SciELO - Scientific Electronic Library Online

vol.8 número3 índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados



Links relacionados

  • Em processo de indexaçãoCitado por Google
  • Em processo de indexaçãoSimilares em Google


SA Orthopaedic Journal

versão On-line ISSN 2309-8309
versão impressa ISSN 1681-150X

SA orthop. j. vol.8 no.3 Centurion Jan. 2009




Alignment in computer-navigated versus conventional total knee arthroplasty for valgus deformity



GM ShettyI; A MullajiII

IMS Orth; Department of Orthopaedic Surgery, Breach Candy Hospital, Mumbai, India
IIFRCS Ed, MCh Orth, MS Orth; Department of Orthopaedic Surgery, Breach Candy Hospital, Mumbai, India





INTRODUCTION: Significant improvement has been reported in limb alignment and component orientation with computer-navigated total knee arthroplasty (TKA) especially in varus deformities. Literature is lacking regarding the radiographic results of navigated TKA in valgus knees. This study aims to analyse the radiographic results of navigated TKAs in valgus knees and compare them with results of our conventional technique.
MATERIALS AND METHODS: We retrospectively analysed 120 primary TKAs done for valgus arthritic knees. Fifty-three computer-navigated TKAs (group N) were compared with a control group of 53 conventional TKAs (group C) for coronal and sagittal alignment of the femoral and tibial components on X-ray imaging at the end of two years after surgery.
RESULTS: We found no significant difference in the postoperative coronal alignment of components between the two groups. The mean postoperative anatomic valgus angle in the group N was 5.48°±2.33° compared to 5.42° ±2.15° in group C (p=0.06). The percentage of outliers, from the acceptable range of 4° to 10° of anatomic tibiofemoral valgus, in group N was 13% (seven TKAs) compared to 17% (nine TKAs) in group C (p=0.78). Posterior femoral offset was restored more accurately in group N (p=0.047) compared to group C (p=0.68). A greater number of femoral components in group N (43%) was placed in extension relative to the distal femoral anatomic axis compared to group C (17%).
CONCLUSION: Sequential soft-tissue release and computer navigation for valgus TKA gives excellent overall alignment with few outliers. The component alignment between the two groups seems to be no different except for the sagittal femoral component orientation.



“Full text available only in PDF format”




1. Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004;428:26-34.         [ Links ]

2. Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991;73:709-14.         [ Links ]

3. Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994;299:153-6.         [ Links ]

4. Ryd L, Lindstrand A, Stenström A, Selvik G. Porous coated anatomic tricompartmental tibial components. The relationship between prosthetic position and micromotion. Clin Orthop Relat Res 1990;251:189-97.         [ Links ]

5. Elkus M, Ranawat CS, Rasquinha VJ, Babhulkar S, Rossi R, Ranawat AS. Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am 2004;86:2671-6.         [ Links ]

6. Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 2005;20(Suppl 3):132-8.         [ Links ]

7. Bolognesi M, Hofmann A. Computer navigation versus standard instrumentation for TKA: a single-surgeon experience. Clin Orthop Relat Res 2005;440:162-9.         [ Links ]

8. Chauhan SK, Scott RG, Breidahl W, Beaver RJ. Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 2004;86:372-7.         [ Links ]

9. Chin PL, Yang KY, Yeo SJ, Lo NN. Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 2005;20:618-26.         [ Links ]

10. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP. Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty2005;20:282-8.         [ Links ]

11. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 2005;433:152-9.         [ Links ]

12. Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK. Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 2005;20:832-9.         [ Links ]

13. Kim SJ, MacDonald M, Hernandez J, Wixson RL. Computer assisted navigation in total knee arthroplasty: improved coronal alignment. J Arthroplasty 2005;20(Suppl 3):123-31.         [ Links ]

14. Stöckl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O. Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 2004;426:180-6.         [ Links ]

15. Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 2007;22:1097-106.         [ Links ]

16. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res 1989;248:9-12.         [ Links ]

17. Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 2002;84:50- 3.         [ Links ]

18. Miyasaka KC, Ranawat CS, Mullaji A. 10- to 20-year follow-up of total knee arthroplasty for valgus deformities. Clin Orthop Relat Res 1997;345:29.         [ Links ]

19. Lombardi AV Jr, Dodds KL, Berend KR, Mallory TH, Adams JB. An algorithmic approach to total knee arthroplasty in the valgus knee. J Bone Joint Surg Am 2004;86(Suppl 2):62-71.         [ Links ]

20. Stern SH, Moeckel BH, Insall JN. Total knee arthroplasty in valgus knees. Clin Orthop Relat Res 1991;273:5-8.         [ Links ]

21. Laskin RS, Beksac B. Stiffness after total knee arthroplasty. J Arthroplasty 2004;19(Suppl 1):41-6.         [ Links ]



Dr Arun Mullaji
The Arthritis Clinic 101, Cornelian, Kemp's Corner
Cumballa Hill, Mumbai 400036
Tel: +91(22) 23856161; Fax: +91(22) 23876110



No benefits or funds were received in support of this study/article.

Creative Commons License Todo o conteúdo deste periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons