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J Knee Surg 2017; 30(09): 909-915
DOI: 10.1055/s-0037-1598037
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dynamic Alignment Analysis in the Osteoarthritic Knee Using Computer Navigation

Ricardo Larrainzar-Garijo
1   Orthopaedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
,
David Murillo-Vizuete
1   Orthopaedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Raul Garcia-Bogalo
1   Orthopaedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
,
David Escobar-Anton
1   Orthopaedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Lissette Horna-Castiñeiras
1   Orthopaedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Juan Vicente Peralta-Molero
1   Orthopaedic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
› Author Affiliations
Further Information

Publication History

15 September 2016

19 December 2016

Publication Date:
13 February 2017 (online)

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Abstract

The lower limb alignment is influenced by the geometry of the joint surfaces and surrounding soft tissue tension. The mechanical behavior changes in a normal, osteoarthritic, and postoperative knee. The purpose of this study is to determine the dynamic coronal femoral tibial mechanical angle (FTMA) in osteoarthritic knees using computer navigation. The authors hypothesize that there are different varus-valgus patterns between flexion and extension in the osteoarthritic knee. We conducted a transversal observational study and included patients with osteoarthritis who underwent primary navigation TKA (Orthopilot version 4.2; B. Braun Aesculap, Tuttlingen, Germany). In total, 98 consecutive patients with 100 osteoarthritic knee joints, on which total knee arthroplasty was performed in our institution from 2009 to 2010, were enrolled in this prospective study. The FTMA was measured with the patient supine with maximum knee extension possible (considering the value as 0), 30, 60, and 90 degrees. All FMTA data obtained were segmented by hierarchic cluster measuring method. Through the clustering system, five segments were generated for varus patients and three for valgus patients: expected varus, expected valgus, severe varus, severe valgus, structured varus, structured valgus, concave varus, mixed varus-valgus, and mixed valgus-varus. The findings of the present study have demonstrated that there is a well-defined dynamic alignment in osteoarthritic knees, resulting in a wide kinematic variation in the coronal FTMA between flexion and full extension. Further studies will be necessary to determine whether this dynamic approach to FTMA has clinical utility in the surgeon's decision-making process.

Keywords

dynamic alignment - femorotibial mechanical angle - lower limb alignment - varus-valgus pattern
 

  • References

  • 1 Howell SM, Kuznik K, Hull ML, Siston RA. Longitudinal shapes of the tibia and femur are unrelated and variable. Clin Orthop Relat Res 2010; 468 (04) 1142-1148
    CrossrefPubMedGoogle Scholar
  • 2 Nowakowski AM, Kamphausen M, Pagenstert G, Valderrabano V, Müller-Gerbl M. Influence of tibial slope on extension and flexion gaps in total knee arthroplasty: increasing the tibial slope affects both gaps. Int Orthop 2014; 38 (10) 2071-2077
    CrossrefPubMedGoogle Scholar
  • 3 Yagishita K, Muneta T, Ikeda H. Step-by-step measurements of soft tissue balancing during total knee arthroplasty for patients with varus knees. J Arthroplasty 2003; 18 (03) 313-320
    CrossrefPubMedGoogle Scholar
  • 4 Tsuneizumi Y, Suzuki M, Miyagi J. , et al. Evaluation of joint laxity against distal traction force upon flexion in cruciate-retaining and posterior-stabilized total knee arthroplasty. J Orthop Sci 2008; 13 (06) 504-509
    CrossrefPubMedGoogle Scholar
  • 5 Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee—the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 1976; 58 (05) 583-594
    CrossrefPubMedGoogle Scholar
  • 6 Deep K, Eachempati KK, Apsingi S. The dynamic nature of alignment and variations in normal knees. Bone Joint J 2015; 97-B (04) 498-502
    CrossrefPubMedGoogle Scholar
  • 7 Deep K, Norris M, Smart C, Senior C. Radiographic measurement of joint space height in non-osteoarthritic tibiofemoral joints. A comparison of weight-bearing extension and 30 degrees flexion views. J Bone Joint Surg Br 2003; 85 (07) 980-982
    CrossrefPubMedGoogle Scholar
  • 8 Tan KG, Sathappan SS, Teo YH, Low WC. Alignment analyses in the varus osteoarthritic knee using computer navigation. Am J Orthop 2015; 44 (06) 277-283
    PubMedGoogle Scholar
  • 9 Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470 (01) 45-53
    CrossrefPubMedGoogle Scholar
  • 10 Victor JM, Bassens D, Bellemans J, Gürsu S, Dhollander AA, Verdonk PC. Constitutional varus does not affect joint line orientation in the coronal plane. Clin Orthop Relat Res 2014; 472 (01) 98-104
    CrossrefPubMedGoogle Scholar
  • 11 Clarke JV, Wilson WT, Wearing SC, Picard F, Riches PE, Deakin AH. Standardising the clinical assessment of coronal knee laxity. Proc Inst Mech Eng H 2012; 226 (09) 699-708
    CrossrefPubMedGoogle Scholar
  • 12 Desme D, Galand-Desme S, Besse JL, Henner J, Moyen B, Lerat JL. [Axial lower limb alignment and knee geometry in patients with osteoarthritis of the knee] [in French]. Rev Chir Orthop Repar Appar Mot 2006; 92 (07) 673-679
    PubMedGoogle Scholar
  • 13 Ghosh KM, Merican AM, Iranpour F, Deehan DJ, Amis AA. Length-change patterns of the collateral ligaments after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20 (07) 1349-1356
    CrossrefPubMedGoogle Scholar
  • 14 Matthews J, Chong A, McQueen D, O'Guinn J, Wooley P. Flexion-extension gap in cruciate-retaining versus posterior-stabilized total knee arthroplasty: a cadaveric study. J Orthop Res 2014; 32 (05) 627-632
    CrossrefPubMedGoogle Scholar
  • 15 Peters CL, Jimenez C, Erickson J, Anderson MB, Pelt CE. Lessons learned from selective soft-tissue release for gap balancing in primary total knee arthroplasty: an analysis of 1216 consecutive total knee arthroplasties: AAOS exhibit selection. J Bone Joint Surg Am 2013; 95 (20) e152
    CrossrefPubMedGoogle Scholar
  • 16 Tanaka K, Muratsu H, Mizuno K, Kuroda R, Yoshiya S, Kurosaka M. Soft tissue balance measurement in anterior cruciate ligament-resected knee joint: cadaveric study as a model for cruciate-retaining total knee arthroplasty. J Orthop Sci 2007; 12 (02) 149-153
    CrossrefPubMedGoogle Scholar
  • 17 Willcox NM, Clarke JV, Smith BR, Deakin AH, Deep K. A comparison of radiological and computer navigation measurements of lower limb coronal alignment before and after total knee replacement. J Bone Joint Surg Br 2012; 94 (09) 1234-1240
    CrossrefPubMedGoogle Scholar
  • 18 Debieux P, de Oliveira JR, Franciozi CE, Kubota MS, Granata Jr G, Luzo MV. Extension and flexion gap balancing and its correlation with alignment in navigated total knee arthroplasty. Orthopedics 2014; 37 (08) e685-e691
    PubMedGoogle Scholar
  • 19 Ghosh KM, Blain AP, Longstaff L, Rushton S, Amis AA, Deehan DJ. Can we define envelope of laxity during navigated knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1736-1743
    CrossrefPubMedGoogle Scholar
  • 20 Lee DH, Shin YS, Jeon JH, Suh DW, Han SB. Flexion and extension gaps created by the navigation-assisted gap technique show small acceptable mismatches and close mutual correlations. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1793-1798
    CrossrefPubMedGoogle Scholar
  • 21 Matsumoto T, Muratsu H, Tsumura N. , et al. Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 2006; 128 (06) 867-871
    CrossrefPubMedGoogle Scholar
  • 22 Moon YW, Kim JG, Woo KJ, Lim SJ, Seo JG. Analysis of medial flexion gap after medial release for varus deformity by navigation-guided TKA. Orthopedics 2011; 34 (05) 355
    PubMedGoogle Scholar
  • 23 Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN. Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1496-1503
    CrossrefPubMedGoogle Scholar
  • 24 Picard F, Deakin AH, Clarke JV, Dillon JM, Gregori A. Using navigation intraoperative measurements narrows range of outcomes in TKA. Clin Orthop Relat Res 2007; 463 (463) 50-57
    CrossrefPubMedGoogle Scholar
  • 25 Stiehl JB, Heck DA. How precise is computer-navigated gap assessment in TKA?. Clin Orthop Relat Res 2015; 473 (01) 115-118
    CrossrefPubMedGoogle Scholar
  • 26 Wilson WT, Deakin AH, Wearing SC, Payne AP, Clarke JV, Picard F. Computer-assisted measurements of coronal knee joint laxity in vitro are related to low-stress behavior rather than structural properties of the collateral ligaments. Comput Aided Surg 2013; 18 (05/06) 181-186
    CrossrefPubMedGoogle Scholar
  • 27 Yoon JR, Jeong HI, Oh KJ, Yang JH. In vivo gap analysis in various knee flexion angles during navigation-assisted total knee arthroplasty. J Arthroplasty 2013; 28 (10) 1796-1800
    CrossrefPubMedGoogle Scholar
  • 28 Deep K, Picard F, Baines J. Dynamic knee behaviour: does the knee deformity change as it is flexed-an assessment and classification with computer navigation. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3575-3583
    CrossrefPubMedGoogle Scholar
  • 29 Zamani Dadaneh S, Qian X. Bayesian module identification from multiple noisy networks. EURASIP J Bioinform Syst Biol 2016; 2016 (01) 5
    CrossrefPubMedGoogle Scholar
  • 30 Kalyani P. Approaches to partition medical data using clustering algorithms. Int J Comput Appl 2012; 49 (23) 7-10
    PubMedGoogle Scholar
  • 31 Mullaji AB, Shetty GM, Lingaraju AP, Bhayde S. Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA?. Clin Orthop Relat Res 2013; 471 (01) 134-141
    CrossrefPubMedGoogle Scholar
  • 32 Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category?. Clin Orthop Relat Res 2013; 471 (03) 1000-1007
    CrossrefPubMedGoogle Scholar
  • 33 Matsumoto T, Muratsu H, Kawakami Y. , et al. Soft-tissue balancing in total knee arthroplasty: cruciate-retaining versus posterior-stabilised, and measured-resection versus gap technique. Int Orthop 2014; 38 (03) 531-537
    CrossrefPubMedGoogle Scholar
  • 34 Roth JD, Howell SM, Hull ML. Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 2015; 97 (20) 1678-1684
    CrossrefPubMedGoogle Scholar
  • 35 Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech 1988; 21 (09) 705-720
    CrossrefPubMedGoogle Scholar
  • 36 Moon YW, Kim JG, Han JH, Do KH, Seo JG, Lim HC. Factors correlated with the reducibility of varus deformity in knee osteoarthritis: an analysis using navigation guided TKA. Clin Orthop Surg 2013; 5 (01) 36-43
    CrossrefPubMedGoogle Scholar
  • 37 Matsumoto T, Mizuno K, Muratsu H. , et al. Influence of intra-operative joint gap on post-operative flexion angle in osteoarthritis patients undergoing posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2007; 15 (08) 1013-1018
    CrossrefPubMedGoogle Scholar
  • 38 Picard F, Deakin AH, Clarke IV, Dillon JM, Kinninmonth AW. A quantitative method of effective soft tissue management for varus knees in total knee replacement surgery using navigational techniques. Proc Inst Mech Eng H 2007; 221 (07) 763-772
    CrossrefPubMedGoogle Scholar
  • 39 Merican AM, Ghosh KM, Iranpour F, Deehan DJ, Amis AA. The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1479-1487
    CrossrefPubMedGoogle Scholar