PERSONALIZED DISTAL FEMORAL VALGUS RESECTION ANGLE IN PRIMARY TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGXilong ,  SHANGXifu , LIGuoyuan , HERui , ZHENGJie

No.Department of Orthopaedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei Anhui, 230001, P. R. China;

Corresponding author：

SHANGXifu, Email: shangxifu@163.com

Keywords：

Total knee arthroplasty; Osteotomy; Femoral mechanical anatomical angle; Mechanical femorotibial angle

DOI：

10.7507/1002-1892.20150007

Video：

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Objective To investigate the feasibility and effectiveness of a personalized distal femoral valgus resection angle for improving postoperative coronal alignment of lower limb in total knee arthroplasty (TKA). Methods A retrospective analysis was made on the clinical data of 50 patients who received primary TKA between January 2013 and February 2013. There were 11 male and 39 female patients with degenerative knee osteoarthritis. The patients were divided into 2 groups. In test group (n=25), the resection angle was adjusted to the femoral mechanical anatomical angle (FMA); in control group (n=25), a fixed distal valgus resection angle of 5° was used. There was no significant difference in gender, age, body mass index, disease duration, sides, grade, preoperative FMA, mechanical femorotibial angle (MFT), and preoperative Knee Society Score (KSS) between 2 groups (P>0.05). Whole long X-ray film was taken to measure FMA and MFT at 3 days after operation, postoperative KSS was used to evaluate the knee function after 6 and 15 months. Results MFT was (-0.20±1.87)° in test group and was (1.71±3.67)° in control group, showing significant difference between 2 groups (t=2.32, P=0.02). The ideal MFT angle (0±3)° was achieved in 22 patients (88%) of test group and in 16 patients (64%) of control group, showing significant difference between 2 groups (χ²=2.32, P=0.02). Primary healing of incision was obtained in all patients of 2 groups. No deep venous thrombosis occurred. The patients of 2 groups were followed up 15 months after operation. There was significant difference in KSS between test and control groups at 6 months (88.23±2.57 vs. 82.92±2.59) (t=7.26, P=0.00) and at 15 months (90.76±2.77 vs. 88.65±1.77) (t=3.20, P=0.02). No sign of prosthesis loosening was observed by X-ray examination. Conclusion Compared with using of a fixed distal femoral resection angle, an individual FMA can significantly improve the postoperative MFT and promote early recovery of the knee function.

Citation： WANGXilong, SHANGXifu, LIGuoyuan, HERui, ZHENGJie. PERSONALIZED DISTAL FEMORAL VALGUS RESECTION ANGLE IN PRIMARY TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 27-30. doi: 10.7507/1002-1892.20150007 Copy

1.	Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clinical Orthop Relat Res, 1983, (173):178-183.
2.	Bonner TJ, Eardley WG, Patterson P, et al. The effect of postoperative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg (Br), 2011, 93(9):1217-1222.
3.	Parratte S, Pagnano M W, Trousdale RT, et al. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg (Am), 2010, 92(12):2143-2149.
4.	Deakin AH, Sarungi M. A comparison of variable angle versus fixed angle distal femoral resection in primary total knee arthroplasty. J Arthroplasty, 2014, 29(6):1133-1137.
5.	Bardakos N, Cil A, Thompson B, et al. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle:a radiographic study. J Arthroplasty, 2007, 22(6 Suppl 2):85-89.
6.	Kharwadkar N, Kent RE, Sharara KH, et al. 5 degerees to 6 degerees of distal femoral cut for uncomplicated primary total knee arthroplasty:is it safe? Knee, 2006, 13(1):57-60.
7.	Nunley RM, Ellison BS, Zhu J, et al. Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res, 2012, 470(3):895-902.
8.	Wang Y, Zeng Y, Dai K, et al. Normal lower-extremity alignment parameters in healthy Southern Chinese adults as a guide in total knee arthroplasty. J Arthroplasty, 2010, 25(4):563-570.
9.	Tang WM, Zhu YH, Chiu KY. Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg (Am), 2000, 82-A(11):1603-1608.
10.	Deakin AH, Basanagoudar PL, Nunag P, et al. Natural distribution of the femoral mechanical-anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee, 2012, 19(2):120-123.
11.	Elkus M, Ranawat CS, Rasquinha VJ, et al. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg (Am), 2004, 86-A(12):2671-2676.
12.	吕厚山, 关振鹏, 周殿阁, 等. 膝关节外翻畸形的人工全膝关节置换术. 中华外科杂志, 2006, 43(20):1305-1308.
13.	Swanson KE, Stocks GW, Warren PD, et al. Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop Relat Res, 2000, (371):246-252.
14.	Jiang CC, Insall JN. Effect of rotation on the axial alignment of the femur:pitfalls in the use of femoral intramedullary guides in total knee arthroplasty. Clin Orthop Relat Res, 1989, (248):50-56.
15.	Krackow KA. The technique of total knee arthroplasty. Philadelphia:CV Mosby Company, 1990.
16.	Whiteside LA, Saeki K, Mihalko WM. Functional medial ligament balancing in total knee arthroplasty. Clin Orthop Relat Res, 2000, (380):45-57.
17.	Brin YS, Nikolaou VS, Joseph L, et al. Imageless computer assisted versus conventional total knee replacement. A Bayesian metaanalysis of 23 comparative studies. Int Orthop, 2011, 35(3):331-339.
18.	Bauwens K, Matthes G, Wich M, et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg (Am), 2007, 89(2):261-269.
19.	Ng VY, DeClaire JH, Berend KR, et al. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res, 2012, 470(1):99-107.

1. Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clinical Orthop Relat Res, 1983, (173):178-183.
2. Bonner TJ, Eardley WG, Patterson P, et al. The effect of postoperative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg (Br), 2011, 93(9):1217-1222.
3. Parratte S, Pagnano M W, Trousdale RT, et al. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg (Am), 2010, 92(12):2143-2149.
4. Deakin AH, Sarungi M. A comparison of variable angle versus fixed angle distal femoral resection in primary total knee arthroplasty. J Arthroplasty, 2014, 29(6):1133-1137.
5. Bardakos N, Cil A, Thompson B, et al. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle:a radiographic study. J Arthroplasty, 2007, 22(6 Suppl 2):85-89.
6. Kharwadkar N, Kent RE, Sharara KH, et al. 5 degerees to 6 degerees of distal femoral cut for uncomplicated primary total knee arthroplasty:is it safe? Knee, 2006, 13(1):57-60.
7. Nunley RM, Ellison BS, Zhu J, et al. Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res, 2012, 470(3):895-902.
8. Wang Y, Zeng Y, Dai K, et al. Normal lower-extremity alignment parameters in healthy Southern Chinese adults as a guide in total knee arthroplasty. J Arthroplasty, 2010, 25(4):563-570.
9. Tang WM, Zhu YH, Chiu KY. Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg (Am), 2000, 82-A(11):1603-1608.
10. Deakin AH, Basanagoudar PL, Nunag P, et al. Natural distribution of the femoral mechanical-anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty. Knee, 2012, 19(2):120-123.
11. Elkus M, Ranawat CS, Rasquinha VJ, et al. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg (Am), 2004, 86-A(12):2671-2676.
12. 吕厚山, 关振鹏, 周殿阁, 等. 膝关节外翻畸形的人工全膝关节置换术. 中华外科杂志, 2006, 43(20):1305-1308.
13. Swanson KE, Stocks GW, Warren PD, et al. Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop Relat Res, 2000, (371):246-252.
14. Jiang CC, Insall JN. Effect of rotation on the axial alignment of the femur:pitfalls in the use of femoral intramedullary guides in total knee arthroplasty. Clin Orthop Relat Res, 1989, (248):50-56.
15. Krackow KA. The technique of total knee arthroplasty. Philadelphia:CV Mosby Company, 1990.
16. Whiteside LA, Saeki K, Mihalko WM. Functional medial ligament balancing in total knee arthroplasty. Clin Orthop Relat Res, 2000, (380):45-57.
17. Brin YS, Nikolaou VS, Joseph L, et al. Imageless computer assisted versus conventional total knee replacement. A Bayesian metaanalysis of 23 comparative studies. Int Orthop, 2011, 35(3):331-339.
18. Bauwens K, Matthes G, Wich M, et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg (Am), 2007, 89(2):261-269.
19. Ng VY, DeClaire JH, Berend KR, et al. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res, 2012, 470(1):99-107.

Chinese Journal of Reparative and Reconstructive Surgery

PERSONALIZED DISTAL FEMORAL VALGUS RESECTION ANGLE IN PRIMARY TOTAL KNEE ARTHROPLASTY

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