pro její přesnost při stanovení mechanické osy a rotace femorální komponenty, zvláště u extraartikulárních deformit na femuru a tibii u poúrazových stavů, kde nelze použít klasickou instrumentaci a nebo v případě přítomnosti implantátů při osteosyntéze (11,17,26).…”

Section: Původní Práce Original Paperunclassified

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Comparison of Patellar Pain after Total Knee Arthroplasty with Conventional versus Individual Femoral Rotational Alignment

Koudela

Koudelová²,

Kormunda³

et al. 2012

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYThe aim of the study was to find out whether the frequency and intensity of patellar pain can be affected by individual rotational alignment of the femoral component in total knee arthroplasty, as compared with the standard 3 degrees of external femoral rotation in conventional procedures. MATERIAL AND METHODSIn randomly selected patients treated for knee osteoarthritis by total joint replacement between January 2007 and January 2011, the occurrence of patellar pain was assessed. The evaluated knees were allocated to two groups. Group 1 included 350 knee joints with conventional femoral rotational alignment, i.e., 3 degrees of external rotation. Group 2 comprised 380 knee joints with an individual rotational alignment of the femoral component based on the condylar twist angle. Post-operative anterior knee pain was assessed on the following scale: 1, no pain; 2, occasional mild pain; 3, moderate pain; 4, severe pain. RESULTSIn group 1, 312 knee joints were free from pain, 15 occasionally experienced mild pain, 15 had moderate and eight had severe pain. A total of 23 revision operations were performed for patellar pain at the anterior knee and pain around the patella refractory to non-steroidal anti-rheumatic and rehabilitation therapy. In group 2, there were 331 pain-free knees, 48 with occasional mild pain, one with moderate pain and no knee with severe pain. No revision surgery was required. One patient with moderate patellar pain underwent surgery for spinal canal stenosis; after that knee pain was only mild. The groups were compared, as to pain assessment results, using the test of equality of relative frequencies, i.e., score categories 1+2 versus 3+4 of 350 (group 1) equalled 23 (6.57%) were compared with 1 (0.26%) of 380 (group 2); the difference was significant (p < 0.001). Using the same test for comparison of the frequency of repeat operations, i.e., 23 (0.57%) of 350 (group 1) versus 0 (0%) of 380 (group 2), also gave a significant result (p = 0.001). DISCUSSIONMild and occasional pain was recorded in both groups, suggesting that femoral component malrotation is not the only cause of patellar pain following total knee arthroplasty. A markedly lower incidence of moderate and severe pain and no need for revision surgery found in group 2 provides evidence that the use of individual rotational alignment of the femoral component is fully justified. CONCLUSIONSAn individual rotational alignment of the femoral component can significantly reduce the incidence of moderate to severe patellar pain or even need for revision surgery.

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Section: Materiál a Metodikaunclassified

Section: Původní Práce Original Paperunclassified

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Comparison of Patellar Pain after Total Knee Arthroplasty with Conventional versus Individual Femoral Rotational Alignment

Koudela

Koudelová²,

Kormunda³

et al. 2012

Acta Chir. orthop. Traum. Cech.

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Comparison and Statistical Evaluation of Two Methods of Condylar Twist Angle Measurement in Total Knee Arthroplasty

Koudela

Koudelová²,

Kormunda³

et al. 2012

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYThe aim of this prospective randomised study was to compare and statistically analyse two methods of condylar twist angle (CTA) measurement in total knee arthroplasty in order to assess their applicability in routine practice. MATERIAL AND METHODSThe study included 238 patients with 256 sites undergoing total knee arthroplasty (TKA) in the period from January 2009 to May 2011. There were 93 men (nine with bilateral TKA) and 145 women (nine with bilateral TKA) with an average age of 69.3 years and a range of 47 to 88 years. The implants NexGen (Zimmer) and ADVANCE ® Medial-Pivot Knee (Wright) were used. In each patient, CTA was measured before surgery by the radiologist on a multidetector CT SOMATOM 64 (Siemens) using the Yoshioki method. The other CTA measurement was made intra-operatively by the surgeon using our modification of the Hofmann method which involved the identification of a reference line for optimal rotational alignment of the femoral component. A STATISTICA 9.0 software package was used for statistical analysis. In addition to basic statistical data, selected data were presented in graphical forms as Box and Whisker's plots and histograms. Changes in CTA and differences between the groups were evaluated using the Wilcoxon signed-rank test. Relationships among the variables were studied using Spearman's correlation coefficient. RESULTSThe statistical analysis showed that the pre-operative CTA value obtained from CT scans was, on the average, higher by 0.5 degrees than the value from intra-operative measurement, as assessed at the level of significance p = 0.001 (signed-rank test). The intra-individual variability was lower than the inter-individual one (14.4% and 30.8%, respectively). This means that both methods are suitable for CTA measurement in the knee joint replacement procedures. Spearman's correlation coefficient was 0.6, which is the value of medium strong correlation. The post-operative CTA assessed on CT scans was in the range of 0 to 2 degrees in 87.5% of the patients. Both the pre-operative and intra-operative CTA values were significantly higher in women than in men (Wilcoxon two-sample test). There was no statistical difference between the left and the right side. DISCUSSIONMalrotation of the femoral component is one of the causes leading to patellar subluxation and pain in the front part of the knee. The post-operative CTA value should be zero. Optimal rotational alignment of the femoral component varies with each patient; in our study it was found in the range of 0 to 7 degrees on the basis of CTA values. We do not recommend 7 degrees of external rotation to be exceeded because of the risk associated with balancing the flexion gaps; nor do we recommend to set internal rotation of the femoral component for the risk of patellar complications. The difference of 0.5 degree found in the CTA value between the two measuring methods can be explained by individual differences in the anatomy of the medial epicondylar region, and by the use of only selected whole numbers (0...

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Total Knee Arthroplasty after Supracondylar Femoral Osteotomy

Cited by 2 publications

References 9 publications

Comparison of Patellar Pain after Total Knee Arthroplasty with Conventional versus Individual Femoral Rotational Alignment

Comparison of Patellar Pain after Total Knee Arthroplasty with Conventional versus Individual Femoral Rotational Alignment

Comparison and Statistical Evaluation of Two Methods of Condylar Twist Angle Measurement in Total Knee Arthroplasty

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