MEASUREMENT OF THE MECHANICAL AXIS OF THE LEG VIA CT IN TOTAL KNEE ARTHROPLASTY. A COMPARATIVE STUDY BETWEEN FOUR TECHNIQUES: STANDARD, MIS, STANDARD-CAS, AND MIS-CAS.

Abstract

Introduction: Computer assisted-surgery (CAS) brings in a great precision to the alignment of the components and the axis of the extremity in total knee arthroplasty (TKA). On the other hand, even though the MIS technique exerts a lesser aesthetic impact, favours the faster recovery of the patient and preserves the soft parts better, it can also lead to mistakes in the alignment of the implant due to the deficient visualization. Adding CAS to MIS may solve this potential complication.

Objective: To compare the alignment of the components with regard to the mechanical axis in four TKA groups (standard surgery, MIS surgery, standard surgery with CAS, and MIS with CAS).

Materials and Methods: Prospective and randomized study. 100 patients with Alhbäck degree III primary degenerative osteoarthritis of the knee and less than 10° of varus-valgus were included. The patients were randomly distributed in 4 groups of 25 patients each, and the same surgeons performed the surgery. Two CT surviews were performed on every patient, one preoperatively and one during the immediate postoperative period, including hip and ankle, where the femoral, tibial and femoro-tibial axis measurements were carried out.

Results: Mean age was 71.63 years (SD 6.68); 81 % of patients were women. Preoperative mean varus was of 7.57° (SD 1.10). No significant differences were found in the femoro-tibial alignment nor in the components with regard to the mechanical femoral axis between the four groups (Table 1). Nevertheless, significant differences in favour of the MIS-CAS technique group for the alignment of the tibial component with regard to the mechanical tibial axis were found.

Conclusions: The MIS technique allows for a well-aligned TKA implantation. Nevertheless, when CAS is coupled with this technique, the alignment of the tibial component is improved. It is possible for the association of MIS and CAS to become a true advance in TKA implantation.