title: Femur positioning in navigated total knee arthroplasty.
abstract: Navigated total knee arthroplasty (TKA) results in better restoration of neutral mechanical axis than does the conventional technique. Nevertheless, coronal malalignment has not been eliminated. It is yet unknown whether errors in implant positioning occur more on the femoral side, more on the tibial side, or equally on both sides. The hypothesis of this study was that a predominance of coronal component malalignment exists on the tibial side in navigated tibia-first TKA.Fifty-seven consecutive navigated (OrthoPilot; B. Braun Aesculap, Tuttlingen, Germany) TKAs were included in this retrospective study. Pre- and postoperative digital whole-leg standing radiographs were analyzed. Coronal alignment was measured for the whole leg pre- and postoperatively. Lateral distal femur angle and medial proximal tibia angle were analyzed on the preoperative radiographs. On the postoperative radiographs, coronal alignment of the femoral and tibial components were measured separately in reference to the tibial and femoral mechanical axis. The coronal alignment improved from 8.2° ± 3.7° preoperatively to 1.1° ± 1.2° postoperatively, with 5 (8%) outliers outside the 3° window. The femoral component was malaligned (0.6° ± 0.6°), whereas the tibial component showed a significantly higher deviation from the mechanical axis of 1.0° ± 1.1° (P=.009). The femoral component was positioned more precisely than the tibial component. The latter influences gap management in the tibia-first technique and may thereby have a relevant effect on joint stability. Accuracy of the surgical technique and differences in the mathematical algorithm for the determination of landmarks are possible reasons for the difference in precision between the femoral and tibial component positioning.
authors.affiliation: Orthopaedic Department, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin, Berlin, Germany. tilman.pfitzner@charite.de
authors.forename: Tilman
authors.initials: T
authors.lastname: Pfitzner
authors.forename: Eric
authors.initials: E
authors.lastname: Röhner
authors.forename: Bernd
authors.initials: B
authors.lastname: Preininger
authors.forename: Carsten
authors.initials: C
authors.lastname: Perka
authors.forename: Georg
authors.initials: G
authors.lastname: Matziolis
mesh_terms: D000368:Aged; D000465:Algorithms; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D017760:Bone Malalignment / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*