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Total diz artroplastisinde ve tibial dizilimde ekstansör hallusis longus tendonunun distal referans noktası olarak kullanılması

Year 2014, , 271 - 275, 30.05.2014
https://doi.org/10.3944/AOTT.2014.3155

Abstract

Amaç:Bu çalışmada, total diz artroplastisinde (TDA) kanal dışı kılavuz sistemlerinde ekstansör hallusis longus (EHL) tendonu ve ikinci metatars referanslı tekniklerin tibial dizilimin üzerindeki etkilerinin karşılaştırılması amaçlandı.

Çalışma planı: Çalışmada 2004 ve 2008 yılları arasında primer TDA yapılmış 79 hastaya ait 100 radyografi incelendi. Hastalar ameliyat sırasında kullanılan distal anatomik referans noktasına göre gruplandırıldılar. EHL referanslı teknik (ERT) grubunda ortalama yaşı 68.3 (dağılım: 56-82) olan 36 hasta yer alırken, ikinci metatars referanslı teknik (MRT) grubundaki 43 hastanın yaş ortalaması 70.2 (dağılım: 54-78) idi. ERT grubunda 47, MRT grubunda 53 komponent yer almaktaydı. Tibial komponentlerin frontal dizilimleri ölçüldü. 90±2° derecelik açılanmalar normal kabul edilirken bu değerin üzerindekiler ‘varus’, altındakiler ise ‘valgus’ olarak işaretlendi.

Bulgular: Ortalama frontal dizilim MRT ve ERT gruplarında, sırası ile, 88.57° ve 89.17° idi. ERT grubunda normal aralıktaki tibial komponentlerin sayısı anlamlı olarak fazlayken (p=0.017) , varus dizilimli komponent sayısı anlamlı olarak düşüktü (p=0.024). İki grup arasında valgus dizilimli normal dağılım dışı değerler açısından anlamlı bir farklılık görülmedi (p=1.000).

Çıkarımlar: Ekstansör hallusis longus tendonunun kullanımı tibial komponentin koronal plandaki dizilimini iyileştirmektedir. EHL tendonu kılavuz dışı sistemlerle güvenle kullanılabilecek bir anatomik referans noktasıdır.

References

  • Stulberg SD. How accurate is current TKR instrumentation? Clin Orthop Relat Res 2003;416:177-84. CrossRef van der Linden-van der Zwaag HM, Valstar ER, van der Molen AJ, Nelissen RG. Transepicondylar axis accuracy in computer assisted knee surgery: a comparison of the CT-based measured axis versus the CAS-determined axis. Comput Aided Surg 2008;13:200-6. CrossRef
  • Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 2009;24(6 Suppl):39-43. CrossRef
  • Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991;73:709-14.
  • Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983;173:178-83.
  • Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004;428:26-34. CrossRef
  • Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB. Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res 1994;309:136-45.
  • Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009;24:570-8. CrossRef
  • Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010;468:45 CrossRef
  • Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 1988;232:168-73.
  • 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.
  • Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 1994;299:31-43.
  • Yaffe MA, Koo SS, Stulberg SD. Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 2008;466:2736-44. CrossRef
  • Teter KE, Bregman D, Colwell CW Jr. Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clin Orthop Relat Res 1995;321:106-10.
  • Cooke NJ, Burnett R. An aid to tibial alignment in total knee replacement. Ann R Coll Surg Engl 2008;90:73-4.
  • Schneider M, Heisel C, Aldinger PR, Breusch SJ. Use of palpable tendons for extramedullary tibial alignment in total knee arthroplasty. J Arthroplasty 2007;22:219-26.
  • Akagi M, Asada S, Mori S, Matsushita T, Hashimoto K, Hamanishi C. Estimation of frontal alignment error of the extramedullary tibial guide on the bi-malleolar technique: a simulation study with magnetic resonance imaging. Knee 2012;19:836-42. CrossRef
  • Sugimura N, Ikeuchi M, Izumi M, Aso K, Ushida T, Tani T. The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013. CrossRef
  • Fukagawa S, Matsuda S, Mitsuyasu H, Miura H, Okazaki K, Tashiro Y, et al. Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees. J Orthop Res 2011;29:919-24.
  • Sikorski JM. Computer-assisted revision total knee replacement. J Bone Joint Surg Br 2004;86:510-4.
  • Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteenyear survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010;92:2143-9. CrossRef
  • Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011;93:1588-96. CrossRef
  • Czurda T, Fennema P, Baumgartner M, Ritschl P. The association between component malalignment and postoperative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc 2010;18:863-9.
  • Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ. Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2009;17:286-92. CrossRef
  • Fang D, Ritter MA. Malalignment: forewarned is forearmed. Orthopedics 2009;32.
  • Löer I, Plitz W. Tibial malalignment of mobile-bearing prostheses-a simulator study. [Article in German] Orthopade 2003;32:296-304. [Abstract] CrossRef
  • Ranawat CS, Boachie-Adjei O. Survivorship analysis and results of total condylar knee arthroplasty. Eight- to 11year follow-up period. Clin Orthop Relat Res 1988;226:6
  • Aglietti P, Buzzi R. Posteriorly stabilised total-condylar knee replacement. Three to eight years’ follow-up of 85 knees. J Bone Joint Surg Br 1988;70:211-6.
  • Reed MR, Bliss W, Sher JL, Emmerson KP, Jones SM, Partington PF. Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg Br 2002;84:858-60.
  • Pang CH, Chan WL, Yen CH, Cheng SC, Woo SB, Choi ST, et al. Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding systems: a prospective study. J Orthop Surg (Hong Kong) 2009;17:170-3.
  • Wong J, Steklov N, Patil S, Flores-Hernandez C, Kester M, Colwell CW Jr, et al. Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty. J Orthop Res 2011;29:347-53. CrossRef

The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment

Year 2014, , 271 - 275, 30.05.2014
https://doi.org/10.3944/AOTT.2014.3155

Abstract

Objective:The aim of this study was to compare the effects on tibial alignment of the use of the extensor hallucis longus (EHL) tendon with the use of the 2nd metatarsal as a reference in total knee arthroplasty (TKA) using the extramedullary technique.

Methods: The study evaluated 100 postoperative radiographs of 79 patients who underwent primary TKA between 2004 and 2008. Patients were grouped according to the distal anatomical landmark used during surgery. There were 36 patients (mean age: 68.3 years, range: 56 to 82 years) in the EHL-referenced (ERT) group and 43 patients (mean age: 70.2 years, range: 54 to 78 years) in the 2nd metatarsal-referenced (MRT) group. There were 47 components in the ERT group and 53 in the MRT group. Frontal alignments of the tibial components were measured. Angles of 90±2° were accepted as the normal boundaries while those above that value were labeled as ‘varus’ and those below as ‘valgus’.

Results: Average frontal alignment was 88.57° in the MRT group and 89.17° in the ERT group. The number of tibial components in the normal range was significantly higher (p=0.017) and the number of varus-oriented components significantly lower (p=0.024) in the ERT group. There were no significant differences in valgus-oriented outliers between groups (p=1.000).

Conclusion: The use of the EHL tendon as a reference improves coronal tibial alignment. The EHL is a reliable anatomical landmark to use with extramedullary guide systems.

References

  • Stulberg SD. How accurate is current TKR instrumentation? Clin Orthop Relat Res 2003;416:177-84. CrossRef van der Linden-van der Zwaag HM, Valstar ER, van der Molen AJ, Nelissen RG. Transepicondylar axis accuracy in computer assisted knee surgery: a comparison of the CT-based measured axis versus the CAS-determined axis. Comput Aided Surg 2008;13:200-6. CrossRef
  • Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 2009;24(6 Suppl):39-43. CrossRef
  • Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991;73:709-14.
  • Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983;173:178-83.
  • Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004;428:26-34. CrossRef
  • Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB. Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res 1994;309:136-45.
  • Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009;24:570-8. CrossRef
  • Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010;468:45 CrossRef
  • Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 1988;232:168-73.
  • 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.
  • Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 1994;299:31-43.
  • Yaffe MA, Koo SS, Stulberg SD. Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 2008;466:2736-44. CrossRef
  • Teter KE, Bregman D, Colwell CW Jr. Accuracy of intramedullary versus extramedullary tibial alignment cutting systems in total knee arthroplasty. Clin Orthop Relat Res 1995;321:106-10.
  • Cooke NJ, Burnett R. An aid to tibial alignment in total knee replacement. Ann R Coll Surg Engl 2008;90:73-4.
  • Schneider M, Heisel C, Aldinger PR, Breusch SJ. Use of palpable tendons for extramedullary tibial alignment in total knee arthroplasty. J Arthroplasty 2007;22:219-26.
  • Akagi M, Asada S, Mori S, Matsushita T, Hashimoto K, Hamanishi C. Estimation of frontal alignment error of the extramedullary tibial guide on the bi-malleolar technique: a simulation study with magnetic resonance imaging. Knee 2012;19:836-42. CrossRef
  • Sugimura N, Ikeuchi M, Izumi M, Aso K, Ushida T, Tani T. The dorsal pedis artery as a new distal landmark for extramedullary tibial alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013. CrossRef
  • Fukagawa S, Matsuda S, Mitsuyasu H, Miura H, Okazaki K, Tashiro Y, et al. Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees. J Orthop Res 2011;29:919-24.
  • Sikorski JM. Computer-assisted revision total knee replacement. J Bone Joint Surg Br 2004;86:510-4.
  • Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteenyear survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010;92:2143-9. CrossRef
  • Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011;93:1588-96. CrossRef
  • Czurda T, Fennema P, Baumgartner M, Ritschl P. The association between component malalignment and postoperative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc 2010;18:863-9.
  • Jung YB, Lee HJ, Jung HJ, Song KS, Lee JS, Yang JJ. Comparison of the radiological results between fluoroscopy-assisted and navigation-guided total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2009;17:286-92. CrossRef
  • Fang D, Ritter MA. Malalignment: forewarned is forearmed. Orthopedics 2009;32.
  • Löer I, Plitz W. Tibial malalignment of mobile-bearing prostheses-a simulator study. [Article in German] Orthopade 2003;32:296-304. [Abstract] CrossRef
  • Ranawat CS, Boachie-Adjei O. Survivorship analysis and results of total condylar knee arthroplasty. Eight- to 11year follow-up period. Clin Orthop Relat Res 1988;226:6
  • Aglietti P, Buzzi R. Posteriorly stabilised total-condylar knee replacement. Three to eight years’ follow-up of 85 knees. J Bone Joint Surg Br 1988;70:211-6.
  • Reed MR, Bliss W, Sher JL, Emmerson KP, Jones SM, Partington PF. Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg Br 2002;84:858-60.
  • Pang CH, Chan WL, Yen CH, Cheng SC, Woo SB, Choi ST, et al. Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding systems: a prospective study. J Orthop Surg (Hong Kong) 2009;17:170-3.
  • Wong J, Steklov N, Patil S, Flores-Hernandez C, Kester M, Colwell CW Jr, et al. Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty. J Orthop Res 2011;29:347-53. CrossRef
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Omer Bilgen This is me

Sadik Bilgen This is me

Cenk Ermutlu This is me

Ferdi Goksel This is me

Necmettin Salar This is me

Publication Date May 30, 2014
Published in Issue Year 2014

Cite

APA Bilgen, O., Bilgen, S., Ermutlu, C., Goksel, F., et al. (2014). The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthopaedica Et Traumatologica Turcica, 48(3), 271-275. https://doi.org/10.3944/AOTT.2014.3155
AMA Bilgen O, Bilgen S, Ermutlu C, Goksel F, Salar N. The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthopaedica et Traumatologica Turcica. May 2014;48(3):271-275. doi:10.3944/AOTT.2014.3155
Chicago Bilgen, Omer, Sadik Bilgen, Cenk Ermutlu, Ferdi Goksel, and Necmettin Salar. “The Extensor Hallucis Longus Tendon As the Distal Reference Point in Total Knee Arthroplasty and Tibial Alignment”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 3 (May 2014): 271-75. https://doi.org/10.3944/AOTT.2014.3155.
EndNote Bilgen O, Bilgen S, Ermutlu C, Goksel F, Salar N (May 1, 2014) The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthopaedica et Traumatologica Turcica 48 3 271–275.
IEEE O. Bilgen, S. Bilgen, C. Ermutlu, F. Goksel, and N. Salar, “The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 3, pp. 271–275, 2014, doi: 10.3944/AOTT.2014.3155.
ISNAD Bilgen, Omer et al. “The Extensor Hallucis Longus Tendon As the Distal Reference Point in Total Knee Arthroplasty and Tibial Alignment”. Acta Orthopaedica et Traumatologica Turcica 48/3 (May 2014), 271-275. https://doi.org/10.3944/AOTT.2014.3155.
JAMA Bilgen O, Bilgen S, Ermutlu C, Goksel F, Salar N. The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthopaedica et Traumatologica Turcica. 2014;48:271–275.
MLA Bilgen, Omer et al. “The Extensor Hallucis Longus Tendon As the Distal Reference Point in Total Knee Arthroplasty and Tibial Alignment”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 3, 2014, pp. 271-5, doi:10.3944/AOTT.2014.3155.
Vancouver Bilgen O, Bilgen S, Ermutlu C, Goksel F, Salar N. The extensor hallucis longus tendon as the distal reference point in total knee arthroplasty and tibial alignment. Acta Orthopaedica et Traumatologica Turcica. 2014;48(3):271-5.