Dr.Raj Kanna - Academia.edu (original) (raw)

Papers by Dr.Raj Kanna

Research paper thumbnail of Modular bicompartmental knee arthroplasty : Indications, technique, prosthetic design, and results

PubMed, Mar 1, 2017

The shifting demographics of patients with localized knee arthritis, including younger, more acti... more The shifting demographics of patients with localized knee arthritis, including younger, more active patients, is a chief motivation for mounting interest in tissue preserving surgical substitutes for total knee arthroplasty (TKA). Unlinked, modular bi-compartmental knee arthroplasty (MBKA) is an emerging knee-resurfacing approach that provides a conservative alternative to TKA. Arthritis involving both patellofemoral and either medial or lateral tibiofemoral compartments, with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with MBKA. It is tailored to treat the pathologic areas of knees with bicompartmental arthritis with the benefit of improved function and tissue conservation. MBKA done in appropriate patients, using precise technique, with appropriate implants has shown to give good short and long term functional results. Long term results using modern MBKA implants are awaited and may further establish the durability and success of the procedure.

Research paper thumbnail of Cruciate retaining total knee arthroplasty has a better 10 year survival than posterior stabilized total knee arthroplasty: a systematic review and meta-analysis

Journal of Experimental Orthopaedics

Purpose There has been a long standing debate regarding superiority of cruciate retaining total k... more Purpose There has been a long standing debate regarding superiority of cruciate retaining total knee arthroplasty over posterior stabilized total knee arthroplasty regarding the short-term outcomes as well as long-term survivorship. The proponents of both the techniques have published vast evidence in favor of their respective surgical method and early outcome in meta-analyses does not seem to be significantly different. The decision to select either design should depend on their long-term survivorship but the literature comparing their long-term survival is sparse.This meta-analysis was conducted in order to answer the following questions: (1) Does cruciate retaining total knee arthroplasty has a better long-term survival beyond 10 years.compared to posterior stabilized total knee arthroplasty? (2) Does cruciate retaining knee arthroplasty has higher complication rates compared to posterior stabilized total knee arthroplasty? Methods The present systematic review and meta-analysis ...

Research paper thumbnail of Efficacy of telerehabilitation for spine pain during the Coronavirus pandemic lockdown: a retrospective propensity score-matched analysis

Disability and Rehabilitation: Assistive Technology

Research paper thumbnail of No influence of obesity on mid-term clinical, functional, and radiological results after computer-navigated total knee arthroplasty using a gap balancing technique

Journal of clinical orthopaedics and trauma, 2021

Objective In obese patients, thick subcutaneous tissue can introduce errors during registration a... more Objective In obese patients, thick subcutaneous tissue can introduce errors during registration and leg weight can influence gap balancing in navigated TKA. Present study is done to determine if computer navigated TKA using a gap balancing technique can achieve consistent accuracy for limb and component alignment, and similar clinical and functional results in obese patients like in non-obese patients. Methods We prospectively compared the radiological, clinical, and functional results of 78 knees in 57 non-obese patients and 79 knees in 58 obese patients who underwent computer-assisted TKA. Non-obese individuals were defined as those having BMI of <30 kg/m2 and obese individuals as BMI ≥30 kg/m2. The degree of knee deformity was calculated by Hip - Knee - Ankle (HKA) angle and clinical and functional assessment was done using the Knee Society Score - clinical knee score and Knee Society Score - function score, respectively. All these were documented before and at 6 months, 2 yea...

Research paper thumbnail of Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

Knee Surgery & Related Research

Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning ... more Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9...

Research paper thumbnail of Modular bicompartmental knee arthroplasty: current technique, prosthetic design, short and long term results

Acta Orthopaedica Belgica, 2016

The shifting demographics of patients with localized knee arthritis, including younger, more acti... more The shifting demographics of patients with localized knee arthritis, including younger, more active patients, is a chief motivation for mounting interest in tissue preserving surgical substitutes for total knee arthroplasty (TKA). Modular unlinked bicompartmental knee arthroplasty (MBKA) is an emerging knee-resurfacing approach that provides a conservative alternative to TKA. Arthritis involving both patellofemoral and medial or lateral tibiofemoral compartments, with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with MBKA. Combined patellofemoral arthroplasty + medial or lateral unicompartmental knee arthroplasty is tailored to treat the pathologic areas of such mid-stage arthritis with the benefit of improved function and tissue conservation. MBKA done in appropriate patients, using precise technique, with appropriate implants has shown to give good short and long term functional results compared to TKA.

Research paper thumbnail of Patellofemoral arthroplasty in a bilateral Syme's amputee

Journal of clinical orthopaedics and trauma

We present the case of a 50-year-old woman, who is a bilateral Syme's amputee and subsequentl... more We present the case of a 50-year-old woman, who is a bilateral Syme's amputee and subsequently underwent patellofemoral arthroplasty (PFA) for osteoarthritis primarily involving the patellofemoral (PF) joint. History and physical examination were suggestive of severe PF arthritis without patellar instability of the right knee. The diagnosis was confirmed by roentgenogram and a PFA was performed. A slightly modified rehabilitation program was implemented and the patient was followed until 6 years after surgery. In comparison to the preoperative scores, the Oxford, the Western Ontario and McMaster Universities (WOMAC), the Knee Society, and the Hospital for Special Surgery Knee Scores improved significantly (p < 0.05) at the time of final follow-up. PF problems specific to below-knee amputees, factors to be considered before performing PFA, and the drawbacks of other treatment modalities in these patients have been discussed.

Research paper thumbnail of Variability in the range of inter-anterior superior iliac spine distance and its correlation with femoral head centre. A prospective computed tomography study of 200 adults

Skeletal Radiology, 2010

The anterior superior iliac spine (ASIS) is commonly used to estimate the centre of the femoral h... more The anterior superior iliac spine (ASIS) is commonly used to estimate the centre of the femoral head and assess limb alignment during surgical procedures. This study aimed to determine the range of inter-anterior superior iliac spine distances (IADs) and inter-femoral head centre distances (IFDs) among individuals and ascertain whether there is correlation between the IFD and the IAD. We also sought to determine whether gender, height and body mass index (BMI) had any influence on IAD and IFD. We prospectively measured IAD and IFD in 200 adults, using transverse computed tomography (CT) scans done for medical causes. We also calculated the distance between the pelvic midline and the centre of the femoral head (XY distance) from the measured IFD. The influence of gender, height and body-mass index on IAD and IFD, and the correlation of IAD with IFD, were also studied. The overall mean IAD, IFD and XY distances were 22.7+/-1.6 cm, 16.0+/-0.8 cm and 8.0+/-0.4 cm, respectively. There was wide variation within the IAD range with 50% (100/200) of the subjects having their IAD within +/-10 mm of the mean compared to 75.5% (151/200) of the subjects with IFD within +/-10 mm of the mean. The probability that the mean XY distance would fall within 10 mm of the true femoral head centre in all subjects was 100%. The gender difference in IAD and IFD was statistically significant (P=0.03 and P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, respectively), height and BMI had no influence, and the correlation of IAD with IFD was weak (0.35). Although the range of IADs showed wide variation among subjects, this study clearly demonstrated the narrow range of the XY distance and IFD in the study population and provides a useful and accurate basis for a new method to determine the femoral head centre clinically and intraoperatively.

Research paper thumbnail of Efficacy of Periarticular Injection of Bupivacaine, Fentanyl, and Methylprednisolone in Total Knee Arthroplasty

The Journal of Arthroplasty, 2010

We evaluated the efficacy of periarticular infiltration of corticosteroid, opioid, and a local an... more We evaluated the efficacy of periarticular infiltration of corticosteroid, opioid, and a local anesthetic by comparing pain scores, knee flexion, and quadriceps function on the day of surgery, first postoperative day, day of discharge, and 2 and 4 weeks after surgery between the infiltrated and the noninfiltrated knee in 40 patients undergoing simultaneous bilateral computer-assisted total knee arthroplasty who were randomized to receive the injection in the right or left knee. In comparison to the noninfiltrated side, the infiltrated knee showed significantly lower pain scores, significantly greater active flexion up to 4 weeks, and superior quadriceps recovery up to 2 weeks after surgery. This simple and inexpensive technique can significantly reduce pain and hasten functional recovery in the first month after total knee arthroplasty.

Research paper thumbnail of Quantification of Effect of Sequential Posteromedial Release on Flexion and Extension Gaps

The Journal of Arthroplasty, 2009

A novel sequence of posteromedial release consistent with surgical technique of total knee arthro... more A novel sequence of posteromedial release consistent with surgical technique of total knee arthroplasty was performed in 15 cadaveric knees. Medial and lateral flexion and extension gaps were measured after each step of the release using a computed tomography-free computer navigation system. A spring-loaded distractor and a manual distractor were used to distract the joint. Posterior cruciate ligament release increased flexion more than extension gap; deep medial collateral ligament release had a negligible effect; semimembranosus release increased the flexion gap medially; reduction osteotomy increased medial flexion and extension gaps; superficial medial collateral ligament release increased medial joint gap more in flexion and caused severe instability. This sequence of release led to incremental and differential effects on flexion-extension gaps and has implications in correcting varus deformity.

Research paper thumbnail of The Influence of Preoperative Deformity on Valgus Correction Angle: An Analysis of 503 Total Knee Arthroplasties

The Journal of Arthroplasty, 2013

We prospectively studied variations in valgus correction angle (VCA) and the influence of preoper... more We prospectively studied variations in valgus correction angle (VCA) and the influence of preoperative limb deformity on VCA in 503 consecutive total knee arthroplasties done in 393 patients. The percentage of limbs that had VCA values less than 5°was 10.9%, and that with VCA values greater than 7°was 44.9%. The percentage of limbs with VCA greater than 7°was significantly more in varus knees, and that with VCA less than 5°was significantly more in valgus knees; preoperative deformity showed a significant correlation with VCA. Choosing a fixedroutine VCA of 5°to 7°may cause an unacceptable planning error that may be minimized by individualizing VCA or using computer navigation.

Research paper thumbnail of Postoperative Limb Alignment and Its Determinants After Minimally Invasive Oxford Medial Unicompartmental Knee Arthroplasty

The Journal of Arthroplasty, 2011

One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee... more One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-kneeankle (HKA) angle of 172.2°± 3.1°improved to 177.1°± 2.9°postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177°± 3°, 14% of the limbs were in excessive varus (b174°), and 11% were in valgus (N180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively.

Research paper thumbnail of Comparison of Limb and Component Alignment Using Computer-Assisted Navigation Versus Image Intensifier-Guided Conventional Total Knee Arthroplasty:: A …

The Journal of …, 2007

Total knee arthroplasty was performed in 282 knees with image-free navigation (group A) and in 18... more Total knee arthroplasty was performed in 282 knees with image-free navigation (group A) and in 185 with optimized conventional technique (group B). Mean postoperative mechanical axis of the limb was 179.7° in group A and 179.1° in group B (P<. 002). There ...

Research paper thumbnail of Modular bicompartmental knee arthroplasty : Indications, technique, prosthetic design, and results

PubMed, Mar 1, 2017

The shifting demographics of patients with localized knee arthritis, including younger, more acti... more The shifting demographics of patients with localized knee arthritis, including younger, more active patients, is a chief motivation for mounting interest in tissue preserving surgical substitutes for total knee arthroplasty (TKA). Unlinked, modular bi-compartmental knee arthroplasty (MBKA) is an emerging knee-resurfacing approach that provides a conservative alternative to TKA. Arthritis involving both patellofemoral and either medial or lateral tibiofemoral compartments, with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with MBKA. It is tailored to treat the pathologic areas of knees with bicompartmental arthritis with the benefit of improved function and tissue conservation. MBKA done in appropriate patients, using precise technique, with appropriate implants has shown to give good short and long term functional results. Long term results using modern MBKA implants are awaited and may further establish the durability and success of the procedure.

Research paper thumbnail of Cruciate retaining total knee arthroplasty has a better 10 year survival than posterior stabilized total knee arthroplasty: a systematic review and meta-analysis

Journal of Experimental Orthopaedics

Purpose There has been a long standing debate regarding superiority of cruciate retaining total k... more Purpose There has been a long standing debate regarding superiority of cruciate retaining total knee arthroplasty over posterior stabilized total knee arthroplasty regarding the short-term outcomes as well as long-term survivorship. The proponents of both the techniques have published vast evidence in favor of their respective surgical method and early outcome in meta-analyses does not seem to be significantly different. The decision to select either design should depend on their long-term survivorship but the literature comparing their long-term survival is sparse.This meta-analysis was conducted in order to answer the following questions: (1) Does cruciate retaining total knee arthroplasty has a better long-term survival beyond 10 years.compared to posterior stabilized total knee arthroplasty? (2) Does cruciate retaining knee arthroplasty has higher complication rates compared to posterior stabilized total knee arthroplasty? Methods The present systematic review and meta-analysis ...

Research paper thumbnail of Efficacy of telerehabilitation for spine pain during the Coronavirus pandemic lockdown: a retrospective propensity score-matched analysis

Disability and Rehabilitation: Assistive Technology

Research paper thumbnail of No influence of obesity on mid-term clinical, functional, and radiological results after computer-navigated total knee arthroplasty using a gap balancing technique

Journal of clinical orthopaedics and trauma, 2021

Objective In obese patients, thick subcutaneous tissue can introduce errors during registration a... more Objective In obese patients, thick subcutaneous tissue can introduce errors during registration and leg weight can influence gap balancing in navigated TKA. Present study is done to determine if computer navigated TKA using a gap balancing technique can achieve consistent accuracy for limb and component alignment, and similar clinical and functional results in obese patients like in non-obese patients. Methods We prospectively compared the radiological, clinical, and functional results of 78 knees in 57 non-obese patients and 79 knees in 58 obese patients who underwent computer-assisted TKA. Non-obese individuals were defined as those having BMI of <30 kg/m2 and obese individuals as BMI ≥30 kg/m2. The degree of knee deformity was calculated by Hip - Knee - Ankle (HKA) angle and clinical and functional assessment was done using the Knee Society Score - clinical knee score and Knee Society Score - function score, respectively. All these were documented before and at 6 months, 2 yea...

Research paper thumbnail of Notching is less, if femoral component sagittal positioning is planned perpendicular to distal femur anterior cortex axis, in navigated TKA

Knee Surgery & Related Research

Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning ... more Purpose In navigated TKA, the risk of notching is high if femoral component sagittal positioning is planned perpendicular to the sagittal mechanical axis of femur (SMX). We intended to determine if, by opting to place the femoral component perpendicular to distal femur anterior cortex axis (DCX), notching can be reduced in navigated TKA. Methods We studied 171 patients who underwent simultaneous bilateral computer-assisted TKA. Femoral component sagittal positioning was planned perpendicular to SMX in one knee (Femur Anterior Bowing Registration Disabled, i.e. FBRD group) and perpendicular to DCX in the opposite knee (Femur Anterior Bowing Registration Enabled, i.e. FBRE group). Incidence and depth of notching were recorded in both groups. For FBRE knees, distal anterior cortex angle (DCA), which is the angle between SMX and DCX, was calculated by the computer. Results Incidence and mean depth of notching was less (p = 0.0007 and 0.009) in FBRE versus FBRD group, i.e. 7% versus 19.9...

Research paper thumbnail of Modular bicompartmental knee arthroplasty: current technique, prosthetic design, short and long term results

Acta Orthopaedica Belgica, 2016

The shifting demographics of patients with localized knee arthritis, including younger, more acti... more The shifting demographics of patients with localized knee arthritis, including younger, more active patients, is a chief motivation for mounting interest in tissue preserving surgical substitutes for total knee arthroplasty (TKA). Modular unlinked bicompartmental knee arthroplasty (MBKA) is an emerging knee-resurfacing approach that provides a conservative alternative to TKA. Arthritis involving both patellofemoral and medial or lateral tibiofemoral compartments, with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with MBKA. Combined patellofemoral arthroplasty + medial or lateral unicompartmental knee arthroplasty is tailored to treat the pathologic areas of such mid-stage arthritis with the benefit of improved function and tissue conservation. MBKA done in appropriate patients, using precise technique, with appropriate implants has shown to give good short and long term functional results compared to TKA.

Research paper thumbnail of Patellofemoral arthroplasty in a bilateral Syme's amputee

Journal of clinical orthopaedics and trauma

We present the case of a 50-year-old woman, who is a bilateral Syme's amputee and subsequentl... more We present the case of a 50-year-old woman, who is a bilateral Syme's amputee and subsequently underwent patellofemoral arthroplasty (PFA) for osteoarthritis primarily involving the patellofemoral (PF) joint. History and physical examination were suggestive of severe PF arthritis without patellar instability of the right knee. The diagnosis was confirmed by roentgenogram and a PFA was performed. A slightly modified rehabilitation program was implemented and the patient was followed until 6 years after surgery. In comparison to the preoperative scores, the Oxford, the Western Ontario and McMaster Universities (WOMAC), the Knee Society, and the Hospital for Special Surgery Knee Scores improved significantly (p < 0.05) at the time of final follow-up. PF problems specific to below-knee amputees, factors to be considered before performing PFA, and the drawbacks of other treatment modalities in these patients have been discussed.

Research paper thumbnail of Variability in the range of inter-anterior superior iliac spine distance and its correlation with femoral head centre. A prospective computed tomography study of 200 adults

Skeletal Radiology, 2010

The anterior superior iliac spine (ASIS) is commonly used to estimate the centre of the femoral h... more The anterior superior iliac spine (ASIS) is commonly used to estimate the centre of the femoral head and assess limb alignment during surgical procedures. This study aimed to determine the range of inter-anterior superior iliac spine distances (IADs) and inter-femoral head centre distances (IFDs) among individuals and ascertain whether there is correlation between the IFD and the IAD. We also sought to determine whether gender, height and body mass index (BMI) had any influence on IAD and IFD. We prospectively measured IAD and IFD in 200 adults, using transverse computed tomography (CT) scans done for medical causes. We also calculated the distance between the pelvic midline and the centre of the femoral head (XY distance) from the measured IFD. The influence of gender, height and body-mass index on IAD and IFD, and the correlation of IAD with IFD, were also studied. The overall mean IAD, IFD and XY distances were 22.7+/-1.6 cm, 16.0+/-0.8 cm and 8.0+/-0.4 cm, respectively. There was wide variation within the IAD range with 50% (100/200) of the subjects having their IAD within +/-10 mm of the mean compared to 75.5% (151/200) of the subjects with IFD within +/-10 mm of the mean. The probability that the mean XY distance would fall within 10 mm of the true femoral head centre in all subjects was 100%. The gender difference in IAD and IFD was statistically significant (P=0.03 and P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001, respectively), height and BMI had no influence, and the correlation of IAD with IFD was weak (0.35). Although the range of IADs showed wide variation among subjects, this study clearly demonstrated the narrow range of the XY distance and IFD in the study population and provides a useful and accurate basis for a new method to determine the femoral head centre clinically and intraoperatively.

Research paper thumbnail of Efficacy of Periarticular Injection of Bupivacaine, Fentanyl, and Methylprednisolone in Total Knee Arthroplasty

The Journal of Arthroplasty, 2010

We evaluated the efficacy of periarticular infiltration of corticosteroid, opioid, and a local an... more We evaluated the efficacy of periarticular infiltration of corticosteroid, opioid, and a local anesthetic by comparing pain scores, knee flexion, and quadriceps function on the day of surgery, first postoperative day, day of discharge, and 2 and 4 weeks after surgery between the infiltrated and the noninfiltrated knee in 40 patients undergoing simultaneous bilateral computer-assisted total knee arthroplasty who were randomized to receive the injection in the right or left knee. In comparison to the noninfiltrated side, the infiltrated knee showed significantly lower pain scores, significantly greater active flexion up to 4 weeks, and superior quadriceps recovery up to 2 weeks after surgery. This simple and inexpensive technique can significantly reduce pain and hasten functional recovery in the first month after total knee arthroplasty.

Research paper thumbnail of Quantification of Effect of Sequential Posteromedial Release on Flexion and Extension Gaps

The Journal of Arthroplasty, 2009

A novel sequence of posteromedial release consistent with surgical technique of total knee arthro... more A novel sequence of posteromedial release consistent with surgical technique of total knee arthroplasty was performed in 15 cadaveric knees. Medial and lateral flexion and extension gaps were measured after each step of the release using a computed tomography-free computer navigation system. A spring-loaded distractor and a manual distractor were used to distract the joint. Posterior cruciate ligament release increased flexion more than extension gap; deep medial collateral ligament release had a negligible effect; semimembranosus release increased the flexion gap medially; reduction osteotomy increased medial flexion and extension gaps; superficial medial collateral ligament release increased medial joint gap more in flexion and caused severe instability. This sequence of release led to incremental and differential effects on flexion-extension gaps and has implications in correcting varus deformity.

Research paper thumbnail of The Influence of Preoperative Deformity on Valgus Correction Angle: An Analysis of 503 Total Knee Arthroplasties

The Journal of Arthroplasty, 2013

We prospectively studied variations in valgus correction angle (VCA) and the influence of preoper... more We prospectively studied variations in valgus correction angle (VCA) and the influence of preoperative limb deformity on VCA in 503 consecutive total knee arthroplasties done in 393 patients. The percentage of limbs that had VCA values less than 5°was 10.9%, and that with VCA values greater than 7°was 44.9%. The percentage of limbs with VCA greater than 7°was significantly more in varus knees, and that with VCA less than 5°was significantly more in valgus knees; preoperative deformity showed a significant correlation with VCA. Choosing a fixedroutine VCA of 5°to 7°may cause an unacceptable planning error that may be minimized by individualizing VCA or using computer navigation.

Research paper thumbnail of Postoperative Limb Alignment and Its Determinants After Minimally Invasive Oxford Medial Unicompartmental Knee Arthroplasty

The Journal of Arthroplasty, 2011

One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee... more One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-kneeankle (HKA) angle of 172.2°± 3.1°improved to 177.1°± 2.9°postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177°± 3°, 14% of the limbs were in excessive varus (b174°), and 11% were in valgus (N180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively.

Research paper thumbnail of Comparison of Limb and Component Alignment Using Computer-Assisted Navigation Versus Image Intensifier-Guided Conventional Total Knee Arthroplasty:: A …

The Journal of …, 2007

Total knee arthroplasty was performed in 282 knees with image-free navigation (group A) and in 18... more Total knee arthroplasty was performed in 282 knees with image-free navigation (group A) and in 185 with optimized conventional technique (group B). Mean postoperative mechanical axis of the limb was 179.7° in group A and 179.1° in group B (P<. 002). There ...