Abstract
Total knee arthroplasty (TKA) is a common orthopaedic procedure. Traditionally the surgeon, based on experience, releases the medial structures in knees with varus deformity and lateral structures in knees with valgus deformity until subjectively they feel that they have achieved the intended alignment. The hypothesis for this study was that deformed knees do not routinely require releases to achieve an aligned lower limb in TKA.
A single surgeon consecutive cohort of 74 patients undergoing computer navigated TKA was examined. The mechanical axes were taken as the references for distal femoral and proximal tibial cuts. The trans-epicondylar axis was taken as the reference for frontal femoral and posterior condylar cuts. A soft tissue release was undertaken after the bony cuts had been made if the mechanical femoro-tibial (MFT) angle in extension did not come to within 2° of neutral as shown by computer readings. The post-operative alignment was recorded on the navigation system and also analysed with hip-knee-ankle (HKA) radiographs.
The range of pre-operative deformities on HKA radiographs was 15° varus to 27° valgus with a mean of 5° varus (SD 7.4°). Only two patients required a medial release. None of the patients required a lateral release. The post implant navigation value was within 2° of neutral in all cases. Post-operative HKA radiographs was available for 71 patients. The mean MFT angle from radiographs was 0.1° valgus (SD 2.1°). The range was from 6° varus to 7° valgus but only six patients (8.5%) were outside the ±3° range. The kinematic analysis also showed it to be within 2 degrees of neutral throughout the flexion making sure it is well balanced in 88% cases.
This series has shown that over 90% of patients had limbs aligned appropriately without the need for routine soft tissue releases. The use of computer assisted bone cuts leads to a low level of collateral release in TKA.
