Abstract
Purpose
The aim of the study was to compare femoropatellar alignment and the incidence of lateral retinacular release (LRR) in total knee arthroplasty (TKA) in which the rotational alignment of the femoral component was determined using a combination of different rotational alignment axes and navigation or a single reference axis in the standard procedure.
Methods
We assessed 66 patients undergoing TKA in whom the rotation of the femoral component was determined on the posterior condylar axis in standard procedures (group A) and 65 patients in whom it was determined by combining the posterior condylar axis, anteroposterior axis and epicondylar axis in navigated procedures (group B). The mean age was 68 and 69 years in groups A and B, respectively. Patellar tracking was assessed after deflation of the tourniquet and LRR performed in the presence of maltracking. Visual analogue scale (VAS), Knee Society Score (KSS), Lonner patellar score and patellar tilt were recorded.
Results
LRR was carried out in 18 cases (27 %) in group A and in four (6 %) in group B (p = 0.003). The KSS and VAS were improved significantly compared to the preoperative status, but with no significant differences between the two groups. The patellar score showed a greater improvement in the navigated compared to the standard group at the four week follow-up. Patella tilt improved significantly in both groups. The complication rate was similar in the two groups.
Conclusions
Combining different rotational alignment axes with navigation significantly reduces patellar maltracking and the need for LRR compared to the standard procedure in which the posterior condylar axis is used as single anatomical reference.
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References
Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45
Lachiewicz PF, Soileau ES (2006) Patellar maltracking in posterior-stabilized total knee arthroplasty. Clin Orthop Relat Res 452:155–158
Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177
Rhoads DD, Noble PC, Reuben JD, Mahoney OM, Tullos HS (1990) The effect of femoral component position on patellar tracking after total knee arthroplasty. Clin Orthop Relat Res 260:43–51
Whiteside LA, Arima J (1995) The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty. Clin Orthop Relat Res 321:168–172
Laskin RS (1995) Flexion space configuration in total knee arthroplasty. J Arthroplasty 10:657–660
Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop 192:13–22
Kusuma SK, Puri N, Lotke PA (2009) Lateral retinacular release during primary total knee arthroplasty: effect on outcomes and complications. J Arthroplasty 24:383–390
Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ (2005) The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 87:2276–2280
Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J (2011) Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop 35(3):331–339
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89:236–243
van der Linden-van der Zwaag HM, Bos J, van der Heide HJ, Nelissen RG (2011) A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop 35(6):845–850
Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S (2008) Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 90:1039–1044
Ritter M, Herbst S, Keating EM, Faris PM, Meding JB (1996) Patellofemoral complications following total knee arthroplasty. Effect of a lateral release and sacrifice of the superior lateral geniculate artery. J Arthroplasty 11:368–372
Scuderi G, Schar SC, Meltzer LP et al (1987) The relationship of lateral releases to patella viability in the total knee arthroplasty. J Arthroplasty 2:209–214
Lonner JH (2006) Patellofemoral arthroplasty. In: Scott NW (ed) Insall and Scott surgery of the knee. Churchill Livingstone Elsevier, Philadelphia, pp 1455–1520
Gomes LSM, Bechtold JE, Gustilo RB (1988) Patellar prosthesis positioning in total knee arthroplasty. A roentgenographic study. Clin Orthop 236:72–81
Laskin RS (2001) Lateral release rates after total knee arthroplasty. Clin Orthop 392:88–93
Chan KC, Gill GS (1999) Postoperative patellar tilt in total knee arthroplasty. J Arthroplasty 14:300–304
Ogata KO, Ishinishi T, Hara M (1997) Evaluation of patellar retinacular tension during total knee arthroplasty. Special emphasis on lateral retinacular release. J Arthroplasty 12:651–656
Engh GA, Parks NL, Ammeen DJ (1996) Influence of surgical approach on lateral retinacular releases in total knee arthroplasty. Clin Orthop 331:56–63
Kainz H, Reng W, Augat P et al (2012) Influence of total knee arthroplasty on patellar kinematics and contact characteristics. Int Orthop 36(1):73–78
Indelli PF, Marcucci M, Cariello D et al (2011) Contemporary femoral designs in total knee arthroplasty: effects on the patello-femoral congruence. Int Orthop. doi:10.1007/s00264-011-1454-9
Mantas JP, Bloebaum RD, Skedros JG et al (1992) Implications of reference axes used for rotational alignment of the femoral component in primary and revision knee arthroplasty. J Arthroplasty 7:531–535
Churchill DL, Incavo SJ, Johnson CC et al (1998) The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop 356:111–118
Jenny JY, Boeri C (2004) Low reproducibility of intra-operative measurement of transepicondylar axis during total knee replacement. Acta Orthop Scand 75:74–77
Polivache PL, Insall JN, Scuderi GR, Font-Rodriguez DE (1996) Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop 331:35–46
Newbern DG, Faris PM, Ritter MA, Keating EM, Meding JB, Berend ME (2006) A clinical comparison of patellar tracking using the transepicondylar axis and the posterior condylar axis. J Arthroplasty 21:1141–1146
Siston RA, Cromie MJ, Gold GE, Goodman SB, Delp SC, Maloney WJ, Giori NJ (2008) Averaging different alignment axes improves femoral rotational alignment in computer-navigated total knee arthroplasty. J Bone Joint Surg Am 90:2098–2104
Kaper BP, Woolfrey M, Bourne RB (2000) The effect of built-in external femoral rotation on patellofemoral tracking in the Genesis II total knee arthroplasty. J Arthroplasty 15:964–969
Kawano T, Miura H, Nagamine R et al (2002) Factors affecting patellar tracking after total knee arthroplasty. J Arthroplasty 17:942–947
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Cinotti, G., Ripani, F.R., Sessa, P. et al. Combining different rotational alignment axes with navigation may reduce the need for lateral retinacular release in total knee arthroplasty. International Orthopaedics (SICOT) 36, 1595–1600 (2012). https://doi.org/10.1007/s00264-012-1523-8
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DOI: https://doi.org/10.1007/s00264-012-1523-8