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Does malalignment affect revision rate in total knee replacements: a systematic review of the literature

To ensure implant durability following Modern total knee replacement (TKR) surgery, one long held principle in condylar total knee arthroplasty is positioning the components in alignment with the mechanical axis and restoring the overall limb alignment to 180° ± 3°. However, this view has been chall...

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Autores principales: Hadi, Mohammed, Barlow, Tim, Ahmed, Imran, Dunbar, Mark, McCulloch, Peter, Griffin, Damian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695472/
https://www.ncbi.nlm.nih.gov/pubmed/26753122
http://dx.doi.org/10.1186/s40064-015-1604-4
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author Hadi, Mohammed
Barlow, Tim
Ahmed, Imran
Dunbar, Mark
McCulloch, Peter
Griffin, Damian
author_facet Hadi, Mohammed
Barlow, Tim
Ahmed, Imran
Dunbar, Mark
McCulloch, Peter
Griffin, Damian
author_sort Hadi, Mohammed
collection PubMed
description To ensure implant durability following Modern total knee replacement (TKR) surgery, one long held principle in condylar total knee arthroplasty is positioning the components in alignment with the mechanical axis and restoring the overall limb alignment to 180° ± 3°. However, this view has been challenged recently. Given the high number of TKR performed, clarity on this integral aspect of the procedure is necessary. To investigate the association between malalignment following primary TKR and revision rates. A systematic review of the literature was conducted using a computerised literature search of Medline, CINHAL, and EMBASE to identify English-language studies published from 2000 through to 2014. Studies with adequate information on the correlation between malalignment and revision rate with a minimum follow-up of 6 months were considered for inclusion. A study protocol, including the detailed search strategy was published on the PROSPERO database for systematic reviews. From an initial 2107 citations, eight studies, with variable methodological qualities, were eligible for inclusion. Collectively, nine parameters of alignment were studied, and 20 assessments were made between an alignment parameter and revision rate. Four out of eight studies demonstrated an association between a malalignment parameter and increased revision rates. In the coronal plane, only three studies assessed the mechanical axis. None of these studies found an association with revision rates, whereas four of the five studies investigating the anatomical axis found an association between malalignment and increased revision rate. This study demonstrates the effect of malalignment on revision rates is likely to be modest. Interestingly, studies that used mechanical alignment in the coronal plane demonstrated no association with revision rates. This questions the premise of patient specific instrumentation devices based on the mechanically aligned knee when considering revision as the endpoint.
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spelling pubmed-46954722016-01-08 Does malalignment affect revision rate in total knee replacements: a systematic review of the literature Hadi, Mohammed Barlow, Tim Ahmed, Imran Dunbar, Mark McCulloch, Peter Griffin, Damian Springerplus Review To ensure implant durability following Modern total knee replacement (TKR) surgery, one long held principle in condylar total knee arthroplasty is positioning the components in alignment with the mechanical axis and restoring the overall limb alignment to 180° ± 3°. However, this view has been challenged recently. Given the high number of TKR performed, clarity on this integral aspect of the procedure is necessary. To investigate the association between malalignment following primary TKR and revision rates. A systematic review of the literature was conducted using a computerised literature search of Medline, CINHAL, and EMBASE to identify English-language studies published from 2000 through to 2014. Studies with adequate information on the correlation between malalignment and revision rate with a minimum follow-up of 6 months were considered for inclusion. A study protocol, including the detailed search strategy was published on the PROSPERO database for systematic reviews. From an initial 2107 citations, eight studies, with variable methodological qualities, were eligible for inclusion. Collectively, nine parameters of alignment were studied, and 20 assessments were made between an alignment parameter and revision rate. Four out of eight studies demonstrated an association between a malalignment parameter and increased revision rates. In the coronal plane, only three studies assessed the mechanical axis. None of these studies found an association with revision rates, whereas four of the five studies investigating the anatomical axis found an association between malalignment and increased revision rate. This study demonstrates the effect of malalignment on revision rates is likely to be modest. Interestingly, studies that used mechanical alignment in the coronal plane demonstrated no association with revision rates. This questions the premise of patient specific instrumentation devices based on the mechanically aligned knee when considering revision as the endpoint. Springer International Publishing 2015-12-30 /pmc/articles/PMC4695472/ /pubmed/26753122 http://dx.doi.org/10.1186/s40064-015-1604-4 Text en © Hadi et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Review
Hadi, Mohammed
Barlow, Tim
Ahmed, Imran
Dunbar, Mark
McCulloch, Peter
Griffin, Damian
Does malalignment affect revision rate in total knee replacements: a systematic review of the literature
title Does malalignment affect revision rate in total knee replacements: a systematic review of the literature
title_full Does malalignment affect revision rate in total knee replacements: a systematic review of the literature
title_fullStr Does malalignment affect revision rate in total knee replacements: a systematic review of the literature
title_full_unstemmed Does malalignment affect revision rate in total knee replacements: a systematic review of the literature
title_short Does malalignment affect revision rate in total knee replacements: a systematic review of the literature
title_sort does malalignment affect revision rate in total knee replacements: a systematic review of the literature
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695472/
https://www.ncbi.nlm.nih.gov/pubmed/26753122
http://dx.doi.org/10.1186/s40064-015-1604-4
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