Preoperative TKA Planning on Long-Leg Hip-Knee-Ankle Radiographs and It’s Impact on Postoperative Coronal Knee Alignment

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Abstract

The importance of measuring of the angle between the mechanical and anatomical femoral axis (РУЛ) during the preoperative total knee arthroplasty (TKA) planning is not recognized by all. Some surgeons believe that it is acceptable to set distal femoral resection guide at 6° or 7° in all cases or adjust femoral resection guide FVA accordingly with patient height.

We conducted two studies. One — retrospective analysis of radiographs of patients with TKA performed since 1.09.2014 till 31.01.2015 (n = 261, 273 TKA). In this cohort, we were looking for correlation between the parameters obtained on long hip-knee-ankle radiographs (FVA, coronal knee alignment) and gender, age, body mass index (BMI) and height, as well as the implant model and the level of constraint. After that we conducted a prospective, randomized trial with TKA performed since 1.02.2015 till 31.05.2015 (n = 225, 225 TKA). The patients were randomly divided into two groups. In the “individual FVA” group (n = 121), the distal femoral resection guide FVA was set accordingly with measured FVA, in the control group (n = 104) — at 7° (average FVA for the Sverdlovsk area patients’ population). We compared TKA x-ray results of both groups.

Results. First stage. We found no correlation between FVA and age, BMI, height and sex of patients (p>0.05). After TKA residual varus deformity of more than 3° (malalignment) (3.9±1.06) was observed in 7% of cases (19 joints). We found correlation between coronal knee malalignment after TKA and two factors: BMI and initial severity of varus deformity (p = 0.003 and p<0.001). Second stage. In the control group we’ve seen femoral component deviation of more than 3° from the perpendicular to neutral mechanical axis (malposition) 3 times more often then in the “individual FVA” group (9 vs. 3, p = 0.021).

Conclusions. We did not identify the dependence of FVA on sex, age, BMI and height. With initial varus of more than 20° and BMI of more than 30 kg/m2, the risk of coronal components malalignment is increased. The average FVA in patients of Sverdlovsk area is 6,7±1,5° (3-11°). Implementation of preoperative FVA measurement and following femoral distal cut adjustments improves femoral component positioning and overall leg alignment postoperatively.

About the authors

M. P. Zinoviev

Ural Clinical Medical and Rehabilitation Center

Author for correspondence.
Email: max_travma@mail.ru

Maxim P Zinoviev — orthopedic surgeon, orthopedic Department N 1.

Nizhny Tagil

Russian Federation

I. A. Atmansky

The South Ural State Medical University

Email: fake@neicon.ru

Igor A. Atmansky — Dr. Sci. (Med.), professor, orthopedic Department.

Chelyabinsk

Russian Federation

A. A. Belokobylov

Scientific Research Institute of Traumatology and Orthopaedic

Email: fake@neicon.ru

Aleksei A. Belokobylov — Cand. Sci. (Med.), head of the orthopedics department №. 4.

Nur-Sultan

Kazakhstan

D. V. Rimashevskiy

People’s Friendship University of Russia Medical Institute

Email: fake@neicon.ru

Denis V. Rimashevskiy — Cand. Sci. (Med.), associate professor, orthopedic and Trauma Department.

Moscow

Russian Federation

References

  1. Parratte S., Pagnano M.W., Trousdale R.T., Berry D. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am. 2010;92(12): 2143-2149. doi: 10.2106/JBJS.I.01398.
  2. Tanzer M., Makhdom A.M. Preoperative planning in primary total knee arthroplasty. J Am Acad Orthop Surg. 2016;24(4):220-230. doi: 10.5435/JAAOS-D-14-00332.
  3. Зиновьев М.П., Паськов Р.В., Римашевский Д.В. Влияние остаточной варусной деформации на клинико-функциональные, рентгенологические и динамометрические результаты тотального эндопротезирования коленного сустава. Травматология и ортопедия России. 2017;(1):108-116. doi: 10.21823/2311-2905-2017-23-1-208-116.
  4. Зиновьев М.П., Паськов Р.В., Сергеев К.С., Римашевский Д.В. Остаточная деформация после двустороннего эндопротезирования коленных суставов: влияние на краткосрочные результаты. Травматология и ортопедия России. 2018;24(2):19-28. doi: 10.21823/2311-2905-2018-24-2-19-28.
  5. Bellemans J. Neutral mechanical alignment: a requirement for successful TKA: opposes. Orthopedics. 2011;34(9): e507-509. doi: 10.3928/01477447-20110714-41.
  6. 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(1):45-53. doi: 10.1007/s11999-011-1936-5.
  7. Vanlommel L., Vanlommel J., Claes S., Bellemans J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc. 2013;21(10):2325-2330. doi: 10.1007/s00167-013-2481-4.
  8. Chao E.Y., Neluheni E.V., Hsu R.W., Paley D.. Biomechanics of malalignment. Orthop Clin North Am. 1994;25(3):379-386.
  9. Longstaff L.M., Sloan K., Stamp N., Scaddan M., Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty. 2009;24(4):570-578.
  10. Ritter M.A., Davis K.E., Meding J.B., Pierson J.L., Berend M.E., Malinzak R.A. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am. 2011;93(17):1588-1596. doi: 10.2106/JBJS.J.00772.
  11. Ritter M.A., Faris P.M., Keating E.M., Meding J.B. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res. 1994;(299):153-156.
  12. Song E.K., Seon J.K., Park S.J., Jung W.B., Park H.W., Lee G.W. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1069-1076. doi: 10.1007/s00167-011-1400-9.
  13. Sparmann M., Wolke B., Czupalla H., Banzer D., Zink A. Positioning of total knee arthroplasty with and without navigation support: a prospective, randomized study. J Bone Joint surgbr. 2003;85(6):830-835.
  14. Петухов А.И., Корнилов Н.Н., Куляба Т.А., Тихилов Р.М., Селин А.В., Кроитору И.И., Игнатенко В.Л., Сараев А.В., Муранчик Ю.И. Современные взгляды на применение компьютерных навигационных систем при первичном тотальном эндопротезировании коленного сустава (обзор литературы). Травматология и ортопедия России. 2010;(1):115-123. doi: 10.21823/2311-2905-2010-0-1-115-123.
  15. Kim Y.H., Kim J.S., Yoon S.H. Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br. 2007;89(4):471-476. doi: 10.1302/0301-620x.89B4.18878
  16. Deakin A.H., Basanagoudar P.L., Nunag P., Johnston A.T., Sarungi M. Natural distribution of the femoral mechanical-anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee. 2012;19(2):120-123. doi: 10.1016/j.knee.2011.02.001.
  17. Kharwadkar N., Kent R.E., Sharara K.H., Naique S. 5 degrees to 6 degrees of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe? Knee. 2006;13(1):57-60. doi: 10.1016/j.knee.2005.07.001.
  18. Wang, Y., Zeng, Y., Dai, K., Zhu Z., Xie L. Normal lowerextremity alignment parameters in healthy Southern chinese adults as a guide in total knee arthroplasty. J Arthroplasty. 2010;25(4):563-570. doi: 10.1016/j.arth.2009.03.021.
  19. Charlson M.E., Pompei P, Ales K.L., Mckenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373-383.
  20. Deakin, A.H., Sarungi, M. A comparison of variable angle versus fixed angle distal femoral resection in primary total knee arthroplasty. J Arthroplasty. 2014; 29(6):1133-1137. doi: 10.1016/j.arth.2013.11.009.
  21. Stucinskas J., Robertsson O., Sirka A., Lebedev A., Wingstrand H., Tarasevicius S. Moderate varus/valgus malalignment after total knee arthroplasty has little effect on knee function or muscle strength 91 patients assesed after 1 year. Acta Orthop. 2015;86(6):728-733. doi: 10.3109/17453674.2015.1059689.
  22. Durandet A., Ricci P.-L., Saveh A.H., Vanat O., Wang B., Esat I., Chizari M. Radiographic Analysis of lower limb axial alignments. In: Proceedings of the World congress on Engineering. London, 2013. Vol. II, WCE 2013, july 3-5, 2013. Available from: http://www.iaeng.org/publication/WCE2013/
  23. Fang D.M., Ritter M.A., Davis K.E. Coronal alignment in total knee arthroplasty: just how important is it. J Arthroplasty. 2009;24(6 Suppl):39-43. doi: 10.1016/j.arth.2009.04.034.
  24. Jarvenpaa J., Kettunen J., Kroger H., Miettinen H. Obesity may impair the early outcome of total knee arthroplasty. Scand J Surg. 2010;99(1):45-49. doi: 10.1177/145749691009900110.
  25. Song M.H., Yoo S.H., Kang S.W., Kim Y.J., Park G.T., Pyeun Y.S. Coronal alignment of the lower limb and the incidence of constitutional varus knee in korean females. Knee Surg Relat Res. 2015;27(1):49-55. doi: 10.5792/ksrr.2015.27.1.49.
  26. Abdel M.P., Oussedik S., Parratte S., Lustig S., Haddad F.S. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J. 2014;96-B(7):857-862. doi: 10.1302/0301-620X.96B7.33946.
  27. Tang W.M., Zhu Y.H., Chiu K.Y. Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg Am. 2000;82-A(11):1603-1608.
  28. Zhou K., Ling T., Xu Y., Li J., Yu H., Wang H. Zhou Z., Pei F. Effect of individualized distal femoral valgus resection angle in primary total knee arthroplasty: A systematic review and meta-analysis involving 1300 subjects. Int J Surg. 2018;50:87-93. doi: 10.1016/j.ijsu.2017.12.028.
  29. Mullaji A.B., Shetty G.M., Lingaraju A.P., Bhayde S. Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA? Clin Orthop Relat Res. 2013;471(1):134-41. doi: 10.1007/s11999-012-2520-3.

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