scholarly journals Coronal Alignment in TKA: Traditional Principles Versus New Concepts

2018 ◽  
Vol 8 (2) ◽  
Author(s):  
Thomas J Parisi ◽  
Jason M Jennings ◽  
Douglas A Dennis
Keyword(s):  
Clinical Laboratory ◽  
Clinical Results ◽  
Important Variable ◽  
Kinematic Alignment ◽  
Coronal Alignment ◽  
Search Terms ◽  
New Concepts ◽  
Total Knee ◽  
Constitutional Varus

Background: Up to 20% of total knee arthroplasty (TKA) patients are not satisfied with their outcome, and coronal alignment is considered an important variable in attaining a well-functioning TKA. Neutral mechanical alignment is not necessarily the anatomic norm and has led some surgeons to advocate a shift in defining and attaining the optimal coronal component alignment. Our aim was to review the different coronal alignment paradigms of TKA and summarize the historical and contemporary outcomes of different alignment techniques.Methods: A systematic review was performed in March 2017 via PubMed using the search terms: coronal alignment, kinematic alignment, and total knee replacement using Boolean “and” in-between terms. Relevant results were then reviewed, analyzed and summarized Conclusions: Early clinical outcomes of kinematically aligned TKAs are promising, but long-term clinical results are unknown. Clinical, laboratory, and retrieval studies suggest that mechanical varus in TKA, especially involving the tibial component, may result in earlier failure. Kinematic alignment with boundaries may be an optimal strategy for patients with pre-operative constitutional varus or congenital tibia vara.

scholarly journals Preoperative Radiological Assessment of The Total Knee Arthroplasty

2021 ◽  
Author(s):  
Atilla Hikmet Cilengir ◽  
Suat Dursun ◽  
Kazım Ayberk Sinci ◽  
Özgür Tosun
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Clinical Results ◽  
Preoperative Imaging ◽  
Radiographic Evaluation ◽  
Prosthetic Material ◽  
Total Knee ◽  
Severity Of The Disease ◽  
Implant Alignment

Total knee arthroplasty (TKA) is a surgery method that can reduce symptoms and restore joint functions. Long-term success of this operation depends on the correct anatomical and mechanical planning before the prosthetic material implantation. Accurate implant alignment together with anatomical balance provides more successful clinical outcomes and longer duration of the prosthetic material. Improper preoperative planning may cause implant loosening and increased load on the knee joint. Conventional radiographs are the most frequently used imaging methods for this purpose. Computed tomography and magnetic resonance imaging may be used in required cases. In addition, computer-aided systems have come into use and successful results have been reported. Early radiographic evaluation is unnecessary after an uncomplicated TKA. Preoperative imaging has several aims such as to assess the severity of the disease, to analyze the reserve bone tissue, to review the relevant anatomy, and to decide which implant and surgical approach will be applied. In this article, we aimed to present the necessary and also auxiliary radiological evaluations made before TKA in order to achieve better clinical results.

scholarly journals Influence of Gender on Occurrence of Aseptic Loosening and Recurrent PJI after Revision Total Knee Arthroplasty

Osteology ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 92-104
Author(s):  
Arne Kienzle ◽  
Sandy Walter ◽  
Yannick Palmowski ◽  
Stephanie Kirschbaum ◽  
Lara Biedermann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Prosthesis Failure ◽  
Coronal Alignment ◽  
Total Knee ◽  
Revision Tka

Background: Periprosthetic joint infection (PJI) is a common yet severe complication after total knee arthroplasty (TKA). Surgical intervention and antibiotic therapy are obligatory to achieve successful, infection-free outcome. Compared to the outcomes after primary TKA, prosthesis failure rates are drastically increased after PJI-dependent revision surgery. Recurrent PJI and aseptic loosening are the most common reasons for prosthesis failure after revision TKA. An open question is the influence of the patients’ gender on long-term prosthesis survival after revision surgery. Additionally, it is unknown whether gender-related parameters and risk factors or differences in treatment are responsible for potential differences in outcome after revision arthroplasty. Patients and Methods: In this report, 109 patients that received TKA revision surgery due to PJI were retrospectively analyzed. We used clinical, paraclinical and radiological examinations to study the influence of gender on the long-term complications aseptic loosening and recurrent PJI after PJI-dependent revision arthroplasty. Results: While overall prosthesis failure rates and risk of recurrent PJI did not differ between genders, the long-term risk of aseptic loosening was significantly elevated in female patients. Postoperative coronal alignment was significantly more varus for women later diagnosed with aseptic loosening. Besides coronal alignment, no gender-dependent differences in clinical presentation or treatment were observed. Conclusions: Female patients displayed a significantly increased risk for aseptic loosening after PJI-dependent revision TKA. The observed gender-dependent differences in long-term outcome in our study support theories surrounding the role of bone metabolism in the development of aseptic loosening. Our data suggest that further research on a female design for PJI-dependent revision prostheses is warranted.

scholarly journals Tibial crest alignment technique-an effective technique to improve coronal alignment of tibial component in tka for arthritic knees

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0051
Author(s):  
Shaival Dalal ◽  
Ghislain Aminake ◽  
Amit Chandratreya ◽  
Rahul Kotwal
Keyword(s):  
Tibial Component ◽  
Mechanical Axis ◽  
Intraclass Correlation ◽  
Coronal Alignment ◽  
Effective Technique ◽  
Angle Of Deviation ◽  
Alignment Technique ◽  
Total Knee ◽  
Implant System

Introduction: Long term survivorship in Total Knee Arthroplasty is significantly dependent on prosthesis alignment.Accuracy of component positioning relies on alignment guides for making precise and accurate bone cuts. Hypotheses: The aim of this study was to determine, compare and analyse the coronal alignment of the tibial component of a single implant system using 3 different techniques. Methods: Retrospective study of cases from a prospectively collected database. Radiological assessment included measurement of the coronal alignment of tibial components of total knee arthroplasties, and its deviation from the mechanical axis. A comparison study of intramedullary, extramedullary and tibial crest alignment methods was performed. Results: 66 consecutive patients (3 groups of 22 each). Mean BMI was 26. The mean angle of deviation from the mechanical axis was significantly lesser (p< 0.05) in the Tibial crest alignment group patients compared to the other 2 groups. Moreover, the number of outliers (+/-3 degrees) were 2 and 4 in the intra and extramedullary group, whereas there were none in the tibial crest group. The inter and intraclass correlation coefficient was 0.8 and 0.9 respectively. Conclusion: The Tibial Crest Alignment Technique is an effective technique to produce consistent results to achieve optimal coronal alignment of the tibial component in TKA, even in patients with high BMI.

Biomechanics and wear comparison between mechanical and kinematic alignments in total knee arthroplasty

2018 ◽  
Vol 232 (12) ◽  
pp. 1209-1218 ◽  
Author(s):  
Zhenxian Chen ◽  
Yongchang Gao ◽  
Shibin Chen ◽  
Qida Zhang ◽  
Zhifeng Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Contact Force ◽  
Knee Arthroplasty ◽  
Kinematic Alignment ◽  
Wear Volume ◽  
Mechanical Alignment ◽  
Collateral Ligament ◽  
Cycle Simulation ◽  
Total Knee

The uses of mechanical and kinematic alignments in total knee arthroplasty are under debate in recent clinical investigations. In this study, the differences in short-term biomechanics and long-term wear volume between mechanical and kinematic alignments in total knee arthroplasty were investigated, based on a subject-specific musculoskeletal multi-body dynamics model during walking gait simulation. An increase of 8.2% in the peak tibiofemoral medial contact force, a posterior contact translation by maximum 4.7 mm and a decrease of 5.5% in the wear volume after a 10-million-cycle simulation were predicted in the kinematic alignment, compared with the mechanical alignment. Nevertheless, the tibiofemoral contact mechanics, the range of motions and the long-term wear were not markedly different between mechanical and kinematic alignments. Furthermore, the mechanical alignment with a posterior tibial slope similar to that under the kinematic alignment was found to produce similar anterior–posterior translation and the range of motion, and an approximate wear volume, compared with the kinematic alignment. The ligament forces under the kinematic alignment were influenced markedly by as much as 25%, 50% and 77% for the medial collateral ligament, lateral collateral ligament and posterior cruciate ligament forces, respectively. And, a maximum increase of 40% for patellofemoral contact force was predicted under the kinematic alignment. These findings suggest that the kinematic alignment is an alternative alignment principle but no marked advantages in biomechanics and wear to the mechanical alignment. The adverse effects of the kinematic alignment on patella loading and soft tissue forces should be noticed.

scholarly journals Therapeutic efficacy of pelotherapy and naftalan applications in patients with slowly resolving pneumonia

2009 ◽  
pp. 39-43
Author(s):  
M. A. Rassulova ◽  
L. A. Sizyakova
Keyword(s):  
Clinical Laboratory ◽  
Clinical Results ◽  
Long Term Results ◽  
Lung Function Testing ◽  
Blood Biochemical ◽  
Radiological Data ◽  
Short And Long Term ◽  
Function Testing

Clinical, laboratory, functional, and radiological examination of 82 patients with slowly resolving pneumonia was performed. The average age of the patients was 42.0 ± 2.4 yrs, 34 (41.5 %) were males and 48 (58.5 %) were females. The patients were randomly divided into 3 comparative groups: the 1st and the 2nd groups received pelotherapy and naftalan, respectively, in combination with medications for relief of symptoms and physiotherapy. The 3rd group (control) patients received medications for relief of symptoms and physiotherapy. Implementation of these methods in treatment of patients with slowly resolving pneumonia could promote regress of residual inflammation, considerably shorten length of the disease, reduce medication load and need in healthcare resources that, in turn, could reduce healthcare expenditures for treatment of such patients. Clinical results were confirmed by short- and long- term results of morphologic and blood biochemical investigations, microscopic examination of sputum, lung function testing, immunological, bronchoscopic and radiological data, investigations of physical capacity and quality of life.

scholarly journals Minimally invasive surgery total knee arthroplasty is less popular, but the prosthesis designed specifically for MIS provides good survival and PROMs with a minimum follow-up of 10 years

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shinya Toyoda ◽  
Takao Kaneko ◽  
Yuta Mochizuki ◽  
Masaru Hada ◽  
Kazutaka Takada ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Knee Arthroplasty ◽  
Invasive Surgery ◽  
Clinical Results ◽  
Good Survival ◽  
Total Knee

Abstract Background The concept of minimally invasive surgery (MIS) was introduced in total knee arthroplasty (TKA) in the late 1990s. The number of MIS TKAs has clearly decreased in recent years. An implant designed specifically for MIS TKA has been used all over the world, but there are no reports of long-term postoperative results. The purpose of this study was to characterize long-term clinical results with a minimum follow-up of 10 years. Methods This retrospective study included 109 consecutive patients with 143 NexGen CR-Flex prostheses, which are MIS tibial component prostheses designed specifically for MIS TKA. Twelve-year survival analysis was performed using Kaplan-Meier method. Revision surgery for any reason was the endpoint. Long-term clinical and radiographic results of 74 knees (55%) in 60 patients with more than 10 years of follow-up were analyzed. Results The cumulative survival rate of the single-radius posterior-stabilized TKA of 74 knees was 94.7% (95% confidence interval, 90–99%) at 12 years after surgery. Seven knees (9%) required additional surgery during the 10-year follow-up because of periprosthetic infections. Mean postoperative Knee Society knee score and functional score were 91 and 74 points, respectively. There were no cases of prosthesis breakage, polyethylene wear, or aseptic loosening of the prosthesis. Conclusion The prosthesis designed specifically for MIS TKA is associated with good survival and clinical results with a minimum follow-up of 10 years, even though MIS TKA has become less popular. Level of evidence III

Initial Experience with the NAVIO Robotic-Assisted Total Knee Replacement—Coronal Alignment Accuracy and the Learning Curve

2021 ◽  
Author(s):  
Kade Collins ◽  
Paul A. Agius ◽  
Andrew Fraval ◽  
Josh Petterwood
Keyword(s):  
Learning Curve ◽  
Mechanical Axis ◽  
New Technology ◽  
Weight Bearing ◽  
Clinical Results ◽  
Coronal Alignment ◽  
Robotic Assisted ◽  
Registration Data ◽  
Curve Effect ◽  
Total Knee

AbstractOne of the primary aim of total knee arthroplasty (TKA) is restoration of the mechanical axis of the lower limb. Maintenance of the mechanical axis within 3 degrees of neutral has been shown to result in improved clinical results and implant longevity. The aim of this study was to investigate the efficacy of this robotic-assisted system in coronal plane component positioning in TKA. We also describe the learning curve associated with adoption of this technology. A total of 72 total knee replacements were completed between November 2017 and September 2018 by a single surgeon using the robotic-assisted surgery (RAS) system. Cases were recorded from the time the study surgeon first adopted this technology and represent the “learning curve.” Pre- and postoperative coronal weight-bearing alignments were measured and intraoperative robotic-assisted registration data and duration of use were collected. Of the 72 TKAs in this series, 93.3% were corrected to the desired alignment of within 3 degrees of neutral. The knees that were not corrected to neutral had a mean preoperative alignment of 11.57 degrees of deformity as compared with 4.29 degrees for those that were corrected to neutral. A learning curve effect during adoption of this new technology was not found when analyzing RAS usage time. The RAS system produced accurate coronal alignment in TKA in more than 93% of cases with no learning curve effect. Our study suggests that this system is easily adopted, safe, and accurate.

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