共查询到20条相似文献,搜索用时 15 毫秒
1.
Purpose
This study aimed to research which was the most reliable of the four techniques based on local anatomic markers used to determine tibial component rotation in total knee arthroplasty, and whether the markers varied in knees with varus deformity. 相似文献2.
Ryo Sugama Yukihide Minoda Akio Kobayashi Hiroyoshi Iwaki Mitsuhiko Ikebuchi Kunio Takaoka Hiroaki Nakamura 《Knee surgery, sports traumatology, arthroscopy》2012,20(12):2454-2459
Purpose
Navigation systems have recently been developed to achieve highly reliable prosthetic alignment in total knee arthroplasty (TKA). However, component alignment in the sagittal plane is less reliable than that in the coronal plane even when navigation systems are used. Previous reports examining men showed differences in targeted sagittal prosthetic alignments of TKA achieved using the conventional technique and various navigation systems. However, there have been few studies examining the use of this technique in women, who are the primary candidates for TKA.Methods
Radiographs of the entire lower extremity were obtained from 20 elder women while standing and sagittal prosthetic alignments in TKA were planned using the conventional technique as well as three navigation approaches to establish reference frames, and the observations were compared.Results
Sagittal alignments simulated using the radiographs for the conventional technique and navigation systems differed within a mean of 3.2°?±?1.7° (mean?±?SD) to 6.3°?±?2.0°. The use of different reference points on the distal femoral condyles (insertion point of the intramedullary rod, center of the anteroposterior direction of the femoral condyles, and most distal point of the femoral condyles) for each navigation system resulted in differences in the sagittal plane up to 3.0°?±?1.5°. The use of navigation systems resulted in a more hyperextended position between the femoral and tibial components compared to that for the conventional technique.Conclusions
Targeted sagittal prosthetic alignments of TKA achieved using the conventional technique and various navigation systems differed in elderly women. The use of different reference points on the distal femoral condyle for navigation systems resulted in different alignment in the sagittal plane. This study showed that alignment tendencies are similar in men and women.Level of evidence
Prognostic studies, IV. 相似文献3.
Hyuk Soo Han Chong Bum Chang Sang Cheol Seong Sahnghoon Lee Myung Chul Lee 《Knee surgery, sports traumatology, arthroscopy》2008,16(4):373-377
The authors aimed to demonstrate the relationship between the sagittal mechanical axis of the tibia and other reference axes
of the tibia and fibula in patients with advanced osteoarthritis of the knee joints, and then to identify a reliable landmark
in order to minimize posterior tibial slope measurement errors. We evaluated 133 osteoarthritic knees with neutral or varus
deformity in 64 female and 8 male patients. Axial computed tomographic images of whole tibiae including knee and ankle joints
were obtained and reconstructed using 3-dimensional imaging software. Angles between the mechanical axis (MA), the tibial
anatomical axis (TAA), the anterior tibial cortex (ATC) and the fibular shaft axis (FSA) were measured, and then medial and
lateral tibial slope angles were measured using all axes. Mean angles between MA and the other anatomical reference lines
(TAA, ATC and FSA) were 0.9, 2.2 and −2.1°, respectively. The mean values of lateral tibial slopes with respect to MA, TAA,
ATC and FSA were 8.7, 10, 12 and 7.3, respectively, and their intra- and inter-observer reliabilities were higher than those
of medial tibial slopes. Although posterior tibial slope change markedly according to the reference axis used, the axes used
in conventional TKA showed significant correlations with each other, and thus, may be used safely if differences with the
mechanical axis are considered. Moreover, the lateral tibial slope might have advantages over the medial tibial slope in terms
of restoration of the natural tibial slope. 相似文献
4.
Roberto Rossi Matteo Bruzzone Davide Edoardo Bonasia Antonio Marmotti Filippo Castoldi 《Knee surgery, sports traumatology, arthroscopy》2010,18(7):889-893
Various techniques exist for establishing tibial rotational alignment during total knee arthroplasty (TKA). The purpose of
this study is to establish the most precise and reproducible method to assess tibial component rotational alignment during
TKA by comparing the flexion-extension technique (ROM) and the Posterior-lateral Corner Locked Technique (PLCL). Twenty posterior
stabilized TKAs were performed on cadavers. The rotation angles of the tibial components obtained using the two techniques
were evaluated. The tibial component rotation axis obtained using the ROM technique and the PLCL method averaged, respectively,
0.35° (±4.2°) externally rotated and 0.34° (±3°) internally rotated to the Akagi line. No significant differences between
the two methods were found and a high correlation exists between the two techniques (Pearson’s coefficient = 0.88). The ROM
and PLCL techniques are both precise and reproducible methods to assess tibial component rotation during TKA. However, while
the ROM technique is dependent on the correct positioning of the femoral component and the soft tissue balancing, the PCLC
method is easier if a complete visualization of the posterior-lateral corner of the cut tibial plateau is achieved. 相似文献
5.
Stephen M. Howell Justin Chen Maury L. Hull 《Knee surgery, sports traumatology, arthroscopy》2013,21(10):2288-2295
Purpose
Our experience with computer plans of kinematically aligned total knee arthroplasty showed that the anteroposterior (AP) axis of the tibial component when viewed in an axial plane did not consistently intersect either the medial border or the medial 1/3 of the tibial tubercle. The purposes were (1) to determine the variability in the mediolateral location of the tibial tubercle with respect to the medial tibia on the magnetic resonance image (MRI) of the knee and (2) to determine whether the AP axis of the kinematically aligned tibial component intersects either the medial border or the medial 1/3 of the tibial tubercle.Methods
One hundred and fifteen knees in 111 consecutive subjects treated with total knee arthroplasty were studied. The mediolateral location of the tibial tubercle was measured from a magnetic resonance image (MRI) of the knee. The distances between the AP axis of the tibial component and the medial border of the tibial tubercle and between the AP axis and the medial 1/3 of the tibial tubercle were measured from a computer plan of the reconstructed knee.Results
On the MRI, the medial border of the tibial tubercle varied 15 mm from the medial border of the tibia. On the computer plan, the AP axis of the tibial component in an axial view of the tibia did not intersect either the medial border (p < 0.0001) or the medial 1/3 of the tibial tubercle (p < 0.0001). In 70 and 86 % of knees, the mediolateral distance of the AP axis of the tibial component was 2 mm or greater from the medial border of the tibial tubercle and the medial 1/3 of the tibial tubercle, respectively, which causes a clinically meaningful error in rotation of 5° or more.Conclusions
Because the mediolateral location of the tibial tubercle varies, the medial border and medial 1/3 of the tibial tubercle are not reliable landmarks when the goal is to kinematically align the rotation of the tibial component on the tibia.Level of evidence
IV. 相似文献6.
Joyce Antony Kevin Tetsworth Erik Hohmann 《Knee surgery, sports traumatology, arthroscopy》2017,25(6):1686-1691
Purpose
Knee kinematics is pivotal to patient satisfaction and functional ability after total knee arthroplasty (TKA). The aim of this study is to examine the influence of sagittal plane component alignment as defined by femoral component angle (FCA), tibial slope (TS) and posterior condylar offset (PCO) on knee kinematics as defined by maximum extension angle (MEA), maximum flexion angle (MFA) and range of motion (ROM) after TKA.Methods
This is a prospective, cross-sectional study of 105 osteoarthritic knees that underwent primary cruciate retaining TKA using a single implant design at a single tertiary institution. The sagittal plane component alignment was measured on weight-bearing true lateral radiographs taken day one post-operation and knee kinematics measured using a goniometer 1 year after TKA by the primary investigator.Results
Although the MFA was influenced by gender (P = 0.04); age, gender and pre-operative kinematics did not otherwise influence post-operative knee kinematics. The prediction model for MFA was statistically significant (P = 0.03) and accounted for 8.4 % of the variance. FCA (r = 0.3, P = 0.01) and PCO (r = 0.2, P = 0.05) demonstrated a statistically significant correlation with MFA. However, the prediction models for ROM and MEA did not achieve statistical significance. FCA (r = 0.2, P = 0.02) demonstrated a statistically significant correlation with ROM.Conclusion
The most important findings of this study are that the FCA demonstrates weak positive correlation with MFA and ROM and that PCO demonstrates weak positive correlation with MFA. However, TS does not contribute significantly to knee kinematics after TKA. This is clinically relevant as orthopaedic surgeons can increase the PCO in cruciate retaining TKA and the FCA within therapeutic limits to improve knee kinematics.Level of evidence
II.7.
Michael Drexler David Backstein Ueli Studler Dror Lakstein Barak Haviv Ran Schwarzkopf Tal Frenkel Rutenberg Yaniv Warschawski Ehud Rath Yona Kosashvili 《Knee surgery, sports traumatology, arthroscopy》2017,25(6):1736-1742
Purpose
The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA).Methods
The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were taken in 25 patients after TKA, in order to simulate the intraoperative appearance of the tibia after making its proximal resection.Results
This angle was found to be similar (n.s.) in normal and post-TKA tibiae [median 20.4° (range 15°–24°) vs. 20.7° (range 16°–25°), respectively]. In 89.3 % of the patients, the angle ranged from 17° to 24°. No statistical difference (p n.s.) was found between women and men in both normal [median ?20.7° (range 16°–25°) vs. 19.9° (range 15°–24°)] and post-TKA tibiae [median 21.4° (range 19°–24°) vs. 20° (range 16°–25°)].Conclusion
This study found that in 90 % of the patients, the medial border of the tibial tuberosity is internally rotated 17°–24° in relation to the line connecting the middle of the tuberosity to the tibial geometric centre. Since this anatomical landmark may be more easily identifiable intraoperatively than the commonly used “medial 1/3”, it can provide a better quantitative reference point and help surgeons achieve a more accurate tibial implant rotational position.Level of evidence
Cohort and case control studies, Level III.8.
Tibial component positioning in total knee arthroplasty: bone coverage and extensor apparatus alignment 总被引:2,自引:0,他引:2
P. Lemaire D. P. Pioletti F.-M. Meyer R. Meuli J. Dörfl P.-F. Leyvraz 《Knee surgery, sports traumatology, arthroscopy》1997,5(4):251-257
Correct positioning of the tibial component in total knee arthroplasty (TKA) must take into account both an optimal bone
coverage (defined by a maximal cortical bearing with posteromedial and anterolateral support) and satisfactory patellofemoral
tracking. Consequently, a compromise position must be found by the surgeon during the operation to simultaneously meet these
two requirements. Moreover, tibial tray positioning depends upon the tibial torsion, which has been shown to act mainly in
the proximal quarter of the tibia. Therefore, the correct application of the tibial tray is also theoretically related to
the level of bone resection. In this study, we first quantified the torsional profile given by an optimal bone coverage for
a symmetrical tibial tray design and for an asymmetrical one. Then, for the two types of tibial trays, we measured the angle
difference between optimal bone coverage and an alignment on the middle of the tibial tubercule. Results showed that the values
of the torsional profile given by the symmetrical tray were more scattered than those from the asymmetrical one. However,
determination of the mean differential angle between the position providing optimal bone coverage and the one providing the
best patellofemoral tracking indicated that the symmetrical prosthetic tray offered the best compromise between these two
requirements. Although the tibiofemoral joint is known to be asymmetric in both shape and dimension, the asymmetrical tray
chosen in this study was found to fulfill this compromise with more difficulty.
Received: 8 November 1996 Accepted: 7 April 1997 相似文献
9.
Hyuk-Soo Han Seung-Baik Kang Chris H. Jo Sun-Hong Kim Jung-Ha Lee 《Knee surgery, sports traumatology, arthroscopy》2010,18(10):1334-1338
Experimental and clinical studies on the accuracy of the intramedullary alignment method have produced different results,
and few have addressed accuracy in the sagittal plane. Reported deviations are not only attributable to the alignment method
but also to radiological errors. The purpose of this study was to evaluate the accuracy of the intramedullary alignment method
in the sagittal plane using computed tomography (CT) and 3-dimensional imaging software. Thirty-one TKAs were performed using
an intramedullary alignment method involving the insertion of a long 8-mm diameter rod into the medullary canal to the distal
metaphysis of the tibia. All alignment instruments were set to achieve an ideal varus/valgus angle of 0° in the coronal plane
and a tibial slope of 0° in the sagittal plane. The accuracy of the intramedullary alignment system was assessed by measuring
the coronal tibial component angle and sagittal tibial slope angles, i.e., angles between the tibial anatomical axis and the
tangent to the medial and lateral tibial plateau or the cut-surface. The mean coronal tibial component angle was 88.5° ± 1.2°
and the mean tibial component slope in the sagittal plane was 1.6° ± 1.2° without anterior slope. Our intramedullary tibial
alignment method, which involves passing an 8-mm diameter long rod through the tibial shaft isthmus, showed good accuracy
(less than 3 degrees of variation and no anterior slope) in the sagittal plane in neutral or varus knees. 相似文献
10.
Shingo Fukagawa Shuichi Matsuda Hideki Mizu-uchi Hiromasa Miura Ken Okazaki Yukihide Iwamoto 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):99-104
Although the results of total knee arthroplasty continue to improve, problems related to the patellofemoral joint remain significant.
This study examined the factors affecting patellar alignment after total knee arthroplasty and subsequent changes in 56 knees
during a postoperative period of 5.3 years. None of the knees examined displayed any clinical complications of the patellofemoral
joint; no revision surgeries were necessary, with acceptable patellar alignment on average. The patellar resection angle had
a strong influence on patellar alignment. Thinning of the patellar remnant on the medial side can increase postoperative lateral
tilt, which leads to a need for lateral retinacular release. Although the changes in patellar alignment were minimal, the
tendency that postoperative varus alignment resulted in patellar lateral tilt was observed. As postoperative femorotibial
misalignment can lead to patellofemoral problems after total knee arthroplasty, surgeons need to pay scrupulous attention
to femorotibial alignment and proper patellar preparation to decrease patellofemoral complications. 相似文献
11.
Tsan-Wen Huang Kuo-Ti Peng Kuo-Chin Huang Mel S. Lee Robert Wen-Wei Hsu 《Knee surgery, sports traumatology, arthroscopy》2014,22(12):2954-2961
Purpose
Marked coronal femoral bowing may bear a risk for mal-alignment of femoral component and reconstructed mechanical axis (MA) by using conventional instrumentations. The aim of this study was to investigate the usefulness of computer-assisted surgery–total knee arthroplasty (CAS-TKA) under this circumstance.Methods
We retrospectively analyzed patients with osteoarthritic knee and marked coronal femoral bowing who underwent TKA at our institution. The CAS-TKA and the conventional techniques were compared by radiographic parameters in coronal and sagittal planes, and rotational alignment of femoral component was assessed by computed tomography (CT) scans. The Hospital for Special Surgery (HSS) and International Knee Society (IKS) scores were obtained for all patients preoperatively and at the last follow-up.Results
A total of 65 knees were enrolled in this study. Twenty-eight TKAs implanted using a CT-free navigation system, and the remaining 37 TKAs implanted using the conventional technique. CAS-TKAs were more consistent than conventional TKAs in aiding proper postoperative MA and ideal alignments of femoral component in the coronal and sagittal planes. However, CAS-TKA group was not obtained at significantly higher rates of femoral component in axial plane. At a mean follow-up of 43 months, there was no significant difference in HSS and IKS scores between the groups.Conclusions
Although CAS-TKA did not have superior functional outcomes in the short-term follow-up, proper coronal and sagittal alignment of femoral component and postoperative MA were obtained in patients with marked coronal femoral bowing. The long-term follow-up will be needed to clarify the eventual benefits.Level of evidence
Retrospective comparative study, Level III. 相似文献12.
Daisuke Hamada Keizo Wada Tomoya Takasago Tomohiro Goto Akihiro Nitta Kosaku Higashino Yoshihiro Fukui Koichi Sairyo 《Knee surgery, sports traumatology, arthroscopy》2018,26(11):3249-3256
Purpose
To compare the kinematics between native knees and knees that have undergone bicruciate-retaining (BCR) total knee arthroplasty (TKA) with cruciate-retaining (CR) TKA converted from BCR TKA in the same whole-body cadaveric specimen using a navigation system and, if differences exist, to investigate the point at which normal kinematics are lost during the procedure.Methods
The rotational kinematics throughout passive flexion of the native knee and of knees after meniscectomy, femoral replacement, BCR TKA, or CR TKA were assessed in nine fresh frozen cadavers using an image-free navigation system.Results
The rotational kinematic pattern of a knee after BCR TKA was different from that of a native knee, especially in the early flexion phase, and was similar to that after CR TKA. Screw-home movement was not observed after BCR TKA, but still occurred after meniscectomy or femoral replacement with intact cruciate ligaments and an intact tibial articular surface.Conclusion
The rotational kinematics of the native knee are not always preserved after BCR TKA. Native rotational kinematics are preserved after meniscectomy and femoral replacement, but are lost after tibial replacement in BCR TKA. Surgeons should pay close attention to maintain the anteroposterior stabilizing function of the ACL in BCR TKA, rather than to restore the native rotational kinematics.13.
14.
Ralf E. Rosenberger Christian Hoser Sebastian Quirbach Rene Attal Alfred Hennerbichler Christian Fink 《Knee surgery, sports traumatology, arthroscopy》2008,16(3):249-257
Accuracy of implant positioning and reconstruction of the mechanical leg axis are major requirements for achieving good long-term results in total knee arthroplasty (TKA). The purpose of the present study was to determine whether image-free computer navigation technology has the potential to improve the accuracy of component alignment in TKA cohorts of experienced surgeons immediately and constantly. One hundred patients with primary arthritis of the knee underwent the unilateral total knee arthroplasty. The cohort of 50 TKAs implanted with conventional instrumentation was directly followed by the cohort of the very first 50 computer-assisted TKAs. All surgeries were performed by two senior surgeons. All patients received the Zimmer NexGen? total knee prosthesis (Zimmer Inc., Warsaw, IN, USA). There was no variability regarding surgeons or surgical technique, except for the use of the navigation system (StealthStation® Treon plus®, Medtronic Inc., Minnesota, MI, USA). Accuracy of implant positioning was measured on postoperative long-leg standing radiographs and standard lateral X-rays with regard to the valgus angle and the coronal and sagittal component angles. In addition, preoperative deformities of the mechanical leg axis, tourniquet time, age, and gender were correlated. Statistical analyses were performed using the SPSS 15.0 (SPSS Inc., Chicago, IL, USA) software package. Independent t-tests were used, with significance set at P < 0.05 (two-tailed) to compare differences in mean angular values and frontal mechanical alignment between the two cohorts. To compute the rate of optimally implanted prostheses between the two groups we used the χ2 test. The average postoperative radiological frontal mechanical alignment was 1.88° of varus (range 6.1° of valgus–10.1° of varus; SD 3.68°) in the conventional cohort and 0.28° of varus (range 3.7°–6.0° of varus; SD 1.97°) in the navigated cohort. Including all criteria for optimal implant alignment, 16 cases (32%) in the conventional cohort and 31 cases (62%) in the navigated cohort have been implanted optimally. The average difference in tourniquet time was modest with additional 12.9 min in the navigated cohort compared to the conventional cohort. Our findings suggest that the experienced knee surgeons can improve immediately and constantly the accuracy of component orientation using an image-free computer-assisted navigation system in TKA. The computer-assisted technology has shown to be easy to use, safe, and efficient in routine knee replacement surgery. We believe that navigation is a key technology for various current and future surgical alignment topics and minimal-invasive lower limb surgery. 相似文献
15.
全膝关节置换术中股骨假体旋转对线的比较研究 总被引:1,自引:0,他引:1
目的 比较全膝关节置换术(TKA)中以经上髁轴和股骨后髁轴外旋3°置放股骨假体外侧支持带的松解率.方法 150例膝关节骨性关节炎患者随机分成两组,一组采用股骨上髁轴确定股骨假体的旋转对线(股骨上髁组),另一组参照股骨后髁连线外旋3°确定股骨假体旋转对线(股骨向髁组).假体安装完毕后以"无拇指"技术评价髌骨轨迹,决定是否需要做外侧支持带松解.结果 股骨上髁轴组外侧支持带松解率为6.3%,股骨后髁轴组外侧支持带松解率为15.8%(P<0.05). 结论 TKA中股骨假体旋转对线对于髌股轨迹的优劣有着显著影响,股骨上髁轴作为旋转对线的参照可以显著改善髌股轨迹,降低外侧支持带松解率. 相似文献
16.
17.
Daniel Hernandez-Vaquero Alfonso Noriega-Fernandez Jose Manuel Fernandez-Carreira Jose Manuel Fernandez-Simon Jimena Llorens de los Rios 《Knee surgery, sports traumatology, arthroscopy》2014,22(12):3127-3134
Purpose
Computer-assisted surgery (CAS) may facilitate better positioning of total knee arthroplasty (TKA) along the coronal and lateral axes; however, there are doubts as to its usefulness in the rotational plane.Methods
This is a prospective study of 95 TKAs comparing two groups: the CAS group and the standard equipment group. The series comprises 95 cases. A radiography of the lower limb and computer tomographies (CTs) of the femoral condylar region, the proximal end of the tibia and the ankle were performed to measure rotational angulation. A month after TKA surgery, the radiography and the CTs were repeated to analyze the position of the prosthetic components in the rotational plane.Results
In the coronal axis, both CAS and mechanical technique improved femoro-tibial alignment, but when there are preexisting deformities ≥4°, CAS obtains better results. A strong correlation (R = 0.94, p = 0.001) was observed between the mean rotational axis measured with CT in the tibial plateau and that measured from the axis of the ankle. The mean initial femoral rotation of the complete series was 6.7° and 2.7° at 1-month follow-up (p < 0.001). In the standard instrumentation group, the femoral rotation went from 6.8° to 2.3°, whereas in the CAS group the femoral rotation went from 6.5° to 3.1° (p = 0.039), which is very close to the ideal 3° angle of external rotation. Tibial rotation changed by 5.28° for the entire patient population, but no differences were found when comparing CAS and standard instrumentation.Conclusion
CAS improves frontal alignment in TKA, especially in the presence of preoperative deformities. In the femoral component, navigation most closely replicated the ideal 3° external rotation of the femoral component, but tibial rotation did not differ when comparing CAS to standard instrumentation.Level of evidence
II. 相似文献18.
19.
Chadd Clary Luke Aram Daren Deffenbaugh Mark Heldreth 《Knee surgery, sports traumatology, arthroscopy》2014,22(12):3012-3018
Purpose
To understand interactions between total knee arthroplasty tibial base design attributes, variations in tibial morphology, and the resulting tibial coverage and rotational alignment.Methods
Tibial anthropometric measurements, including aspect ratio (medial–lateral width/anterior–posterior length) and tibial asymmetry, were taken for 14,791 total knee arthroplasty patients and compared with the ability of four different commercial tibial base designs to cover the resected plateau. The anthropometric measurements were also compared with the resulting tibial base rotation, which occurred when rotating the base to maximize coverage.Results
All four tibial base designs resulted in similar coverage ranging from 80.2 (4.7) % to 83.8 (4.6) %. Mean tibial base rotation when placed to maximize coverage ranged from 3.7 (4.4)° (internal) to 3.8 (4.5)° (external) relative to the medial third of the tibial tubercle. More asymmetric tibiae and tibiae with a lower aspect ratios resulted in increased internal tibial base rotation.Conclusions
The four tibial base designs assessed provided similar levels of tibial bone coverage across the patient population, despite different design features. Rotating the tibial base to maximize coverage did not significantly increase the tibial coverage, but induced variability in tibial base alignment. Certain tibial anthropometrics may predispose particular patients to internal tibial base mal-rotation. 相似文献20.
Natsuki Sugimura Masahiko Ikeuchi Masashi Izumi Koji Aso Takahiro Ushida Toshikazu Tani 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2618-2622