Download PDF
J Knee Surg 2022; 35(13): 1385-1392
DOI: 10.1055/s-0041-1723971
Original Article

Clinical Efficacy of Preoperative CT-Assisted Planning for Primary Total Knee Arthroplasty: A Pilot Randomized Clinical Trial

Ahmed Saeed Younis 
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Mohammed El Sayed Awad
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Tarek M. Samy
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Wael Samir Osman
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Sherif Mostafa Abdeldayem
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Zeiad M. Zakaria
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Ayman Fathy 
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
,
Radwan G. Metwaly
1   Department of Orthopaedics, Ain Shams University, Cairo, Egypt
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

This study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of the included patients showed 5 patients with valgus deformity and 45 patients with varus deformity with the mean coronal alignment of 7.5 degrees. CT scan showed the mean PCA of 3.7 degrees (1.3 degrees). The axial knee postoperative X-ray showed the mean patellar tilt angle of 2.1 degrees (0.5 degrees) and 1.9 degrees (0.5 degrees) in groups 1 and 2, respectively. The congruence angle was 4 degrees (2.6 degrees) in group 1 and 5.5 degrees (3.2 degrees) in group 2. The median Knee Society functional score in group 1 was 85 (12), while it was 84 (7.5) in group 2. The median postoperative Western Ontario and McMaster Universities Arthritis Index score in group 1 was 84 (18.6) whereas 80.2 (13.6) in group 2. The median postoperative Bartlett score in group 1 was 30 (5), while it was 30 (6) in group 2. The use of preoperative CT scan did not improve the patient functional scores after TKA.

Keywords

CT scan - total knee arthroplasty - posterior condylar angle


Publication History

Received: 14 October 2020

Accepted: 02 January 2021

Article published online:
22 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rodricks DJ, Patil S, Pulido P, Colwell Jr CW. Press-fit condylar design total knee arthroplasty. Fourteen to seventeen-year follow-up. J Bone Joint Surg Am 2007; 89 (01) 89-95
    CrossrefPubMedGoogle Scholar
  • 2 Choi Y-J, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016; 28 (01) 1-15
    CrossrefPubMedGoogle Scholar
  • 3 Park JH, Bin SI, Kim JM. et al. Comparison of patellar tracking according to different angles of external rotation of femoral component in varus knee of Asians. J Orthop Surg (Hong Kong) 2017; 25 (03) 2309499017739498 DOI: 10.1177/2309499017739498.
    CrossrefPubMedGoogle Scholar
  • 4 Dennis DA, Komistek RD, Kim RH, Sharma A. Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (01) 102-107
    CrossrefPubMedGoogle Scholar
  • 5 Kobayashi H, Akamatsu Y, Kumagai K. et al. The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 2947-2953
    CrossrefPubMedGoogle Scholar
  • 6 Oshima Y, Iizawa N, Kataoka T, Majima T, Takai S. A computed-tomography-scan-based template to place the femoral component in accurate rotation with respect to the surgical epicondylar axis in total knee arthroplasty. Knee 2018; 25 (01) 195-202
    CrossrefPubMedGoogle Scholar
  • 7 Jabalameli M, Moradi A, Bagherifard A, Radi M, Mokhtari T. Evaluation of distal femoral rotational alignment with spiral CT scan before total knee arthroplasty (A study in Iranian population). Arch Bone Jt Surg 2016; 4 (02) 122-127
    PubMedGoogle Scholar
  • 8 Griffin FM, Insall JN, Scuderi GR. The posterior condylar angle in osteoarthritic knees. J Arthroplasty 1998; 13 (07) 812-815
    CrossrefPubMedGoogle Scholar
  • 9 McDougall CJ, Gallie P, Whitehouse SL. Preoperative assessment of femoral rotation and its relationship with coronal alignment: a magnetic resonance imaging study. J Orthop 2016; 13 (04) 290-293
    CrossrefPubMedGoogle Scholar
  • 10 Meric G, Gracitelli GC, Aram LJ, Swank ML, Bugbee WD. Variability in distal femoral anatomy in patients undergoing total knee arthroplasty: measurements on 13,546 computed tomography scans. J Arthroplasty 2015; 30 (10) 1835-1838
    CrossrefPubMedGoogle Scholar
  • 11 Luyckx T, Zambianchi F, Catani F, Bellemans J, Victor J. Coronal alignment is a predictor of the rotational geometry of the distal femur in the osteo-arthritic knee. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2331-2337
    CrossrefPubMedGoogle Scholar
  • 12 Konigsberg B, Hess R, Hartman C, Smith L, Garvin KL. Inter- and intraobserver reliability of two-dimensional CT scan for total knee arthroplasty component malrotation. Clin Orthop Relat Res 2014; 472 (01) 212-217
    CrossrefPubMedGoogle Scholar
  • 13 Luxenhofer M, Beisemann N, Schnetzke M. et al. Diagnostic accuracy of intraoperative CT-imaging in complex articular fractures - a cadaveric study. Sci Rep 2020; 10 (01) 4530 DOI: 10.1038/s41598-020-61267-w.
    CrossrefPubMedGoogle Scholar
  • 14 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
    PubMedGoogle Scholar
  • 15 Scoring K. KOOS Scoring 2012. 2012: 4-6
    PubMedGoogle Scholar
  • 16 Orthopaedic Scores. n.d. WOMAC Score. Accessed January 21, 2020 at: http://www.orthopaedicscore.com/scorepages/knee_injury_osteopaedic_outcome_score_womac.html?textfield=&textfield=&x=1&month=1&YYYY=2002&thirtyone=1&thirtytwo=2&-thirtythree=3&reset=Reset&total=50.0
    PubMedGoogle Scholar
  • 17 Asada S, Akagi M, Matsushita T, Hashimoto K, Mori S, Hamanishi C. Effects of cartilage remnants of the posterior femoral condyles on femoral component rotation in varus knee osteoarthritis. Knee 2012; 19 (03) 185-189
    CrossrefPubMedGoogle Scholar
  • 18 Tanzer M, Makhdom AM. Preoperative planning in primary total knee arthroplasty. J Am Acad Orthop Surg 2016; 24 (04) 220-230
    CrossrefPubMedGoogle Scholar
  • 19 Thomas S, Rupiper D, Stacy GS. Imaging of the patellofemoral joint. Clin Sports Med 2014; 33 (03) 413-436
    CrossrefPubMedGoogle Scholar
  • 20 Hoang A, Goodman SM, Navarro-Millán IY. et al. Patients and surgeons provide endorsement of core domains for total joint replacement clinical trials. Arthritis Res Ther 2017; 19 (01) 267
    CrossrefPubMedGoogle Scholar
  • 21 Giesinger K, Hamilton DF, Jost B, Holzner B, Giesinger JM. Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthritis Cartilage 2014; 22 (02) 184-189
    CrossrefPubMedGoogle Scholar
  • 22 Aglietti P, Sensi L, Cuomo P, Ciardullo A. Rotational position of femoral and tibial components in TKA using the femoral transepicondylar axis. Clin Orthop Relat Res 2008; 466 (11) 2751-2755
    CrossrefPubMedGoogle Scholar
  • 23 Lee JK, Lee S, Chun SH, Kim KT, Lee MC. Rotational alignment of femoral component with different methods in total knee arthroplasty: a randomized, controlled trial. BMC Musculoskelet Disord 2017; 18 (01) 217
    CrossrefPubMedGoogle Scholar
  • 24 Bell SW, Young P, Drury C. et al. Component rotational alignment in unexplained painful primary total knee arthroplasty. Knee 2014; 21 (01) 272-277
    CrossrefPubMedGoogle Scholar
  • 25 Sheth NP, Husain A, Nelson CL. Surgical techniques for total knee arthroplasty: measured resection, gap balancing, and hybrid. J Am Acad Orthop Surg 2017; 25: 499-508
    CrossrefPubMedGoogle Scholar
  • 26 Berger RA, Crossett LS. Determining the rotation of the femoral and tibial components in total knee arthroplasty: a computer tomography technique. Oper Tech Orthop 1998; 8 (03) 128-133
    CrossrefPubMedGoogle Scholar
  • 27 Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J. How precise can bony landmarks be determined on a CT scan of the knee?. Knee 2009; 16 (05) 358-365
    CrossrefPubMedGoogle Scholar
  • 28 Fosco M, Rimondi E, Amendola L, Rossi G, Tigani D. Revision of knee prostheses with components malrotation : treatment algorithm using a computed tomographic analysis. Eur Orthop Traumatol 2010; 1: 61-68
    CrossrefPubMedGoogle Scholar
  • 29 Cieliński Ł, Kusz D, Wójcik M, Kamiński J, Kusz M. Variation in the posterior condylar angle. Ortop Traumatol Rehabil 2016; 18 (06) 549-561
    CrossrefPubMedGoogle Scholar
  • 30 Akagi M, Yamashita E, Nakagawa T, Asano T, Nakamura T. Relationship between frontal knee alignment and reference axes in the distal femur. Clin Orthop Relat Res 2001; (388) 147-156
    CrossrefPubMedGoogle Scholar
  • 31 Howell SM, Howell SJ, Hull ML. Assessment of the radii of the medial and lateral femoral condyles in varus and valgus knees with osteoarthritis. J Bone Joint Surg Am 2010; 92 (01) 98-104
    CrossrefPubMedGoogle Scholar
  • 32 Figueroa J, Guarachi JP, Matas J, Arnander M, Orrego M. Is computed tomography an accurate and reliable method for measuring total knee arthroplasty component rotation?. Int Orthop 2016; 40 (04) 709-714
    CrossrefPubMedGoogle Scholar
  • 33 Silva A, Pinto E, Sampaio R. Rotational alignment in patient-specific instrumentation in TKA: MRI or CT?. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3648-3652
    CrossrefPubMedGoogle Scholar
  • 34 Thienpont E, Schwab PE, Paternostre F, Koch P. Rotational alignment of the distal femur: anthropometric measurements with CT-based patient-specific instruments planning show high variability of the posterior condylar angle. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 2995-3002
    CrossrefPubMedGoogle Scholar
  • 35 Matsumoto T, Muratsu H, Tsumura N. et al. Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system. J Biomech Eng 2006; 128 (06) 867-871
    CrossrefPubMedGoogle Scholar