Effect of surgeon’s handedness on distribution of prosthesis during primary total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Lei ¹ ,  ZHAO Fengchao ² , ZHA Guochun ¹ , ZHENG Xin ¹ , YANG Guanjie ¹ , XU Shizhuang ¹

1. Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, 221002, P.R.China;
2. Xuzhou Medical University, Xuzhou Jiangsu, 221004, P.R.China;

Corresponding author：

ZHAO Fengchao, Email: zhjianzh@vip.sina.com

Keywords：

Total knee arthroplasty; prosthesis positioning; handedness; influence factor

DOI：

10.7507/1002-1892.201911042

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Objective To evaluate the effect of the surgeon’s handedness on the distribution of prosthesis during primary total knee arthroplasty (TKA).Methods A retrospective analysis was performed on 86 patients (100 knees) with primary TKA completed by the same right-handed surgeon between December 2016 and December 2018, including 72 cases of single knee and 14 of bilateral knees. The patients were divided into dominant group (right side) and non-dominant group (left side) according to the operating position of the surgeon and each group had 50 knees. There was no significant difference in gender, age, body mass index, disease duration, clinical diagnosis, preoperative Hospital for Special Surgery (HSS) score, and other general data between the two groups (P>0.05). The operation time and complications were recorded in both groups. The function of knee was evaluated by HSS score. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured by using X-ray film of full-length lower extremity before TKA and at 2 weeks after TKA that were used to evaluate the coronal position of the prosthesis. Posterior distal femoral angle (PDFA) and posterior proximal tibial angle (PPTA) were measured by using lateral X-ray films at 3 months after operation that were used to evaluate the sagittal position of the prosthesis.Results There was no significant difference in operation time between the two groups (t=−1.128, P=0.262). One case of posterior tibial artery thrombosis occurred in the dominant group, and 1 case of poor healing of the incision occurred in each of the dominant group and the non-dominant group. Patients in both groups were followed up 12-34 months with an average of 22.0 months. The HSS scores at last follow-up were 87.2±4.3 in the dominant group and 86.8±5.0 in the non-dominant group. There was no significant difference between the two groups (t=0.471, P=0.639). No complications such as periprosthetic infection, prosthetic loosening, or periprosthetic fracture occurred during follow-up. There was no significant difference in the HKA, mLDFA, and mMPTA between the two groups before and after operation (P>0.05). The differences in the incidence of sagittal femoral prosthesis malposition and PDFA between the two groups were significant (P<0.05); however, there was no significant difference in the PPTA, the rate of femoral prosthesis distributed in the neutral position, the incidence of over-flexed femoral prosthesis, and the incidence of anterior femoral notch (P>0.05).Conclusion The surgeon’s handedness is one of the factors affecting the placement of the sagittal femoral prosthesis in primary TKA. The incidence of sagittal femoral prosthesis malposition could increase when the surgeon performs on the non-dominant side.

Citation： LIU Lei, ZHAO Fengchao, ZHA Guochun, ZHENG Xin, YANG Guanjie, XU Shizhuang. Effect of surgeon’s handedness on distribution of prosthesis during primary total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 696-701. doi: 10.7507/1002-1892.201911042 Copy

1.	Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty, 2009, 24(4): 570-578.
2.	刘浩, 吴博, 郑清源, 等. 个性化股骨远端截骨导向器与传统手术工具在全膝关节置换术中的对比研究. 中华骨科杂志, 2018, 38(19): 1170-1176.
3.	Moloney D, Bishay M, Ivory J, et al. Failure of the sliding hip screw in the treatment of femoral neck fractures: ‘Left-handed surgeons for left-sided hips’. Injury, 1994, 25(Suppl 2): B9-B13.
4.	Pennington N, Redmond A, Stewart T, et al. The impact of surgeon handedness in total hip replacement. Ann R Coll Surg Engl, 2014, 96(6): 437-441.
5.	Yaman O, Acaroğlu E. Role of surgeon handedness in transpedicular screw insertion. Acta Orthop Traumatol Turc, 2014, 48(5): 479-482.
6.	Akyoldaş G, Şentürk S, Yaman O, et al. Can right-handed surgeons insert upper thoracic pedicle screws in much comfortable position? Right-handedness problem on the left side. J Korean Neurosurg Soc, 2018, 61(5): 568-673.
7.	Kurmis AP. Understanding the role of computer navigation in primary total knee arthroplasty: Commentary on an article by Seung Joon Rhee, MD, et al.: “A comparison of long-term outcomes of computer-navigated and conventional total knee arthroplasty. A meta-analysis of randomized controlled trials”. J Bone Joint Surg (Am), 2019, 101(20): e111.
8.	Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia, 1971, 9(1): 97-113.
9.	Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
10.	Heyse TJ, Decking R, Davis J, et al. Varus gonarthrosis predisposes to varus malalignment in TKA. HSS J, 2009, 5(2): 143-148.
11.	Song X, Ni M, Li H, et al. Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach? J Orthop Surg Res, 2018, 13(1): 123.
12.	Mehta S, Lotke PA. Impact of surgeon handedness and laterality on outcomes of total knee arthroplasties: should right-handed surgeons do only right TKAs? Am J Orthop, 2007, 36(10): 530-533.
13.	Scott CEH, Clement ND, Yapp LZ, et al. Association between femoral component sagittal positioning and anterior knee pain in total knee arthroplasty: A 10-year case-control follow-up study of a cruciate-retaining single-radius design. J Bone Joint Surg (Am), 2019, 101(17): 1575-1585.
14.	Tanikawa H, Tada M, Harato K, et al. Influence of total knee arthroplasty on patellar kinematics and patellofemoral pressure. J Arthroplasty, 2017, 32(1): 280-285.
15.	Zalzal P, Backstein D, Gross AE, et al. Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses. J Arthroplasty, 2006, 21(5): 737-743.
16.	Dennis DA, Kim RH, Johnson DR, et al. The John Insall Award: control-matched evaluation of painful patellar crepitus after total knee arthroplasty. Clin Orthop Relat Res, 2011, 469(1): 10-17.
17.	Kim YH, Park JW, Kim JS, et al. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop, 2014, 38(2): 379-385.
18.	Hsieh JY, Lan MS, Chang YH, et al. The association between surgery laterality in orthopedists and the choices of prostheses in total knee and hip replacement. Open Journal of Orthopedics, 2018, 8(7): 257-266.
19.	马俊, 黄泽宇, 沈彬, 等. 矢状位假体位置对 PS 型全膝关节置换术术后关节活动度的影响. 四川医学, 2017, 38(6): 605-609.
20.	孙振辉, 曹建刚, 田孟强, 等. 股骨远端屈曲角度对人工全膝关节置换股骨假体矢状位力线及功能恢复影响的研究. 中国修复重建外科杂志, 2011, 25(1): 38-41.

1. Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty, 2009, 24(4): 570-578.
2. 刘浩, 吴博, 郑清源, 等. 个性化股骨远端截骨导向器与传统手术工具在全膝关节置换术中的对比研究. 中华骨科杂志, 2018, 38(19): 1170-1176.
3. Moloney D, Bishay M, Ivory J, et al. Failure of the sliding hip screw in the treatment of femoral neck fractures: ‘Left-handed surgeons for left-sided hips’. Injury, 1994, 25(Suppl 2): B9-B13.
4. Pennington N, Redmond A, Stewart T, et al. The impact of surgeon handedness in total hip replacement. Ann R Coll Surg Engl, 2014, 96(6): 437-441.
5. Yaman O, Acaroğlu E. Role of surgeon handedness in transpedicular screw insertion. Acta Orthop Traumatol Turc, 2014, 48(5): 479-482.
6. Akyoldaş G, Şentürk S, Yaman O, et al. Can right-handed surgeons insert upper thoracic pedicle screws in much comfortable position? Right-handedness problem on the left side. J Korean Neurosurg Soc, 2018, 61(5): 568-673.
7. Kurmis AP. Understanding the role of computer navigation in primary total knee arthroplasty: Commentary on an article by Seung Joon Rhee, MD, et al.: “A comparison of long-term outcomes of computer-navigated and conventional total knee arthroplasty. A meta-analysis of randomized controlled trials”. J Bone Joint Surg (Am), 2019, 101(20): e111.
8. Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia, 1971, 9(1): 97-113.
9. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
10. Heyse TJ, Decking R, Davis J, et al. Varus gonarthrosis predisposes to varus malalignment in TKA. HSS J, 2009, 5(2): 143-148.
11. Song X, Ni M, Li H, et al. Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach? J Orthop Surg Res, 2018, 13(1): 123.
12. Mehta S, Lotke PA. Impact of surgeon handedness and laterality on outcomes of total knee arthroplasties: should right-handed surgeons do only right TKAs? Am J Orthop, 2007, 36(10): 530-533.
13. Scott CEH, Clement ND, Yapp LZ, et al. Association between femoral component sagittal positioning and anterior knee pain in total knee arthroplasty: A 10-year case-control follow-up study of a cruciate-retaining single-radius design. J Bone Joint Surg (Am), 2019, 101(17): 1575-1585.
14. Tanikawa H, Tada M, Harato K, et al. Influence of total knee arthroplasty on patellar kinematics and patellofemoral pressure. J Arthroplasty, 2017, 32(1): 280-285.
15. Zalzal P, Backstein D, Gross AE, et al. Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses. J Arthroplasty, 2006, 21(5): 737-743.
16. Dennis DA, Kim RH, Johnson DR, et al. The John Insall Award: control-matched evaluation of painful patellar crepitus after total knee arthroplasty. Clin Orthop Relat Res, 2011, 469(1): 10-17.
17. Kim YH, Park JW, Kim JS, et al. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop, 2014, 38(2): 379-385.
18. Hsieh JY, Lan MS, Chang YH, et al. The association between surgery laterality in orthopedists and the choices of prostheses in total knee and hip replacement. Open Journal of Orthopedics, 2018, 8(7): 257-266.
19. 马俊, 黄泽宇, 沈彬, 等. 矢状位假体位置对 PS 型全膝关节置换术术后关节活动度的影响. 四川医学, 2017, 38(6): 605-609.
20. 孙振辉, 曹建刚, 田孟强, 等. 股骨远端屈曲角度对人工全膝关节置换股骨假体矢状位力线及功能恢复影响的研究. 中国修复重建外科杂志, 2011, 25(1): 38-41.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of surgeon’s handedness on distribution of prosthesis during primary total knee arthroplasty

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