سامانه مدیریت نشریات علمی دانشگاه علوم پزشکی مشهد

Hasani Satehi, Sadegh, Razzaghof, Mohammadreza, Rahimnia, Amirhossein, Tamehri Zadeh, Seyed Saeed, Salehi, Milad, Mortazavi, SM Javad. (1404). Predictors of Lower Limb Coronal Malalignment after Conventional Total Knee Arthroplasty Using a Mechanical Alignment Strategy. , 13(11), 726-737. doi: 10.22038/abjs.2024.81663.3719
Sadegh Hasani Satehi; Mohammadreza Razzaghof; Amirhossein Rahimnia; Seyed Saeed Tamehri Zadeh; Milad Salehi; SM Javad Mortazavi. "Predictors of Lower Limb Coronal Malalignment after Conventional Total Knee Arthroplasty Using a Mechanical Alignment Strategy". , 13, 11, 1404, 726-737. doi: 10.22038/abjs.2024.81663.3719
Hasani Satehi, Sadegh, Razzaghof, Mohammadreza, Rahimnia, Amirhossein, Tamehri Zadeh, Seyed Saeed, Salehi, Milad, Mortazavi, SM Javad. (1404). 'Predictors of Lower Limb Coronal Malalignment after Conventional Total Knee Arthroplasty Using a Mechanical Alignment Strategy', , 13(11), pp. 726-737. doi: 10.22038/abjs.2024.81663.3719
Hasani Satehi, Sadegh, Razzaghof, Mohammadreza, Rahimnia, Amirhossein, Tamehri Zadeh, Seyed Saeed, Salehi, Milad, Mortazavi, SM Javad. Predictors of Lower Limb Coronal Malalignment after Conventional Total Knee Arthroplasty Using a Mechanical Alignment Strategy. , 1404; 13(11): 726-737. doi: 10.22038/abjs.2024.81663.3719

Predictors of Lower Limb Coronal Malalignment after Conventional Total Knee Arthroplasty Using a Mechanical Alignment Strategy

The Archives of Bone and Joint Surgery
مقاله 8، دوره 13، شماره 11، بهمن 2025، صفحه 726-737    اصل مقاله (1.16 M)
نوع مقاله: RESEARCH PAPER
شناسه دیجیتال (DOI): 10.22038/abjs.2024.81663.3719
نویسندگان
Sadegh Hasani Satehi1؛ Mohammadreza Razzaghof2؛ Amirhossein Rahimnia3؛ Seyed Saeed Tamehri Zadeh3؛ Milad Salehi1؛ SM Javad Mortazavi* 2
1Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
2Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran -Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
3Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
چکیده
Objectives: The primary goal of total knee arthroplasty (TKA) is to restore the neutral mechanical axis of the lower limb using mechanical alignment. However, no studies to date have investigated the risk factors of coronal malalignment (CM) following conventional TKA. In this study, we aimed to determine the incidence of post-TKA CM and identify its potential risk factors.
Methods: We retrospectively reviewed all conventional primary TKAs utilizing cemented posterior-stabilized prostheses in our institute from January 2019 to 2022. The following variables were extracted from the Joint Reconstruction Research Center (JRRC) Knee Registry Database: demographics, varus classification, flexion contracture, femoral and tibial bowing, pre- and postoperative Hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle (MPTA), joint-line congruency angle (JLCA), and caput-collum-diaphyseal (CCD) angle. Multiple logistic regression was used to develop a predictive model for post-TKA CM.
Results: Among the 402 TKAs analyzed after exclusions, 172 (42.79%) fell outside the acceptable postoperative HKAA range (180° ± 3°). Of the 17 factors studied, the following were associated with an increased risk of postoperative CM: flexion contracture > 10° (OR = 2.95, P < 0.001), femoral bowing > 4.9° (OR= 1.89, P= 0.006), tibial bowing > 2.2° (OR= 2.00, P= 0.002), preoperative MPTA≤ 85° (OR= 1.68, P= 0.037) or HKAA ≥ 20° varus (OR= 5.07, P= 0.017), preoperative JLCA 4°-10° (OR= 2.49, P= 0.023), and CCD ≤ 131° (OR= 1.62, P= 0.044). The results remained almost consistent even after excluding the extreme HKAA outliers (> ±6° varus and valgus).
Conclusion: In mechanically aligned TKAs, the risk of post-TKA CM can be estimated preoperatively based on specific risk factors (e.g., a 40.5% risk for patients with ≥ 3 risk factors). Identifying higher risks can warn the surgeon to address these factors and perform the TKA with greater precision.
        Level of evidence: III
کلیدواژه‌ها
Alignment؛ Coronal malalignment؛ Hip-knee-ankle axis؛ Mechanical axis؛ Predictor؛ Total knee arthroplasty
مراجع
  1. Oussedik S, Abdel MP, Victor J, Pagnano MW, Haddad FS. Alignment in total knee arthroplasty. The Bone & Joint Journal. 2020;102-B(3):276-279. doi:10.1302/0301-620x.102b3.Bjj-2019-1729.
  2. Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clinical Orthopaedics and Related Research®. 1985;192:13-22. doi:10.1097/00003086-198501000-00003.
  3. Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 2009;24(6):39-43. doi:10.1016/j.arth.2009.04.034.
  4. Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73(5):709-714. doi:10.1302/0301-620X.73B5.1894655.
  5. Lombardi AV, Berend KR, Ng VY. Neutral mechanical alignment: a requirement for successful TKA: affirms. Orthopedics. 2011;32(9):691-691. doi:10.3928/01477447-20110714-40.
  6. Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty. 2009;24(4):560-569. doi:10.1016/j.arth.2008.02.018.
  7. Martin A, Wohlgenannt O, Prenn M, Oelsch C, von Strempel A. Imageless navigation for TKA increases implantation accuracy. Clin Orthop. 2007;460:178-184. doi:10.1097/blo.0b013e31804ea45f
  8. Rajasekaran RB, Palanisami DR, Natesan R, Rajasekaran S. Minimal under-correction gives better outcomes following total knee arthroplasty in severe varus knees—myth or reality?—analysis of one hundred sixty two knees with varus greater than fifteen degrees. Int Orthop. 2020;44(4):715-723. doi:10.1007/s00264-018-4240-0.
  9. Lin Y, Cai W, Xu B, et al. Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials. Biomed Res Int. 2020;2020. doi:10.1155/2020/2164371.
  10. Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007;22(8):1097-1106. doi:10.1016/j.arth.2007.08.001.
  11. Maus U, Marques CJ, Scheunemann D, et al. No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc. 2018;26(9):2788-2796. doi:10.1007/s00167-017-4741-1.
  12. Ren Y, Cao S, Wu J, Weng X, Feng B. Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis. Postgraduate Medical Journal. 2019;95(1121):125-133. doi:10.1136/postgradmedj-2018-136190.
  13. Razzaghof M, Mortazavi SJ, Moharrami A, Noori A, Irani PT. The Effect of Intramedullary vs Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes Following Total Knee Arthroplasty: A Randomized Clinical Trial. Archives of Bone and Joint Surgery. 2023;11(7):441.
  14. Chowdhry M, Bamne AB, Na YG, Kang YG, Kim TK. Prevalence and predictors of post-operative coronal alignment outliers and their association with the functional outcomes in navigated total knee arthroplasty. J Arthroplasty. 2014;29(12):2357-2362. doi:10.1016/j.arth.2014.07.015.
  15. Mullaji AB, Shetty GM, Lingaraju A, Bhayde S. Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA? Clin Orthop. 2013;471(1):134-141. doi:10.1007/s11999-012-2520-3.
  16. Miyasaka T, Kurosaka D, Saito M, Omori T, Ikeda R, Marumo K. Accuracy of Computed Tomography–Based Navigation-Assisted Total Knee Arthroplasty: Outlier Analysis. J Arthroplasty. 2017;32(1):47-52. doi:10.1016/j.arth.2016.05.069.
  17. Gaillard R, Cerciello S, Lustig S, Servien E, Neyret P. Risk factors for tibial implant malpositioning in total knee arthrosplasty—consecutive series of one thousand, four hundred and seventeen cases. Int Orthop. 2017;41(4):749-756. doi:10.1007/s00264-016-3307-z.
  18. Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT. Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1602-1609. doi:10.1007/s00167-017-4744-y.
  19. Yau WP, Chiu KY, Tang WM, Ng TP. Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. Journal of orthopaedic surgery (Hong Kong). 2007;15(1):32-36. doi:10.1177/230949900701500108.
  20. Müller M. Die hüftnahen Femurosteotomien, Bd. 1. In: Thieme Verlag, Stuttgart; 1957.
  21. Aglietti P, Buzzi R, Scrobe F. Autologous bone grafting for medial tibial defects in total knee arthroplasty. J Arthroplasty. 1991;6(4):287-294. doi:10.1016/s0883-5403(06)80178-6.
  22. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why are total knee arthroplasties failing today? Clin Orthop. 2002;404:7-13. doi:10.1097/01.blo.0000036002.13841.32.
  23. Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am. 2011;93(17):1588-1596. doi:10.2106/JBJS.J.00772.
  24. Shatrov J, Parker D. Computer and robotic - assisted total knee arthroplasty: a review of outcomes. J Exp Orthop. 2020;7(1):70-70. doi:10.1186/s40634-020-00278-y.
  25. Antonios JK, Korber S, Sivasundaram L, et al. Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors. Arthroplast Today. 2019;5(1):88-95. doi:10.1016/j.artd.2019.01.002.
  26. Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK. Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty. 2012;27(6):1177-1182. doi:10.1016/j.arth.2011.12.028.
  27. Rhee SJ, Kim H-J, Lee C-R, Kim C-W, Gwak H-C, Kim J-H. A Comparison of Long-Term Outcomes of Computer-Navigated and Conventional Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Bone Joint Surg Am. 2019;101(20):1875-1885. doi:10.2106/jbjs.19.00257.
  28. Srivastava A, Lee GY, Steklov N, Colwell Jr CW, Ezzet KA, D'Lima DD. Effect of tibial component varus on wear in total knee arthroplasty. The Knee. 2012;19(5):560-563. doi:10.1016/j.knee.2011.11.003.
  29. Lüring C, Beckmann J, Haiböck P, Perlick L, Grifka J, Tingart M. Minimal invasive and computer assisted total knee replacement compared with the conventional technique: a prospective, randomised trial. Knee Surg Sports Traumatol Arthrosc. 2008;16(10):928-934. doi:10.1007/s00167-008-0582-2.
  30. Böhling U, Schamberger H, Grittner U, Scholz J. Computerised and technical navigation in total knee-arthroplasty. Journal of Orthopaedics and Traumatology. 2005;6(2):69-75. doi:10.1007/s10195-005-0084-7.
  31. Huang T-W, Hsu W-H, Peng K-T, Hsu R-W. Total knee replacement in patients with significant femoral bowing in the coronal plane: a comparison of conventional and computer-
 

        assisted surgery in an Asian population. J Bone Joint Surg Br. 2011;93(3):345-350. doi:10.1302/0301-620X.93B3.25990.

  1. Wright JG, Treble N, Feinstein AR. Measurement of lower limb alignment using long radiographs. J Bone Joint Surg Br. 1991;73(5):721-723. doi:10.1302/0301-620X.73B5.1894657.
  2. Kim Y-H, Park J-W, Kim J-S, Park S-D. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop. 2014;38(2):379-385. doi:10.1007/s00264-013-2097-9.
  3. Kazemi SM, Shafaghi T, Minaei R, Osanloo R, Abrishamkarzadeh H, Safdari F. The Effect of Sagittal Femoral Bowing on the Femoral Component Position in Total Knee Arthroplasty. Arch Bone Jt Surg. 2017;5(4):250-254.
 

 

 

 

 

 

 

 

 

 

 

 

 

آمار
تعداد مشاهده مقاله: 170
تعداد دریافت فایل اصل مقاله: 209