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J Knee Surg 2022; 35(12): 1285-1294
DOI: 10.1055/s-0040-1722694
Original Article

Mechanical Alignment in Knee Replacement Homogenizes Postoperative Coronal Hip–Knee–Ankle Angle in Varus Knees: A Navigation-Based Study

Ricardo Larrainzar-Garijo 
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
2   Departamento Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
,
Elisa M. Molanes-Lopez
3   Departamento de Estadística e Investigación Operativa, Unidad Departamental de Bioestadística, Facultad de Medicina, Universidad Complutense, Madrid Spain
,
David Murillo-Vizuete
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Raul Garcia-Bogalo
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
,
David Escobar-Anton
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Jesus Lopez-Rodriguez
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Angel Diez-Fernandez
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
,
Fernando Corella-Montoya
1   Department of Orthopadic and Trauma, Hospital Universitario Infanta Leonor, Madrid, Spain
2   Departamento Cirugía, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Abstract

After knee replacement, postoperative lower limb alignment is influenced by the geometry of the prosthesis position and surrounding soft tissue that contributes to the hip–knee–ankle (HKA) angle. The purpose of this study is to determine the dynamic coronal HKA angle after mechanical alignment in total knee replacement using computer navigation. We conducted a pre–post design study of 71 patients with varus osteoarthritic knees on which total knee arthroplasty was performed. The HKA was measured before and at the end of the surgical procedure with the patient in the supine position using a navigation system at 30, 60, and 90 degrees of knee flexion. Postoperative implant position and flexion and extension gaps were assessed. HKA was clustered in three preoperative dynamic patterns (PDPs; Varus-Neutral, Varus-Valgus, and Varus-Varus). There were statistically significant differences in the dynamic coronal HKA between the preoperative and postoperative statuses after mechanically aligned knee replacement (with p < 0.0001) Before the surgical procedure, statistically significant differences were found between patterns at any angle of flexion confirming a well-differentiated preoperative dynamic behavior between the three groups. Postoperatively, 98.6% (71 out of 72) of the knees were within ± 3 degrees of the HKA at full extension. Fifty-eight knees (80.6%) were assessed to a “within-range” postoperative dynamic alignment at any grade of flexion considered. There are differences between the preoperative and postoperative status of the dynamic coronal HKA angle after mechanically aligned knee replacement. We proposed that an excellent dynamic HKA alignment is achieved not only at full extension within the range of 0 ± 3 degrees but also when this alignment is maintained at 30, 60, and 90 degrees.

Keywords

computer assisted - arthroplasty - replacement - knee - femorotibial mechanical angle - dynamic alignment


Publication History

Received: 30 July 2020

Accepted: 29 November 2020

Article published online:
20 January 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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