Abstract
The purposes of this study were (1) to compare lower limb alignment measurements between radiographs and computer-assisted surgery and (2) to evaluate the discrepancy in lower limb alignment between computer-assisted surgery with a high tibial osteotomy protocol and computer-assisted surgery with a total knee arthroplasty (TKA) protocol in the same knee. Seventy-one TKAs were performed on patients with primary osteoarthritis using computer-assisted surgery. Preoperative lower limb alignment was measured using the mechanical axis during bipedal, weight-bearing, whole-leg anteroposterior radiography (measure 1). The intraoperative mechanical axis was measured with computer-assisted surgery according to the high tibial osteotomy protocol before joint exposure (measure 2). After changing the software and joint exposure, the intraoperative mechanical axis was measured with computer-assisted surgery according to TKA protocol (measure 3). After final TKA implantation, the lower limb mechanical axis was measured with computer-assisted surgery following the TKA protocol (measure 4). Postoperative lower limb alignment was measured using the mechanical axis on whole-leg standing anteroposterior radiographs (measure 5). The mechanical axis and median value from each group were compared. Factors affecting the mechanical axis measurement were also analyzed. The difference in the mechanical axis between measures 1 and 2, measures 1 and 3, and measures 2 and 3 was significant (P<.0001, <.0001, and =.0007, respectively). The difference between measures 4 and 5 was also significant (P<.0001). Factors affecting the mechanical axis measurement, such as age, height, weight, and range of motion, showed no correlation (R2=.07244 and adjusted R2=.01622). The pre- and postoperative radiological measurements of limb alignment using the mechanical axis were different from the intraoperative measurements with navigation.
- 1.Knutson K, Lindstrand A, Lidgren L. Survival of knee arthroplasties. A nation-wide multicentre investigation of 8000 cases. J Bone Joint Surg Br. 1986; 68(5):795–803. Crossref Medline, Google Scholar
- 2.Skytta ET, Lohman M, Tallroth K, Remes V. Comparison of standard anteroposterior knee and hip-to-ankle radiographs in determining the lower limb and implant alignment after total knee arthroplasty. Scand J Surg. 2009; 98(4):250–253. Crossref Medline, Google Scholar
- 3.Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004; 86(5):682–687. Crossref Medline, Google Scholar
- 4.Hankemeier S, Hufner T, Wang G, Navigated intraoperative analysis of lower limb alignment. Arch Orthop Trauma Surg. 2005; 125(8):531–535.
10.1007/s00402-005-0038-9 Crossref Medline, Google Scholar - 5.Alan RK, Shin MS, Tria AJ. Initial experience with electromagnetic navigation in total knee arthroplasty: a radiographic comparative study. J Knee Surg. 2007; 20(2):152–157. Crossref Medline, Google Scholar
- 6.Kim SJ, MacDonald M, Hernandez J, Wixson RL. Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty. 2005; 20(7 suppl 3):123–131.
10.1016/j.arth.2005.05.003 Crossref Medline, Google Scholar - 7.Kim YH, Kim JS, Choi Y, Kwon OR. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am. 2009; 91(1):14–19.
10.2106/JBJS.G.01700 Crossref Medline, Google Scholar - 8.Ossendorf C, Fuchs B, Koch P. Femoral stress fracture after computer navigated total knee arthroplasty. Knee. 2006; 13(5):397–399.
10.1016/j.knee.2006.06.002 Crossref Medline, Google Scholar - 9.Stulberg SD, Yaffe MA, Koo SS. Computer-assisted surgery versus manual total knee arthroplasty: a case-controlled study. J Bone Joint Surg Am. 2006; 88(suppl 4):47–54.
10.2106/JBJS.F.00698 Crossref Medline, Google Scholar - 10.Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res. 1990; (255):215–227. Medline, Google Scholar
- 11.Weng YJ, Hsu RW, Hsu WH. Comparison of computer-assisted navigation and conventional instrumentation for bilateral total knee arthroplasty. J Arthroplasty. 2009; 24(5):668–673.
10.1016/j.arth.2008.03.006 Crossref Medline, Google Scholar - 12.Cho HJ, Jung JW, Seong SC, Kim TK. Prevalence of radiographic knee osteoarthritis in elderly Koreans. J Korean Knee Society. 2009; 21(4):223–230. Google Scholar
- 13.Sailer J, Scharitzer M, Peloschek P, Giurea A, Imhof H, Grampp S. Quantification of axial alignment of the lower extremity on conventional and digital total leg radiographs. Eur Radiol. 2005; 15(1):170–173.
10.1007/s00330-004-2436-8 Crossref Medline, Google Scholar - 14.Kendoff D, Citak M, Pearle A, Influence of lower limb rotation in navigated alignment analysis: implications for high tibial osteotomies. Knee Surg Sports Traumatol Arthrosc. 2007; 15(8):1003–1008.
10.1007/s00167-007-0308-x Crossref Medline, Google Scholar - 15.Bae DK, Song SJ, Shin MC, Noh JH. Navigation versus radiographic measurements in the open-wedge high tibial osteotomy using computer assisted surgery (CAS). J Korean Orthop Assoc. 2008; 43(3):301–307.
10.4055/jkoa.2008.43.3.301 Crossref, Google Scholar - 16.Tsukada S, Wakui M. Decreased accuracy of acetabular cup placement for imageless navigation in obese patients. J Orthop Sci. 2010; 15(6):758–763.
10.1007/s00776-010-1546-1 Crossref Medline, Google Scholar - 17.Hasart O, Perka C, Christian K, Asbach P, Janz V, Wassilew GI. Influence of body mass index and thickness of soft tissue on accuracy of ultrasound and pointer based registration in navigation of cup in hip arthroplasty. Technol Health Care. 2010; 18(4–5):341–351. Crossref Medline, Google Scholar
