Correlation of knee and hindfoot deformities in advanced knee OA: compensatory hindfoot alignment and where it occurs (original) (raw)
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The Bone & Joint Journal, 2021
Aims Patients with a deformity of the hindfoot present a particular challenge when performing total knee arthroplasty (TKA). The literature contains little information about the relationship between TKA and hindfoot alignment. This systematic review aimed to determine from both clinical and radiological studies whether TKA would alter a preoperative hindfoot deformity and whether the outcome of TKA is affected by the presence of a postoperative hindfoot deformity. Methods A systematic literature search was performed in the databases PubMed, EMBASE, Cochrane Library, and Web of Science. Search terms consisted of “total knee arthroplasty/replacement” combined with “hindfoot/ankle alignment”. Inclusion criteria were all English language studies analyzing the association between TKA and the alignment of the hindfoot, including the clinical or radiological outcomes. Exclusion criteria consisted of TKA performed with a concomitant extra-articular osteotomy and case reports or expert opini...
Functional Outcome Based on Mechanical Axis Alignment Following Total Knee Arthroplasty
Cureus, 2022
Background Total knee arthroplasty (TKA) is the most commonly performed and highly successful surgical intervention for end-stage osteoarthritis of the knee, and it offers patients pain relief, functional recovery, and improved quality of life. The success of knee arthroplasty depends on various factors such as precise surgical technique, alignment of the limb and components, patient selection, and compliance with rehabilitation. Mechanical alignment of the lower limb has been considered an important factor in planning and assessing the success of TKA. Optimal alignment remains a matter of controversy; hence, it is paramount to assess the alignment and functional outcomes. Aim and objective This study aimed to evaluate the reliability of conventional instrumentation in imparting the intended femoral and tibial coronal alignment, as well as study the functional outcome among the neutrally aligned outliers with respect to the mechanical axis of the lower limb using standing long-leg radiographs. Methodology This is a prospective, hospital-based, observational study that was conducted on 60 knees in 42 patients with primary osteoarthritis of the knee joint in the department of orthopedics, Satguru Partap Singh (SPS) Hospitals, Ludhiana. Patients undergoing total knee arthroplasty who fulfilled the inclusion criteria were included in our study and evaluated using Knee Society Score and knee flexion range at periodic follow-up till six months. Preoperative and postoperative standing long-leg radiographs were done for all the patients, and their functional outcome was compared among inliers and outliers. Results Out of these 60 total knee arthroplasties, 18 patients were operated on both knees, and 24 patients were operated on a single knee. There were 25 female patients and 17 male patients. The mean for pre-operative mechanical axis alignment angle was 11.88° ± 5.63° with a range from-3° to 27°, which changed to 2.90° ± 1.59° with a range from 0° to 8° at six months follow-up. It was observed that 42 of the knees were in the inliers, and the remaining 18 knees were in the outliers group. On comparison among inliers and outliers, we found that the mean range of motion was 108.29° ± 4.82° for the inliers group and 106.11° ± 4.04° for the outliers group (p = 0.091), depicting non-significant statistical comparison. Mean Knee Society Score values in inliers and outliers group were 152.45 ± 5.33 and 151.61 ± 3.55, respectively (p = 0.740), showing no statistical significance. Conclusion At six months follow-up, there is no difference in the knee range of motion and Knee Society Scores between mechanical axis inliers and outliers. Thus, we conclude that although every knee arthroplasty is intended to have neutral mechanical alignment, there is no effect of mild mechanical axis malalignment on functional outcome following total knee arthroplasty in the short term.
Biosciences Biotechnology Research Asia, 2014
This study was designed to evaluate accuracy of lower limb alignment in patients with Total Knee Arthroplasty (TKA) in Fajr Hospital of Tehran in 2008 to 2013. All patients evaluated in the study had undergone TKA surgery during the years 2008 to 2013. A checklist was used to collect data. Evaluations for the angle between the femoral mechanical axis and the tibial mechanical axis and lower limb mechanical axis were calculated from X-rays of alignment taken before and after the surgery.Assessment for effects of the surgery were made according to Knee Society scores (KSS) taken before the operation and 12 months after the procedure. This study evaluated 102 patients within average age of. 65.79± 6.8 years. Fourteen patients were male and 88 were female. The mean for mechanical axis angle in the lower extremity was 1.54±2.94 in various, the mean for range of motion (ROM) was 112.07±18.75, the mean for flexion contracture (FC) was 2.42 ±3. 77 degrees.Results determined no significant difference between these angles in terms of sex, side of the defect and the type of surgery. The mean duration of hospitalization was reported as 8.5±3.46 days. KSS showed better results after TKA. The results showed that TKA, as a routine procedure in the treatment of the last stages of knee disorders as such as osteoarthritis, rheumatoid arthritis and the other defects can be useful and that factors such as sex, type of surgery and side of involvement made no difference in the results of TKA.
International Journal of Orthopaedics Sciences, 2019
The main aim of this study is to radiologically assess the components alignment in various planes in total knee replacement and to assess its relationship to the functional outcome using the knee society score. Materials and Methods: This hospital based prospective observational study of 30 patients was conducted in the department of Orthopaedics at Maharaja Agrasen Hospital, New Delhi on patients who underwent elective primary Total Knee Arthroplasty and the period of study being 24 months from June 2016 to May 2018. All patients were assessed clinically and functionally using the Knee Society Score pre and post operatively for a follow up period of 6 months. Results: The mean coronal alignment and rotational alignment of femoral component in our study was 5.87 degrees and 2.99 degrees of external rotation respectively. The mean tibial component coronal and rotational alignment in our study was 90 degrees and 17.77 degrees respectively. The mean preoperative flexion of 81.33 degrees increased to 113.5 degrees postoperatively with a significant p value of <0.001. There was significant improvement of Knee Clinical Score and Knee Functional Score following Total Knee Arthroplasty with a p value <0.001. Conclusion: In our study the use of conventional extra medullary guide for tibia and intramedullary guide for femur to align a total knee replacement provided acceptable alignment and gives a good functional outcome as measured by knee society score.
BMC Musculoskeletal Disorders, 2020
Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA metho...
Effect of Rotation and Knee Flexion on Radiographic Alignment in Total Knee Arthroplasties
Clinical Orthopaedics and Related Research, 1996
A synthetic femur and tibia were used to create a model resurfacing total knee arthroplasty. The femoral component was placed in 7" valgus; the tibial component was placed in 2" varus with a 5" posterior slope. The overall anatomic alignment was 5" valgus. A series of radiographs were taken on 14 inch x 17 inch plates, in full extension and 10" flexion, with the limb rotated, in 5" increments, from 20" external rotation to 25" internal rotation. Seven orthopaedic surgeons independently measured the tibiofemoral angle and tibial alignment for each series of radiographs; interobserver variability was insignificant. Average radiographic anatomic alignment ranged from 2.29' valgus in 20" external rotation and 10" flexion, to 6.73" valgus in 25" internal rotation and 10" flexion. Limb rotation and knee flexion of lo", either alone or in combination, had a highly statistically significant effect on measured values of the anatomic alignment. Tibia1 alignment ranged from 5" varus in 20" external rotation to 3" valgus in 25" internal rotation, with the knee flexed 10". The variability associated with changes in rotation was statisti-From the Arthritis Management Service,
The early outcome of kinematicversusmechanical alignment in total knee arthroplasty
The Bone & Joint Journal, 2016
AimsOur aim was to compare kinematic with mechanical alignment in total knee arthroplasty (TKA).Patients and MethodsWe performed a prospective blinded randomised controlled trial to compare the functional outcome of patients undergoing TKA in mechanical alignment (MA) with those in kinematic alignment (KA). A total of 71 patients undergoing TKA were randomised to either kinematic (n = 36) or mechanical alignment (n = 35). Pre- and post-operative hip-knee-ankle radiographs were analysed. The knee injury and osteoarthritis outcome score (KOOS), American Knee Society Score, Short Form-36, Euro-Qol (EQ-5D), range of movement (ROM), two minute walk, and timed up and go tests were assessed pre-operatively and at six weeks, three and six months and one year post-operatively.ResultsA total of 78% of the kinematically aligned group (28 patients) and 77% of the mechanically aligned group (27 patients) were within 3° of their pre-operative plan. There were no statistically significant differen...
Biomedical and Pharmacology Journal, 2014
Total Knee Arthroplasty (TKA) is being used with the main goal of pain reduction and lower extremity alignment correction with a proven positive impact. Surgeons' criterion for the suitability of extremity alignment is to compare them (The angle between femur mechanical axis with tibial mechanical axis) with extremity mechanical axis (a line connecting the midpoint of the femoral head to the midpoint of the talus). Most professionals consider ideal up to 3 degrees difference between extremity alignment with extremity mechanical axis after surgery, thereby increasing the life of the arthroplasty components. In this study, the intention was to show parameters associated with surgery success with the evaluation of patients with ATK successful surgery. In this study, 102 patients with TKA operation in Fajr Hospital of Tehran were selected and required information was extracted from their archived files. Having no arthroplasty after the operation was the main criterion for selecting these patients. Statistical analysis showed that parameters such as BMI, gender, urinary tract infection, and so do not affect the success of ATK surgery. However, it was shown that there is a significant relationship between the success rates of surgery on left knee with the type of surgery. Although there is no significant relationship between some underlying factors such as blood group, gender, or urinary tract infections with the success of TKA surgery, the type of surgery can be an important and determinant factor in the success of the surgery. Statistical analysis on TKA surgery can provide useful information to successfully conduct this type of operation in the future.
The Journal of arthroplasty, 2017
Total knee arthroplasty (TKA), aiming at neutral mechanical alignment (MA), inevitably modifies the patient's native knee anatomy. Another option is kinematic alignment (KA), which aims to restore the original anatomy of the knee. The aim of this study was to evaluate the variations in lower limb anatomy of a patient population scheduled for TKA, and to assess the use of a restricted KA TKA protocol and compare the resulting anatomic modifications with the standard MA technique. A total of 4884 knee computed tomography scans were analyzed from a database of patients undergoing TKA with patient-specific instrumentation. The lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and hip-knee-ankle angle (HKA) were measured. Bone resections were compared using a standard MA and a restricted KA aiming for independent tibial and femoral cuts of maximum ±5° deviation from the coronal mechanical axis and a resulting overall coronal HKA within ±3° of neutral. The mean...