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- Title
Tibia‐first, gap‐balanced patient‐specific alignment restores bony phenotypes and joint line obliquity in a great majority of varus and straight knees and normalises valgus and severe varus deformities.
- Authors
Graichen, Heiko; Avram, George Mihai; Strauch, Marco; Kaufmann, Verena; Hirschmann, Michael T.
- Abstract
Purpose: The present study focuses on testing the capability of a restricted tibia‐first, gap‐balanced patient‐specific alignment technique (PSA) to restore bony morphology and phenotypes. Methods: Three‐hundred and sixty‐seven patients were treated with navigated total knee arthroplasty and tibia‐first gap‐balanced PSA technique. Boundaries for medial proximal tibial angle were 86°–92°, mechanical lateral distal femoral angle 86°–92°, and hip–knee–ankle angle 175°–183°. Knees were classified by coronal plane alignment of the knee (CPAK), with subsequent analyses comparing pre‐ and postoperative distributions. Phenotype classification within CPAK groups assessed pre‐ and postoperative distributions. Results: Preoperatively, the largest CPAK group was type II (30.8%), followed by type I (20.5%) and type V (17.8%). Postoperatively, type II remained the largest group (39%), followed by type V (30%). All groups with varus/valgus deformities (I, III, IV and VI) became smaller. While in straight legs (II, IV), the CPAK was restored in more than 70%–75%, in varus groups (I, IV) in 40%–50% and in valgus (III and VI) in 5%–18%. The joint line obliquity remained the same in the majority of knees (straight >75%; varus 63%–80%; valgus VI 95%), with the exception of CPAK III (40%). The phenotype analysis showed for straight legs a phenotype restoration of 85%, for varus 94% and for valgus 37%. Joint line convergence angle was reduced significantly in all groups from 1.8°–4.3° preoperatively to 0.6°–1.2° postoperatively. Conclusion: PSA restores bony phenotypes and joint line obliquity in the majority of straight and varus knees, while most of the valgus and extreme varus knees are normalised. Level of Evidence: Level III, retrospective cohort study.
- Subjects
TOTAL knee replacement; PHENOTYPES; ANATOMICAL planes; KNEE; HUMAN abnormalities
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2024, Vol 32, Issue 5, p1287
- ISSN
0942-2056
- Publication type
Article
- DOI
10.1002/ksa.12145