Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections
Purpose Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modification of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the go...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2023-03, Vol.31 (3), p.768-776 |
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| creator | Graichen, Heiko Luderer, Verena Strauch, Marco Hirschmann, Michael T. Scior, Wolfgang |
| description | Purpose
Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modification of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and (2) in what percentage non-anatomical cuts are needed to achieve these goals.
Methods
Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle |
| doi_str_mv | 10.1007/s00167-022-07014-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2674755271</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2779683551</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-8ed18d60a14cfff7897d0dd58b74c9a257baaca4790bf32b05c06b5422abd6ad3</originalsourceid><addsrcrecordid>eNp9kctu1DAYhS1ERYfCC7BAltiwqKnjS5wsUQUFqaKbsrZ-X5LxKHEGOxk078OD4mnKRSxY2T7-zvltHYReVfRdRam6ypRWtSKUMUIVrQRhT9CmEpwTxYV6ija0FYwwKutz9DznHaVlK9pn6JzLWjWN5Bv04wscQg-zd5e4hz0xMEC0pxO43ZKLjkdvtxCDhQHDEPo4-jhjsNvgDz7_LUWHV3uIPe4nGDIOEQM--HTE29Bv8d4nW1DoPTbLjL-HuWiQ5gDDcMRxigQizNP4MCz57O0cpphfoLOupPmXj-sF-vrxw_31J3J7d_P5-v0tsVzJmTTeVY2rKVTCdl2nmlY56pxsjBK2BSaVAbAgVEtNx5mh0tLaSMEYGFeD4xfo7Zq7T9O3xedZjyFbP5Q_-WnJmtVKKCmZqgr65h90Ny0pltdpplRbN1zKE8VWyqYp5-Q7vU9hhHTUFdWnDvXaoS4d6ocONSum14_Rixm9-235VVoB-ArkchV7n_7M_k_sT6BYqrA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2779683551</pqid></control><display><type>article</type><title>Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections</title><source>Wiley Journals</source><source>SpringerLink Journals</source><creator>Graichen, Heiko ; Luderer, Verena ; Strauch, Marco ; Hirschmann, Michael T. ; Scior, Wolfgang</creator><creatorcontrib>Graichen, Heiko ; Luderer, Verena ; Strauch, Marco ; Hirschmann, Michael T. ; Scior, Wolfgang</creatorcontrib><description>Purpose
Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modification of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and (2) in what percentage non-anatomical cuts are needed to achieve these goals.
Methods
Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle < 178°;
n
= 680) were included. All surgeries were performed as computer assisted surgery (CAS) in AMA technique. CAS data at the end of surgery were analysed with respect to HKA and gap-sizes. All bone cuts were quantified. Depending on the amount of deformity, a subgroup analysis was performed. It was analysed whether the amount of deformity influences the non-anatomical cuts by correlation analysis.
Results
AMA reached the goals for postoperative HKA (3° corridor) in 636 cases (93.5%). While extension and flexion gap balance were achieved in more than 653 cases (96%), flexion and extension gap size were equalled in 615 knees (90.4%). The resections of the lateral tibia plateau and distal and posterior medial femoral condyle were anatomical (Tibia: 7.0 ± 1.7 mm; medial condyle distal: 7.8 ± 1.4 mm; medial posterior: 8.2 ± 1.8 mm). The number of non-anatomical resections for those cuts were low; 67 (9.9%); 24 (3.5%); 32 (4.7%). For the medial tibia plateau and the lateral posterior condyle, the cuts were non-anatomical in a high percentage of cases; Tibia: 606 (89.1%), lateral posterior condyle: 398 (58.5%). Moderate but significant correlations were found between resection differences and amount of deformity (medio-lateral: tibia: 0.399; distal femur: 0.310; posterior femur: 0.167). No correlations were found between resection differences and gap values.
Conclusion
AMA reaches the intended target for HKA and gap balance in over 612 (90%) of cases and maintains the medial femoral condyle anatomically. Non-anatomical tibial resection causes increased external rotation of the femoral component and by that non-anatomical cut of the posterior lateral condyle. Nonanatomical resections of AMA might be one reason for the persisting high rate of unsatisfied patients after TKA. Anatomical and individual alignment philosophies might help to reduce this rate of dissatisfaction.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-022-07014-2</identifier><identifier>PMID: 35678853</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alignment ; Ankle ; Biomedical materials ; Bone surgery ; CAS ; Computer assisted surgery ; Correlation analysis ; Femoral components ; Femur ; Knee ; Medicine ; Medicine & Public Health ; Orthopedics ; Sports Medicine ; Subgroups ; Surgery ; Tibia</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-03, Vol.31 (3), p.768-776</ispartof><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2022</rights><rights>2022. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).</rights><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-8ed18d60a14cfff7897d0dd58b74c9a257baaca4790bf32b05c06b5422abd6ad3</citedby><cites>FETCH-LOGICAL-c375t-8ed18d60a14cfff7897d0dd58b74c9a257baaca4790bf32b05c06b5422abd6ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-022-07014-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-022-07014-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35678853$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graichen, Heiko</creatorcontrib><creatorcontrib>Luderer, Verena</creatorcontrib><creatorcontrib>Strauch, Marco</creatorcontrib><creatorcontrib>Hirschmann, Michael T.</creatorcontrib><creatorcontrib>Scior, Wolfgang</creatorcontrib><title>Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modification of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and (2) in what percentage non-anatomical cuts are needed to achieve these goals.
Methods
Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle < 178°;
n
= 680) were included. All surgeries were performed as computer assisted surgery (CAS) in AMA technique. CAS data at the end of surgery were analysed with respect to HKA and gap-sizes. All bone cuts were quantified. Depending on the amount of deformity, a subgroup analysis was performed. It was analysed whether the amount of deformity influences the non-anatomical cuts by correlation analysis.
Results
AMA reached the goals for postoperative HKA (3° corridor) in 636 cases (93.5%). While extension and flexion gap balance were achieved in more than 653 cases (96%), flexion and extension gap size were equalled in 615 knees (90.4%). The resections of the lateral tibia plateau and distal and posterior medial femoral condyle were anatomical (Tibia: 7.0 ± 1.7 mm; medial condyle distal: 7.8 ± 1.4 mm; medial posterior: 8.2 ± 1.8 mm). The number of non-anatomical resections for those cuts were low; 67 (9.9%); 24 (3.5%); 32 (4.7%). For the medial tibia plateau and the lateral posterior condyle, the cuts were non-anatomical in a high percentage of cases; Tibia: 606 (89.1%), lateral posterior condyle: 398 (58.5%). Moderate but significant correlations were found between resection differences and amount of deformity (medio-lateral: tibia: 0.399; distal femur: 0.310; posterior femur: 0.167). No correlations were found between resection differences and gap values.
Conclusion
AMA reaches the intended target for HKA and gap balance in over 612 (90%) of cases and maintains the medial femoral condyle anatomically. Non-anatomical tibial resection causes increased external rotation of the femoral component and by that non-anatomical cut of the posterior lateral condyle. Nonanatomical resections of AMA might be one reason for the persisting high rate of unsatisfied patients after TKA. Anatomical and individual alignment philosophies might help to reduce this rate of dissatisfaction.</description><subject>Alignment</subject><subject>Ankle</subject><subject>Biomedical materials</subject><subject>Bone surgery</subject><subject>CAS</subject><subject>Computer assisted surgery</subject><subject>Correlation analysis</subject><subject>Femoral components</subject><subject>Femur</subject><subject>Knee</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Sports Medicine</subject><subject>Subgroups</subject><subject>Surgery</subject><subject>Tibia</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1DAYhS1ERYfCC7BAltiwqKnjS5wsUQUFqaKbsrZ-X5LxKHEGOxk078OD4mnKRSxY2T7-zvltHYReVfRdRam6ypRWtSKUMUIVrQRhT9CmEpwTxYV6ija0FYwwKutz9DznHaVlK9pn6JzLWjWN5Bv04wscQg-zd5e4hz0xMEC0pxO43ZKLjkdvtxCDhQHDEPo4-jhjsNvgDz7_LUWHV3uIPe4nGDIOEQM--HTE29Bv8d4nW1DoPTbLjL-HuWiQ5gDDcMRxigQizNP4MCz57O0cpphfoLOupPmXj-sF-vrxw_31J3J7d_P5-v0tsVzJmTTeVY2rKVTCdl2nmlY56pxsjBK2BSaVAbAgVEtNx5mh0tLaSMEYGFeD4xfo7Zq7T9O3xedZjyFbP5Q_-WnJmtVKKCmZqgr65h90Ny0pltdpplRbN1zKE8VWyqYp5-Q7vU9hhHTUFdWnDvXaoS4d6ocONSum14_Rixm9-235VVoB-ArkchV7n_7M_k_sT6BYqrA</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Graichen, Heiko</creator><creator>Luderer, Verena</creator><creator>Strauch, Marco</creator><creator>Hirschmann, Michael T.</creator><creator>Scior, Wolfgang</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20230301</creationdate><title>Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections</title><author>Graichen, Heiko ; Luderer, Verena ; Strauch, Marco ; Hirschmann, Michael T. ; Scior, Wolfgang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-8ed18d60a14cfff7897d0dd58b74c9a257baaca4790bf32b05c06b5422abd6ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Alignment</topic><topic>Ankle</topic><topic>Biomedical materials</topic><topic>Bone surgery</topic><topic>CAS</topic><topic>Computer assisted surgery</topic><topic>Correlation analysis</topic><topic>Femoral components</topic><topic>Femur</topic><topic>Knee</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Sports Medicine</topic><topic>Subgroups</topic><topic>Surgery</topic><topic>Tibia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graichen, Heiko</creatorcontrib><creatorcontrib>Luderer, Verena</creatorcontrib><creatorcontrib>Strauch, Marco</creatorcontrib><creatorcontrib>Hirschmann, Michael T.</creatorcontrib><creatorcontrib>Scior, Wolfgang</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graichen, Heiko</au><au>Luderer, Verena</au><au>Strauch, Marco</au><au>Hirschmann, Michael T.</au><au>Scior, Wolfgang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>31</volume><issue>3</issue><spage>768</spage><epage>776</epage><pages>768-776</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modification of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and (2) in what percentage non-anatomical cuts are needed to achieve these goals.
Methods
Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle < 178°;
n
= 680) were included. All surgeries were performed as computer assisted surgery (CAS) in AMA technique. CAS data at the end of surgery were analysed with respect to HKA and gap-sizes. All bone cuts were quantified. Depending on the amount of deformity, a subgroup analysis was performed. It was analysed whether the amount of deformity influences the non-anatomical cuts by correlation analysis.
Results
AMA reached the goals for postoperative HKA (3° corridor) in 636 cases (93.5%). While extension and flexion gap balance were achieved in more than 653 cases (96%), flexion and extension gap size were equalled in 615 knees (90.4%). The resections of the lateral tibia plateau and distal and posterior medial femoral condyle were anatomical (Tibia: 7.0 ± 1.7 mm; medial condyle distal: 7.8 ± 1.4 mm; medial posterior: 8.2 ± 1.8 mm). The number of non-anatomical resections for those cuts were low; 67 (9.9%); 24 (3.5%); 32 (4.7%). For the medial tibia plateau and the lateral posterior condyle, the cuts were non-anatomical in a high percentage of cases; Tibia: 606 (89.1%), lateral posterior condyle: 398 (58.5%). Moderate but significant correlations were found between resection differences and amount of deformity (medio-lateral: tibia: 0.399; distal femur: 0.310; posterior femur: 0.167). No correlations were found between resection differences and gap values.
Conclusion
AMA reaches the intended target for HKA and gap balance in over 612 (90%) of cases and maintains the medial femoral condyle anatomically. Non-anatomical tibial resection causes increased external rotation of the femoral component and by that non-anatomical cut of the posterior lateral condyle. Nonanatomical resections of AMA might be one reason for the persisting high rate of unsatisfied patients after TKA. Anatomical and individual alignment philosophies might help to reduce this rate of dissatisfaction.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35678853</pmid><doi>10.1007/s00167-022-07014-2</doi><tpages>9</tpages></addata></record> |
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| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-03, Vol.31 (3), p.768-776 |
| issn | 0942-2056 1433-7347 |
| language | eng |
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| source | Wiley Journals; SpringerLink Journals |
| subjects | Alignment Ankle Biomedical materials Bone surgery CAS Computer assisted surgery Correlation analysis Femoral components Femur Knee Medicine Medicine & Public Health Orthopedics Sports Medicine Subgroups Surgery Tibia |
| title | Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections |
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