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Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique

Background: The purpose of this study was to describe the femoral component rotation in total knee arthroplasty (TKA) using a tibia-first, gap-balancing, “functional alignment” technique. Methods: Ninety-seven patients with osteoarthritis received a TKA using computer navigation. The tibial resectio...

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Autores principales: Dlaska, Constantin, Ismailidis, Petros, Doma, Kenji, Brandon, Benjamin, Wilkinson, Matthew, Hazratwala, Kaushik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9697292/
https://www.ncbi.nlm.nih.gov/pubmed/36431156
http://dx.doi.org/10.3390/jcm11226680
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author Dlaska, Constantin
Ismailidis, Petros
Doma, Kenji
Brandon, Benjamin
Wilkinson, Matthew
Hazratwala, Kaushik
author_facet Dlaska, Constantin
Ismailidis, Petros
Doma, Kenji
Brandon, Benjamin
Wilkinson, Matthew
Hazratwala, Kaushik
author_sort Dlaska, Constantin
collection PubMed
description Background: The purpose of this study was to describe the femoral component rotation in total knee arthroplasty (TKA) using a tibia-first, gap-balancing, “functional alignment” technique. Methods: Ninety-seven patients with osteoarthritis received a TKA using computer navigation. The tibial resection was performed according to the kinematic alignment (KA) principles, while the femoral rotation was set according to the gap-balancing technique. Preoperative MRIs and intraoperative resection depth data were used to calculate the following rotational axes: the transepicondylar axis (TEA), the posterior condylar axis (PCA) and the prosthetic posterior condylar axis (rPCA). The angles between the PCA and the TEA (PCA/TEA), between the rPCA and the PCA (rPCA/PCA) and between the rPCA and the TEA (rPCA/TEA) were measured. Data regarding patellar maltracking and PROMs were collected for 24 months postoperatively. Results: The mean PCA/TEA, rPCA/TEA and rPCA/PCA angles were −5.1° ± 2.1°, −4.8° ± 2.6° and −0.4° ± 1.7°, respectively (the negative values denote the internal rotation of the PCA to the TEA, rPCA to TEA and rPCA to PCA, respectively). There was no need for lateral release and no cases of patellar maltracking. Conclusions: A tibia-first, gap-balancing, “functional alignment” approach allows incorporating a gap-balancing technique with kinematic principles. Sagittal complexities in the proximal tibia (variable medial and lateral slopes) can be accounted for, as the tibial resection is completed prior to setting the femoral rotation. The prosthetic femoral rotation is internally rotated relative to the TEA, almost parallel to the PCA, similar to the femoral rotation of the KA-TKA technique. This technique did not result in patellar maltracking.
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spelling pubmed-96972922022-11-26 Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique Dlaska, Constantin Ismailidis, Petros Doma, Kenji Brandon, Benjamin Wilkinson, Matthew Hazratwala, Kaushik J Clin Med Article Background: The purpose of this study was to describe the femoral component rotation in total knee arthroplasty (TKA) using a tibia-first, gap-balancing, “functional alignment” technique. Methods: Ninety-seven patients with osteoarthritis received a TKA using computer navigation. The tibial resection was performed according to the kinematic alignment (KA) principles, while the femoral rotation was set according to the gap-balancing technique. Preoperative MRIs and intraoperative resection depth data were used to calculate the following rotational axes: the transepicondylar axis (TEA), the posterior condylar axis (PCA) and the prosthetic posterior condylar axis (rPCA). The angles between the PCA and the TEA (PCA/TEA), between the rPCA and the PCA (rPCA/PCA) and between the rPCA and the TEA (rPCA/TEA) were measured. Data regarding patellar maltracking and PROMs were collected for 24 months postoperatively. Results: The mean PCA/TEA, rPCA/TEA and rPCA/PCA angles were −5.1° ± 2.1°, −4.8° ± 2.6° and −0.4° ± 1.7°, respectively (the negative values denote the internal rotation of the PCA to the TEA, rPCA to TEA and rPCA to PCA, respectively). There was no need for lateral release and no cases of patellar maltracking. Conclusions: A tibia-first, gap-balancing, “functional alignment” approach allows incorporating a gap-balancing technique with kinematic principles. Sagittal complexities in the proximal tibia (variable medial and lateral slopes) can be accounted for, as the tibial resection is completed prior to setting the femoral rotation. The prosthetic femoral rotation is internally rotated relative to the TEA, almost parallel to the PCA, similar to the femoral rotation of the KA-TKA technique. This technique did not result in patellar maltracking. MDPI 2022-11-10 /pmc/articles/PMC9697292/ /pubmed/36431156 http://dx.doi.org/10.3390/jcm11226680 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dlaska, Constantin
Ismailidis, Petros
Doma, Kenji
Brandon, Benjamin
Wilkinson, Matthew
Hazratwala, Kaushik
Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique
title Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique
title_full Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique
title_fullStr Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique
title_full_unstemmed Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique
title_short Femoral Component Rotation in Total Knee Arthroplasty Using a Tibia-First, Gap-Balancing, “Functional Alignment” Technique
title_sort femoral component rotation in total knee arthroplasty using a tibia-first, gap-balancing, “functional alignment” technique
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9697292/
https://www.ncbi.nlm.nih.gov/pubmed/36431156
http://dx.doi.org/10.3390/jcm11226680
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