Is an x-ray of the knee sufficient to assess the alignment of the leg? A study of total joint replacement with surgical navigation

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Published Jul 31, 2022
DOI: https://doi.org/10.18103/mra.v10i7.2959

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Main Article Content

Daniel Hernandez-Vaquero, MD, PhD
School of Medicine, University of Oviedo, Department of Orthopaedic Surgery. Oviedo,Spain
Alfonso Noriega-Fernandez, MD, PhD
St Agustin University Hospital. Department of Orthopaedic Surgery. Aviles, Spain
Sergio Roncero-Gonzalez, MD
St Agustin University Hospital. Department of Orthopaedic Surgery. Aviles, Spain
Jose Manuel Fernandez-Carreira, MD, PhD
Epidemiologist. Jarrio Hospital. SESPA. Coaña, Spain

Abstract

Background: Understanding the femorotibial mechanical axis (FTMA) of the leg is a necessary requirement to assess the outcome of total knee replacement (TKR). Short radiographs, which only capture the knee joint and do not include the center of the femoral head and center of the ankle, only provide us the anatomical axis (FTAA), and not the FTMA. The purpose of this study was to compare the FTMA and FTAA before and after navigated TKR.


Methods: In 130 patients undergoing surgery to implant the same TKR model, an x-ray was taken including the hip, knee and ankle. Images were analysed using a computer program that calculates the mechanical and anatomical axis of the femur, tibia and femorotibial joint. An image-free navigation system with femorotibial tensioned gap technique was used for the arthroplasty implantation. After surgery, a new long x-ray was taken, where the measurements indicated above were taken again.


Results: Pre-operative x-rays showed a mean difference of 6º between FTAA and FTMA (p<0.001). No significant interaction was seen with patient height, but it was in patients with varus deformity and higher BMI (p=0.029); the greatest discrepancy between the anatomical and mechanical axis of the limb was found in individuals with excess weight. After TKR, the mean FTMA was modified to achieve a neutral axis (180° ±3°), as well as a concentration of the figures that showed great pre-procedure disparity, which was verified by the difference in the pre- and post-operative SD (11.85 versus 3.13). The maximum difference between FTAA and FTMA, which stood at 18º before decreased to 5.5º post-TKR.


Conclusions: There is a major discrepancy between the FTAA and FTMA that increases when there is pre-operative varus deformity and in patients with excess weight. After TKR, the FTMA became concentrated, and the mean axis shifted towards the neutral axis. Performing x-rays that only include the knee is not useful for assessing the limb’s alignment prior to or after TKR.

Keywords: Total knee replacement, short x-ray, long x-ray, mechanical alignment, femoro-tibial axis, varus deformity, valgus deformity

Article Details

How to Cite
HERNANDEZ-VAQUERO, Daniel et al. Is an x-ray of the knee sufficient to assess the alignment of the leg? A study of total joint replacement with surgical navigation. Medical Research Archives, [S.l.], v. 10, n. 7, july 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2959>. Date accessed: 24 nov. 2024. doi: https://doi.org/10.18103/mra.v10i7.2959.
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Issue
Vol 10 No 7 (2022): Vol.10 Issue 7 July 2022
Section
Research Articles

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