Skip to main content

Advertisement

SpringerLink
Log in

Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig?

Should we use hip-ankle radiographs to assess the coronal alignment after total knee arthroplasty?

  • Originalien
  • Published:
Der Orthopäde Aims and scope Submit manuscript

An Erratum to this article was published on 28 June 2016

Zusammenfassung

Hintergrund

Es besteht kein Konsensus, ob die mechanische Beinachse nach Knie-TEP-Implantation mittels einer Ganzbeinstandaufnahme dokumentiert werden muss, oder ob eine a.-p.-Zielaufnahme ausreicht, die Achsverhältnisse nach Knie-TEP-Implantation zu überprüfen. Die Studie untersucht, ob die Kniegelenkswinkel sowie die anatomische und mechanische Achse nach Knie-TEP anhand einer a.-p.-Aufnahme des Kniegelenkes reproduzierbar zu messen sind.

Material und Methoden

An 100 postoperativen Ganzbeinaufnahmen a.-p. nach Knie-TEP-Implantation wurden die mechanische und anatomische Beinachse sowie die Kniegelenkswinkel vermessen. Anschließend wurden diese Parameter an reduzierten Bildausschnitten von 80, 60 und 40 % erhoben. Die Inter-Observer-Korrelation (ICC) sowie die Differenz der Werte zwischen reduziertem Bildausschnitt und Ganzbeinaufnahme wurden analysiert.

Ergebnisse

Der ICC für den mechanischen femorotibialen Winkel betrug für die Ganzbeinaufnahme 0,95 und reduzierte sich bei der 40 %-Aufnahme auf 0,61. Für die anatomischen Winkel zeigte sich auch bei reduziertem Bildausschnitt eine exzellente Reproduzierbarkeit. Während der mechanische femorotibiale Winkel signifikant von der Ganzbeinaufnahme abwich, wiesen sämtliche Kniegelenkswinkel sowie die anatomische Achse keine signifikanten Abweichungen von der Ganzbeinaufnahme auf.

Diskussion

Die mechanische Beinachse nach Knie-TEP kann ausschließlich an einer Ganzbeinaufnahme valide gemessen werden. Jedoch zeigt die Messung der anatomischen Winkel und der anatomischen Achse am reduzierten Bildausschnitt eine hohe Reproduzierbarkeit und ist ausreichend geeignet, die koronare Komponentenausrichtung zu beurteilen. Die routinemäßige Anfertigung einer postoperativen Ganzbeinstandaufnahme nach Knie-TEP sollte daher kritisch hinterfragt werden.

Abstract

Background

There is no consensus on whether hip-ankle radiographs or rather standardized a‑p knee-radiographs should be used to assess implant position and coronal alignment after total knee arthroplasty (TKA). This study investigates whether implant position and alignment after TKA can reproducibly be assessed using a‑p knee-radiographs rather than hip-ankle radiographs.

Materials and methods

This study was performed on 100 weight-bearing hip-ankle radiographs after conventional primary TKA. The true mechanical and anatomical femorotibial angle as well as coronal implant position was assessed on hip-ankle radiographs. The radiographs were then cropped to 80, 60 and 40 % of the leg-length and tibial coronal implant position, and the anatomical axis and a surrogate mechanical axis were obtained. The difference in the alignment parameters between the hip-ankle radiographs were statistically compared with the cropped radiographs and the inter-observer correlation coefficient (ICC) was calculated.

Results

The ICC for measurement of the mechanical femorotibial angle was higher in hip-ankle radiographs (0.95) when compared with a radiograph cropped to 40 % (0.61). There was a significant difference in the mechanical femorotibial angle between hip-ankle radiographs and any cropped radiograph. However, there were no significant differences in coronal implant position and the anatomical femorotibial angle between hip-ankle radiographs and any cropped radiograph.

Conclusions

We conclude that standard a‑p knee-radiographs are insufficient to assess the mechanical alignment following TKA. However, standard a‑p knee-radiographs are appropriate to assess the implant position when referenced against the anatomical axes. Weight-bearing hip-ankle radiographs should be questioned as a routine after TKA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Abu-Rajab RB, Deakin AH, Kandasami M et al (2015) Hip-knee-ankle radiographs are more appropriate for assessment of post-operative mechanical alignment of total knee arthroplasties than standard AP knee radiographs. J Arthroplast 30:695–700

    Article  Google Scholar 

  2. Babazadeh S, Dowsey MM, Bingham RJ et al (2013) The long leg radiograph is a reliable method of assessing alignment when compared to computer-assisted navigation and computer tomography. Knee 20:242–249

    Article  PubMed  Google Scholar 

  3. Bellemans J, Colyn W, Vandenneucker H et al (2012) The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470:45–53

    Article  PubMed  Google Scholar 

  4. Berend ME (2010) Consequences of Malalignment in total knee arthroplasty: Few if any-opposes. Semin Arthroplasty 21:99–101

    Article  Google Scholar 

  5. Berend ME, Ritter MA, Meding JB et al (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 428:26–34

    Article  PubMed  Google Scholar 

  6. Chang CB, Choi JY, Koh IJ et al (2010) What should be considered in using standard knee radiographs to estimate mechanical alignment of the knee? Osteoarthr Cartil 18:530–538

    Article  CAS  PubMed  Google Scholar 

  7. Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: Just how important is it? J Arthroplasty 24:39–43

    Article  PubMed  Google Scholar 

  8. Felson DT, Cooke TD, Niu J et al (2009) Can anatomic alignment measured from a knee radiograph substitute for mechanical alignment from full limb films? Osteoarthr Cartil 17:1448–1452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Green GV, Berend KR, Berend ME et al (2002) The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: The posteromedial hot spot. J Arthroplast 17:1033–1039

    Article  Google Scholar 

  10. Howell SM, Howell SJ, Kuznik KT et al (2013) Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res 471:1000–1007

    Article  PubMed  Google Scholar 

  11. Howell SM, Papadopoulos S, Kuznik K et al (2015) Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty? Int Orthop 39:2117–2124

    Article  PubMed  Google Scholar 

  12. Kim YH, Park JW, Kim JS et al (2014) The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop 38:379–385

    Article  PubMed  Google Scholar 

  13. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  14. Mcdaniel G, Mitchell KL, Charles C et al (2010) A comparison of five approaches to measurement of anatomic knee alignment from radiographs. Osteoarthr Cartil 18:273–277

    Article  CAS  PubMed  Google Scholar 

  15. Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Jt Surg Am 69:745–749

    CAS  Google Scholar 

  16. Park A, Stambough JB, Nunley RM et al (2015) The inadequacy of short knee radiographs in evaluating coronal alignment after total knee arthroplasty. J Arthroplasty 31(4):878–882

    Article  PubMed  Google Scholar 

  17. Parratte S, Pagnano MW, Trousdale RT et al (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Jt Surg Am 92:2143–2149

    Article  Google Scholar 

  18. Pfitzner T, Roth P Von, Perka C et al (2014) Intramedullary control of distal femoral resection results in precise coronal alignment in TKA. Arch Orthop Trauma Surg 134:459–465

    Article  PubMed  Google Scholar 

  19. Ritter MA, Davis KE, Davis P et al (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Jt Surg Am 95:126–131

    Article  Google Scholar 

  20. Ritter MA, Faris PM, Keating EM et al (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156

    PubMed  Google Scholar 

  21. Sheehy L, Felson D, Zhang Y et al (2011) Does measurement of the anatomic axis consistently predict hip-knee-ankle angle (HKA) for knee alignment studies in osteoarthritis? Analysis of long limb radiographs from the multicenter osteoarthritis (MOST) study. Osteoarthr Cartil 19:58–64

    Article  CAS  PubMed  Google Scholar 

  22. Vanlommel L, Vanlommel J, Claes S et al (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21:2325–2330

    Article  PubMed  Google Scholar 

  23. Werner FW, Ayers DC, Maletsky LP et al (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38:349–355

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland

    J. Dargel, C. K. Boese, P. Eysel & J. Oppermann

  2. Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland

    J. Dargel, P. Eysel & J. Oppermann

  3. Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland

    L. Pennig

  4. St. Vinzenz-Krankenhaus Düsseldorf, Schloßstraße 85, 40477, Düsseldorf, Deutschland

    C. Schnurr

Authors
  1. J. Dargel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Pennig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Schnurr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. K. Boese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Eysel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Oppermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Dargel.

Ethics declarations

Interessenkonflikt

J. Dargel, L. Pennig, C. Schnurr, C.K. Boese, P. Eysel und J. Oppermann geben an, dass kein Interessenkonflikt besteht.

Die Untersuchung wurde durch die medizinische Ethikkommission der Uniklinik zu Köln genehmigt (Ethiknummer 13-195).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dargel, J., Pennig, L., Schnurr, C. et al. Ist die postoperative Ganzbeinaufnahme nach Knie-TEP-Implantation notwendig?. Orthopäde 45, 591–596 (2016). https://doi.org/10.1007/s00132-016-3264-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-016-3264-7

Schlüsselwörter

Keywords

Search

Navigation