The aim of this study was to determine the association between knee alignment and the vertical orientation of the femoral neck in relation to the floor. This could be clinically important because changes of femoral neck orientation might alter chondral joint contact zones and joint reaction forces, potentially inducing problems like pain in pre-existing chondral degeneration. Further, the femoral neck orientation influences the ischiofemoral space and a small ischiofemoral distance can lead to impingement. We hypothesized that a valgus knee alignment is associated with a more vertical orientation of the femoral neck in standing position, compared to a varus knee. We further hypothesized that realignment surgery around the knee alters the vertical orientation of the femoral neck. Long-leg standing radiographs of patients undergoing realignment surgery around the knee were used. The hip-knee-ankle angle (HKA) and the vertical orientation of the femoral neck in relation to the floor were measured, prior to surgery and after osteotomy-site-union. Linear regression was performed to determine the influence of knee alignment on the vertical orientation of the femoral neck.Aims
Methods
The radiologic and clinical results of High Tibial Osteotomies (HTO) strongly rely on the accuracy of correction, and inadequate intraoperative measurements of the
Introduction Correct postoperative leg alignment and stability of total knee prothesis over the full range of movement is one critical factor for successful TKA. This can only be achieved by correct implantation of prothesis and soft tissue handling. Still arthrotomy, surgical approach and handling of patella are discussed controversially. Materials and Methods In a cadaver specimen study we evaluated the influence of everted or subluxated patella on limb axis during balancing of the knee in three different standard surgical approaches. For each approach we operated five knees. Leg alignment was visualised by Ci CT-free DePuy/BrainLAB navigation system. First, physiological leg alignment was measured. Then the different approaches were performed and a.p.
Introduction: High tibial osteotomy is a recognised method of treatment for malalignment and osteoarthritis in young patients. Today computer aided surgery provides a chance to improve the existing techniques with a traceable planning and a higher degree of accuracy. Intraoperative use of fluoroscopy can be reduced and the results regarding
Introduction: Minimal-invasive techniques in total joint replacement are perceived to reduce soft tissue trauma. In TKR, reduced exposure during surgery bares the risk of component malpositioning. Therefore we have combined minimal invasive surgical techniques with non-CT based navigation in TKR. The purpose of this observational study is to describe first results of a controlled observational study comparing minimal invasive navigated total knee arthroplasty (MINI-NAV-TKR) to open navigated total knee arthroplasty (NAV-TKR) with respect to component positioning, surgery time and immediate postoperative complications. Materials and Methods: From June to September 2004, 26 MINI-NAV-TKR and 33 NAV-TKR have been performed by five surgeons in an unselected group of patients. In both groups, preoperative deformation of the mechanical
Long term successful results of high tibial osteotomy (HTO) strongly depend on the degree of correction, and inadequate intraoperative measurements of the
The accuracy of component implantation is an important factor affecting long term results of unicompartmental knee replacement (UKR), particularly, since overcorrection of the
Introduction: There is an ongoing discussion about potential risks and benefits of minimally invasive approaches (MIS) in total joint replacement. The aim of this study was to evaluate, whether a higher incidence of malalignments could be observed after minimally invasive navigated TKA and wether the results in the early postoperative period were better compared to standard approaches. Methods: A total of 50 patients were treated with a navigated (OrthoPilot 4.2) Columbus knee prosthesis (BBraun Aesculap, Germany). In 25 patients either a standard or a minimally invasive (mini-mid-vastus) approach was carried out. In both groups the same exclusion criteria for MIS were adopted. Initially during surgery (Nav1a) and finally after implantation of the original components (Nav1b) the mechanical
Introduction: There is an ongoing discussion about potential risks and benefits of minimally invasive approaches (MIS) in total joint replacement. The aim of this study was to evaluate, whether a higher incidence of misalignments could be observed after minimally invasive navigated TKA and whether the results in the early postoperative period were better compared to standard approaches. Methods: A total of 50 patients were treated with a navigated (OrthoPilot 4.2) Columbus knee prosthesis (BBraun Aesculap, Tuttlingen, Germany). In 25 patients either a standard or a minimally invasive (mini-mid-vastus) approach was carried out. In both groups the same exclusion criteria for MIS were adopted. Initially during surgery (Nav1a) and finally after implantation of the original components (Nav1b) the mechanical
Introduction. Recent studies have challenged the concept that a single ‘correct’ alignment to standardised anatomical references is the primary driver of TKA performance with regards to patient satisfaction outcomes. Patient specific variations in musculoskeletal anatomy are one explanation for this. Virtual simulated environments such as rigid body modelling allow for the impact of component alignment and variable patient specific musculoskeletal anatomy to be studied simultaneously. This study aims to determine if the output kinematics derived from consideration of both postoperative component alignment and patient specific musculoskeletal modelling has predictive potential of Patient Reported Outcomes. Method. Landmarking of key anatomical points and 3D registration of implants was performed on 96 segmented post-operative CT scans of TKAs. Both femoral and tibia implant components were registered. Acadaver rig validated platform for generating patient specific rigid body musculoskeletal models was used to assess the resultant motions and contact forces through a 0 to 140 degree deep knee bend cycle. Resultant kinematics were segmented and tested for differentiation with and correlation to a 12 month postoperative Knee injury and Osteoarthritis Outcome Score (KOOS). Results. Significant negative correlations (p<0.05) were found between the postoperative KOOS symptoms score and the rollback occurring in midflexion, quadriceps force in mid flexion, patella shear force and patella tilt at 90 degrees of flexion. A significant positive correlation was found between lateral shit of the patella through flexion and the symptoms score. (p<0.05) When segmenting those KOOS scores performing in the lowest 20% of patients, both rollback and the three patella measurements have statistically significantly different means (t test, p<0.05). There were other trends present that are discernible but do not have linear correlations, as they are cross-dependant on other kinematic factors or are not linear in nature. When segmenting the varus/valgus angular change into those with a varus angular change from extension to full flexion between 0 and 4 degrees (long
Aim: Preliminary results and complications of AGC Total knee Arthroplasty with early results are presented. Materials and Methods: 51 AGC Total Knee Arthroplasties were undertaken between October 2005 and September 2006. There were 22 males and 28 females. Indication for Total Knee Arthroplasty was Primary and Traumatic Osteoarthris. Brain Lab Implant dedicated Navigation was used. Results: Outliers were significantly reduced. Complications including superficial infection, late rehabilitation, and stiffness are reported. No revision was undertaken. Tips and pearls regarding navigated Arthroplasty with reference to learning curve are discussed. Discussion: Each navigation system type has its advantages and disadvantages and can be used with minimally invasive surgery (MIS) total knee arthroplasty (TKA). In addition, concerns for computer glitches, training of personnel, extra time requirements, cost and ability to demonstrate improvements in technique and results are discussed. Conclusions: Navigated Knee Arthroplasty using AGC-Biomet implant is recommended. Early experience is reported. Salient features of early learning curve are discussed. The current paper shows how the anatomic approach can influence soft tissue tension and support the surgeon during release of soft tissues in
Soft tissue management is a critical factor in total knee arthroplasty especially in valgus knees. The stepwise release has been based upon surgeon’s experience until now. Computer assisted surgery gained increasing scientific interest in recent times and allows the intraoperative measurement of
Revision total knee replacement (TKR) is a challenging procedure, especially because most of the standard bony and ligamentous landmarks used during primary TKR are lost due to the index implantation. One might also assume that the conventional instruments, which rely on visual or anatomical alignments or intra-or extramedullary rods, are associated with significant higher variation of the
Computer based navigation system improved the accuracy of limb and component alignment and decreased the incidence of outliers. The majority of previous studies were based on the infrared navigation system. We evaluate the availability and accuracy of the electromagnectic(EM) navigation system in total knee arthroplasty. From July 2006 to January 2007, 40 patients (50 TKAs) with osteoarthritis were participated in this study. AxiEM(Medtronics) was used and Nexgen CR(26 cases), and Nexgen CR flex(24 cases) were used. We analyzed the failure mode of navigation (7 cases), operation time and radiologic results (limb and component alignment). Total registration time was 4 minutes 45 seconds in average (Range: 3 minutes 45 seconds – 6 minutes 55 seconds). Failures in clinical applications resulted from non-recognition of EM tracker or paddle by metallic interference in 4 cases and from informational changes during surgery by fixation loss or loosening of the tracker in 3 cases. Radiologically, the mechanical axis changed from −11.2±7.21 (Range: −25.8~3.1) to 1.0±1.25(Range: −2.1~4.0) and 1 case of outlier occurred (valgus 4°). Component alignment is measured as followed: 89.3±1.6° of Theta angle, 89.9±1.5° of Beta angle, 1.8±2.5° of Gamma angle, 86.1±2.9 of Delta angle°. There were no complications related to the EM navigation. The EM navigation system helped to achieve accurate alignment of component and lower
Revision TKR is a challenging procedure, especially because most of the standard bony and ligamentous landmarks are lost due to the primary implantation. However, as for primary TKR, restoration of the joint line, adequate limb axis correction and ligamentous stability are considered critical for the short- and long-term outcome of revision TKR. There is no available data about the range of tolerable leg alignment after revision TKR. However, it is logical to assume that the same range than after primary TKR might be accepted, that is ± 3° off the neutral alignment. One might also assume that the conventional instruments, which rely on visual or anatomical alignments or intra- or extramedullary rods, are associated with significant higher variation of the
Computer based navigation system improved the accuracy of limb and component alignment and decreased the incidence of outliers. The majority of previous studies were based on the infrared navigation system. We evaluate the availability and accuracy of the electromagnectic(EM) navigation system in total knee arthroplasty. From July 2006 to January 2007, 40 patients (50 TKAs) with osteoarthritis were participated in this study. AxiEM(Medtronics) was used and Nexgen CR(26 cases), and Nexgen CR flex(24 cases) were used. We analyzed the failure mode of navigation (7 cases), operation time and radiologic results (limb and component alignment). Total registration time was 4 minutes 45 seconds in average (Range : 3 minutes 45 seconds ~ 6 minutes 55 seconds). Failures in clinical applications resulted from non-recognition of EM tracker or paddle by metallic interference in 4 cases and from informational changes during surgery by fixation loss or loosening of the tracker in 3 cases. Radiologically, the mechanical axis changed from −11.2±7.21 (Range : −25.8~3.1) to 1.0±1.25(Range : −2.1~4.0) and 1 case of outlier occurred (valgus 4°). Component alignment is measured as followed: 89.3±1.6° of Theta angle, 89.9±1.5° of Beta angle, 1.8±2.5° of Gamma angle, 86.1±2.9 of Delta angle°. There were no complications related to the EM navigation. The EM navigation system helped to achieve accurate alignment of component and lower
Malpositioning of the component of a total knee implant and malalignment of the leg is one of the significant factors for the outcome after Total Knee Arthroplasty. Previous studies have shown that the use of a navigation system can improve these. This article presents the initial results of a prospective and non-randomised study describing navigated implantation in TKA with special reference to soft tissue balancing in knees with posttraumatic deformity. The secondary objective is to found out reproducibility of the software. Methods: Since January 2004, 15 patients with post-traumatic arthrosis of the knee and axial malalignment of more than 15 degrees, pre operative arc of motion 75 degrees admitted to our senior author for TKA have been followed up prospectively. The data were collected over a period of 25 months. Apart from the usual clinical evaluations, no patients had CT of the leg prior to the operation &
postoperatively. Intra-operative and peri-operative morbidity data were collected and blood loss measured. Results: A postoperative
INTRODUCTION. Computer-aided systems have been developed recently in order to improve the precision of implantation of a total knee replacement (TKR). Several authors demonstrated that the accuracy of implantation of TKR was higher with the help of a navigation system in comparison to the conventional, manual technique. Theoretically, the clinical results and the survival rates should be improved. Our team was one of the first all over the world which decided to use routinely a navigation system for TKR. Prostheses designed with a mobile bearing polyethylene component allow an increased congruence between femoral and tibial gliding surface, and should decrease the risk of long-term polyethylene wear. We designed a prosthetic system with one of the highest congruence on the current market. These prostheses might be technically more demanding than more conventional designs, and involve specific complications like bearing luxation. Navigation systems might be helpful in this was as well. In the present study, we wanted to test clinically the theoretic advantages of these three specific points of our system (navigated implantation, mobile bearing and increased congruence) with a five-year clinical and radiological follow-up. MATERIAL AND METHODS. 128 patients were operated on at our Department with this TKR system between 2000, and were contacted for a five-year clinical and radiological follow-up. The clinical and functional results were evaluated according to the Knee Society Scoring System (KSS). The subjective results were analyzed with the Oxford Knee Score. The accuracy of implantation was assessed on post-operative long leg antero-posterior and lateral X-rays. The survival rate after 5 years was calculated according to the Kaplan-Meier technique. RESULTS. The mean clinical score was 87 points (maximum of 100 points). The mean pain score was 43 points (maximum of 50 points). The mean flexion angle was 118°, and 33% oft he patients were able to reach 130° of knee flexion or more. The mean functional score was 70 points (maximum of 100). The mean Oxford Score was 23 points (best score = 12 points, worst score = 60 points). An optimal correction of the coronal
Introduction: The hypothesis of this work is to demonstrate that the Flexible Flat Foot (FFF) in children is not affected for any kind of treatment. The objective is: 1.-Rate the evolution of FFF during growing. 2.- Evaluate the accuracy of diagnosis criterion. 3.-Appoint the optimal age to diagnose and treat the FFF. 4.- Evaluate the different kinds of treatment. Material and methods: 242 children of both sex, aged between 3 and 5 years old, diagnosed of flexible flat foot. We compare three groups of treatment during three years. One group were treated with orthopaedic shoes and internal wedges, other with inserts, and the third were a control group. We evaluated: Clinical findings: age, sex, flat foot family antecedents, weight, degree of flat foot, valgus of ankle, age of begin to walk, ligament hiperlaxity, vicious direction of