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J Knee Surg
DOI: 10.1055/a-2265-9896
Original Article

What Is the Correlation between Coronal Plane Alignment Measured on Pre- and Postoperative Weight-bearing Radiographs and Intraoperative Navigation When Stress Is Applied to the Knee?

Anthony O'Neill
1   Mater Public and Private Hospital, South Brisbane, Queensland, Australia
2   Brisbane Private Hospital, Brisbane City, Queensland, Australia
,
Michael McAuliffe
3   Ipswich General Hospital, Queensland Health, Ipswich, Queensland, Australia
4   CJM Centre, Ipswich, Queensland, Australia
5   Mater Private Hospital, Springfield Lakes, Queensland, Australia
6   St Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
,
Tristan Pillay 
4   CJM Centre, Ipswich, Queensland, Australia
5   Mater Private Hospital, Springfield Lakes, Queensland, Australia
6   St Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
,
Gautam Garg
3   Ipswich General Hospital, Queensland Health, Ipswich, Queensland, Australia
7   School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
,
Sarah Whitehouse
8   School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, Queensland, Australia
,
Ross Crawford 
9   Orthopaedic Research Unit, Queensland University of Technology, Brisbane, Queensland, Australia
10   The Prince Charles Hospital, Chermside, Queensland, Australia
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Abstract

This study examines the correlation between the weight-bearing (WB) long leg radiograph (LLR)-derived hip–knee–ankle angle (HKAA) and intraoperative supine computer-assisted surgery (CAS)-derived HKAA measurements at the beginning and end of total knee arthroplasty (TKA). The primary aim of the study was to determine if WB alignment could be mimicked or inferred based on intraoperative alignment findings. We conducted a prospective analysis from a cohort of 129 TKAs undergoing a CAS TKA at a single center by a single surgeon. The HKAA was recorded using the CAS navigation system immediately postregistration of navigation data and after implantation of the prosthesis. The intraoperative HKAA was recorded in both the supine “resting” position of the knee and also while the knee was manipulated in an effort to replicate the patient's WB alignment. These measurements were compared with the HKAA recorded on pre- and postoperative WB LLRs. There was a strong correlation between the preoperative WB LLR HKAA and the intraoperative preimplant CAS-derived stressed HKAA (R = 0.946). However, there was no correlation between the postoperative WB LLR HKAA and the postimplant insertion HKAA as measured intraoperatively via CAS for either a “resting” or “stressed” position of the operated knee (R = 0.165 and R = 0.041, respectively). Thus, the interpretation of intraoperative alignment data is potentially problematic. Despite technological advances in the development and utilization of computer navigation and robotics in arthroplasty to help obtain the optimal alignment, it would seem apparent from our study that this alignment does not correlate to upright stance postoperatively. Surgeons should apply caution to the strength of assumptions they place on intraoperative coronal plane alignment findings.

Keywords

knee osteoarthritis - total knee arthroplasty - coronal alignment - computer-assisted surgery - long leg radiographs


Publication History

Received: 21 November 2023

Accepted: 08 February 2024

Accepted Manuscript online:
09 February 2024

Article published online:
05 March 2024

© 2024. Thieme. All rights reserved.

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

 

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