Influencing factors of lower extremity alignment in total knee arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2023.03.015

Abstract

Abstract:

Total knee arthroplasty (TKA) is the main operation method in the treatment of knee diseases, which has good effect in reducing the pain of diseased joints and improving joint function. The goal of the TKA is to restore normal knee function and stability. However, 20% of patients receiving TKA are not satisfied with the postoperative results, and the lower limb alignment is closely related to joint stability, prosthesis loosening rate, and patient satisfaction. Patients with poor alignment usually have symptoms such as knee instability, knee pain, and early prosthesis loosening in severe cases. Many factors might affect the force line of lower limb, for example, the osteotomy angle of femoral valgus, the osteotomy angle of femoral external rotation, the method of determining the coronal position of the tibia line of force, and the alignment of the tibia rotation all have important effects on the lower limb line of force after knee replacement. Poor alignment of the lower limb is a common indication of knee revision. Through literature review, the influencing factors of lower limb force line were analyzed to improve the attention of joint surgeons.

Key words: Arthroplasty, replacement, knee, Lower extremity

Bo Li, Limo Zhang, Chenggang Qiao, Jinquan Bao, Zhigang Bai, Wenqiang Zhao. Influencing factors of lower extremity alignment in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 398-403.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2023.03.015

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2023/V17/I03/398

Figures/Tables 1

References 50

[1]	Ethgen O, Bruyère O, Richy F, et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature[J]. J Bone Joint Surg Am, 2004, 86(5): 963－974.
[2]	Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J]. J Bone Joint Surg Am, 2007, 89(4): 780－785.
[3]	Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function[J]. J Arthroplasty, 2009, 24(4): 570－578.
[4]	Moreland JR. Mechanisms of failure in total knee arthroplasty[J]. Clin Orthop Relat Res, 1988(226): 49－64.
[5]	高嘉翔，邢丹，林剑浩. 下肢力线的测量及其在全膝关节置换术中的应用[J]. 中华外科杂志，2020, 58(6): 478－480.
[6]	Hungerford DS, Krackow KA. Total joint arthroplasty of the knee[J]. Clin Orthop Relat Res, 1985(192): 23－33.
[7]	Srivastava A, Lee GY, Steklov N, et al. Effect of tibial component varus on wear in total knee arthroplasty[J]. Knee, 2012, 19(5): 560－563.
[8]	Rivière C, Iranpour F, Auvinet E, et al. Alignment options for total knee arthroplasty: a systematic review[J]. Orthop Traumatol Surg Res, 2017, 103(7): 1047－1056.
[9]	Incavo SJ, Schmid S, Sreenivas K, et al. Total knee arthroplasty using anatomic alignment can produce mid-flexion laxity[J]. Clin Biomech (Bristol, Avon), 2013, 28(4): 429－435.
[10]	Insall JN, Binazzi R, Soudry M, et al. Total knee arthroplasty[J]. Clin Orthop Relat Res, 1985(192): 13－22.
[11]	Vanlommel L, Vanlommel J, Claes S, et al. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2325－2330.
[12]	朱诗白，陈曦，钱文伟，等. 浅谈全膝关节置换术中的冠状位下肢力线[J]. 中华外科杂志，2018, 56(9): 665－669.
[13]	Cherian JJ, Kapadia BH, Banerjee S, et al. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications[J]. Curr Rev Musculoskelet Med, 2014, 7(2): 89－95.
[14]	Weber P, Gollwitzer H. Kinematic alignment in total knee arthroplasty[J]. Oper Orthop Traumatol, 2021, 33: 525－537.
[15]	Risitano S, Cacciola G, Sabatini L, et al. Restricted kinematic alignment in primary total knee arthroplasty: a systematic review of radiographic and clinical data[J]. J Orthop, 2022, 33: 37－43.
[16]	Kharwadkar N, Kent RE, Sharara KH, et al. 5 degrees to 6 degrees of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe？[J]. Knee, 2006, 13(1): 57－60.
[17]	Wang Y, Zeng Y, Dai K, et al. Normal lower-extremity alignment parameters in healthy Southern Chinese adults as a guide in total knee arthroplasty[J]. J Arthroplasty, 2010, 25(4): 563－570.
[18]	Costa MA, Mozella Ade P, Cobra HA. Distal femoral cut in total knee arthroplasty in a Brazilian population[J]. Rev Bras Ortop, 2015, 50(3): 295－299.
[19]	龚翼星，毛晓芬，杨波，等. 数字医学在骨科中的应用进展[J/CD]. 中华关节外科杂志(电子版), 2018, 12(2): 266－270.
[20]	Tan H, Wang Y, Long T, et al. How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty[J]. Int Orthop, 2018, 42(3): 537－542.
[21]	McGrory JE, Trousdale RT, Pagnano MW, et al. Preoperative hip to ankle radiographs in total knee arthroplasty[J]. Clin Orthop Relat Res, 2002, 404: 196－202.
[22]	Lonner JH, Laird MT, Stuchin SA. Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties[J]. Clin Orthop Relat Res, 1996(331): 102－106.
[23]	Bardakos N, Cil A, Thompson B, et al. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle: a radiographic study[J]. J Arthroplasty, 2007, 22(6 Suppl 2): 85－89.
[24]	Glasser J, Mariorenzi M, Blood T, et al. Distal femoral valgus cut angles unreliable in total knee arthroplasty[J]. J Orthop, 2021, 24: 29－33.
[25]	Nuño-Siebrecht N, Tanzer M, Bobyn JD. Potential errors in axial alignment using intramedullary instrumentation for total knee arthroplasty[J]. J Arthroplasty, 2000, 15(2): 228－230.
[26]	Reed SC, Gollish J. The accuracy of femoral intramedullary guides in total knee arthroplasty[J]. J Arthroplasty, 1997, 12(6): 677－682.
[27]	Wangroongsub Y, Cherdtaweesup S. Proper entry point for femoral intramedullary guide in total knee arthroplasty[J]. J Med Assoc Thai., 2009, 92(Suppl 6): S1－S5.
[28]	Ma LY, Wei HY, Wan FY, et al. An innovative three-dimensional method for identifying a proper femoral intramedullary entry point in total knee arthroplasty[J]. Chin Med J, 2018, 131(21): 2531－2536.
[29]	Meding JB, Berend ME, Ritter MA, et al. Intramedullary vs extramedullary femoral alignment guides: a 15-year follow-up of survivorship[J]. J Arthroplasty, 2011, 26(4): 591－595.
[30]	刘扬德，赵宇驰，王维光，等. 全膝关节置换中股骨外旋截骨对下肢动态力线的影响[J]. 中华骨科杂志，2015，35(10)：1048－1054.
[31]	Sheth NP, Husain A, Nelson CL. Surgical techniques for total knee arthroplasty: measured resection, gap balancing, and hybrid[J]. J Am Acad Orthop Surg, 2017, 25(7): 499－508.
[32]	Aglietti P, Sensi L, Cuomo P, et al. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis[J]. Clin Orthop Relat Res, 2008, 466(11): 2751－2755.
[33]	Whiteside LA, Arima J. The anteroposterior axis for femoral rotational alignment in valgus total knee arthroplasty[J]. Clin Orthop Relat Res, 1995, (321): 168－172.
[34]	Berger RA, Rubash HE, Seel MJ, et al. Determining the rotational alignment of the femoral component in total knee arthroplasty using the epicondylar axis[J]. Clin Orthop Relat Res, 1993(286): 40－47.
[35]	Nikolaides AP, Kenanidis EI, Papavasiliou KA, et al. Measured resection versus gap balancing technique for femoral rotational alignment: a prospective study[J]. J Orthop Surg, 2014, 22(2): 158－162.
[36]	Tapasvi SR, Shekhar A, Patil SS, et al. Comparison of gap balancing vs measured resection technique in patients undergoing simultaneous bilateral total knee arthroplasty: one technique per knee[J]. J Arthroplasty, 2020, 35(3): 732－740.
[37]	Michaut M, Beaufils P, Galaud B, et al. Rotational alignment of femoral component with computed-assisted surgery (CAS) during total knee arthroplasty[J]. Rev Chir Orthop Reparatrice Appar Mot, 2008, 94(6): 580－584.
[38]	de Kroon KE, Houterman S, Janssen RP. Leg alignment and tibial slope after minimal invasive total knee arthroplasty: a prospective, randomized radiological study of intramedullary versus extramedullary tibial instrumentation[J]. Knee, 2012, 19(4): 270－274.
[39]	Denis K, van Ham G, Bellemans J, et al. How correctly does an intramedullary rod represent the longitudinal tibial axes？[J]. Clin Orthop Relat Res, 2002(397): 424－433.
[40]	Tsukeoka T, Tsuneizumi Y, Lee TH. Accuracy of the second metatarsal as a landmark for the extramedullary tibial cutting guide in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 2969－2974.
[41]	程吕，陈心星，马济民，等. 全膝关节置换术中膝内翻患者胫骨髓外定位方法的准确性研究[J]. 实用骨科杂志，2022, 28(7): 645－647.
[42]	Sugimura N, Ikeuchi M, Izumi M, et al. The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2618－2622.
[43]	Tsukeoka T, Lee TH, Tsuneizumi Y, et al. The tibial crest as a practical useful landmark in total knee arthroplasty[J]. Knee, 2014, 21(1): 283－289.
[44]	Akagi M, Oh M, Nonaka T, et al. An anteroposterior axis of the Tibia for total knee arthroplasty[J]. Clin Orthop Relat Res, 2004, 420: 213－219.
[45]	Kim JI, Jang J, Lee KW, et al. Anterior tibial curved cortex is a reliable landmark for tibial rotational alignment in total knee arthroplasty[J]. BMC Musculoskelet Disord, 2017, 18(1): 252.
[46]	Lu Y, Ren X, Liu B, et al. Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis[J]. BMC Musculoskelet Disord, 2020, 21(1): 323.
[47]	Nam JH, Koh YG, Kim PS, et al. Evaluation of tibial rotational axis in total knee arthroplasty using magnetic resonance imaging[J]. Sci Rep, 2020, 10(1): 14068.
[48]	Baldini A, Indelli PF, de Luca L, et al. Rotational alignment of the tibial component in total knee arthroplasty: the anterior tibial cortex is a reliable landmark[J]. Joints, 2013, 1(4): 155－160.
[49]	Eckhoff DG, Metzger RG, Vandewalle MV. Malrotation associated with implant alignment technique in total knee arthroplasty[J]. Clin Orthop Relat Res, 1995, (321): 28－31.
[50]	Kawaguchi K, Inui H, Yamagami R, et al. A new technique for determining the rotational alignment of the tibial component during total knee arthroplasty[J]. Knee, 2021, 29: 323－331.

分类	具体因素
股骨侧因素	股骨外翻截骨角度股骨外旋截骨角度
胫骨侧因素	确定胫骨冠状位力线的方法胫骨旋转对线

分类	具体因素
股骨侧因素	股骨外翻截骨角度股骨外旋截骨角度
胫骨侧因素	确定胫骨冠状位力线的方法胫骨旋转对线

Please choose a citation manager

Content to export