Imaging study on effect of femoral intramedullary guide on the alignment of femoral prosthesis in unicompartmental knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Tao ,  TU Yihui , XUE Huaming , MA Tong , WEN Tao , XUE Long , WANG Fangxing , MENG Yu

Department of Adult Joint Reconstructive Surgery【？】, Yangpu Hospital, Shanghai Tongji University, Shanghai, 200090, P.R.China;

Corresponding?author：

TU Yihui, Email: tyh2010@126.com

Keywords：

Knee joint; unicompartmental knee arthroplasty; femoral intramedullary guide; femoral component alignment

DOI：

10.7507/1002-1892.201808045

Video：

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Objective To explore the imaging features of intramedullary guide rod and its influence on the alignment of the femoral prosthesis in unicompartmental knee arthroplasty (UKA). Methods Between August 2016 and November 2016, 50 patients (50 knees) with primary anteromedial osteoarthritis were treated with UKA by Oxford MicroPlasty minimally invasive replacement system. There were 10 males and 40 females. The age ranged from 62 to 77 years with an average of 68.8 years. Preoperative varus and flexion deformity angles were (5.22±3.46)° and (7.42±2.65)°, respectively. The knee range of motion (ROM) was (106.85±7.62)°. The Hospital for Special Surgery (HSS) score was 68.26±4.65. The angles between the femoral intramedullary guide rod and the anatomical axis of femur on the coronal and sagittal planes, the femoral component valgus/varus angle (FCVA), the femoral component posterior slope angle (FCPSA), knee varus deformity angle, and knee flexion deformity angle were measured by intra- and post-operative X-ray films. The postoperative ROM and HSS score were measured. Results Intraoperative X-ray films measurement showed that the lateral side angles between femoral intramedullary guide rod and femoral anatomical axis were observed on coronal plane, and the angles ranged from 0.28 to 2.06° with an average of 0.96°. While the posterior side angles were observed on sagittal plane, and the angles ranged from 0.09 to 0.48° with an average of 0.23°. The angulations (>1°) between femoral intramedullary part guide rod and outside part of the rod were confirmed in 12 cases (24%) on coronal plane. Postoperative femoral prosthesis were mild varus in 38 patients (76%). The FCVA ranged from –1.76 to 4.08° with an average of 2.21°. The FCPSA ranged from 7.12 to 13.86° with an average of 9.16°. All patients were followed up 22-26 months, with an average of 24.5 months. The incisions healed by first intention. At last follow-up, the varus and flexion deformity angles were (1.82±1.05) and (2.54 ± 1.86)°, respectively. ROM was (124.62±5.85)° and HSS score was 91.58±3.65. There were significant differences between pre- and post-operative parameters (P<0.05). No complication such as dislocation or aseptic loosening of the prosthesis occurred during the follow-up. Conclusion UKA by Oxford MicroPlasty minimally invasive replacement system can obtain accurate femoral prosthesis position with the help of intramedullary guide system, and the effectiveness is excellent.

Citation： YANG Tao, TU Yihui, XUE Huaming, MA Tong, WEN Tao, XUE Long, WANG Fangxing, MENG Yu. Imaging study on effect of femoral intramedullary guide on the alignment of femoral prosthesis in unicompartmental knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 8-12. doi: 10.7507/1002-1892.201808045 Copy

1.	涂意輝, 薛華明, 蔡珉巍, 等. 微創單髁置換術治療膝內側間室骨性關節炎的早期并發癥. 中國矯形外科雜志, 2011, 19(17): 1416-1418.
2.	Clarius M, Hauck C, Seeger JB, et al. Correlation of positioning and clinical results in Oxford UKA. Int Orthop, 2010, 34(8): 1145-1151.
3.	KimJG, Kasat NS, Bae JH, et al. The radiological parameters correlated with the alignment of the femoral component after Oxford phase 3 unicompartmental knee replacement. J Bone Joint Surg (Br), 2012, 94(11): 1499-1505.
4.	Hurst JM, Berend KR. Mobile-bearing unicondylar knee arthroplasty: the Oxford experience. Orthop Clin North Am, 2015, 46(1): 113-124.
5.	Tu Y, Xue H, Ma T, et al. Superior femoral component alignment can be achieved with Oxford microplasty instrumentation after minimally invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 729-735.
6.	趙東方, 孔祥朋, 王毅, 等. 第三代 Oxford 單髁假體安放位置對人工單髁關節置換術近期療效的影響. 中國修復重建外科雜志, 2018, 32(12): 1518-1523.
7.	Hurst JM, Berend KR, Adams JB, et al. Radiographic comparison of mobile-bearing partial knee single-peg versus twin-peg design. J Arthroplasty, 2015, 30(3): 475-478.
8.	Morris MJ, Frye BM, Ekpo TE, et al. Unicompartmental knee replacement with new Oxford instruments. Operative Techniques in Orthopaedics, 2012, 22(4): 189-195.
9.	Tsai TY, Dimitriou D, Liow MH, et al. Three-dimensional imaging analysis of unicompartmental knee arthroplasty evaluated in standing oosition: component alignment and in vivo articular contact. J Arthroplasty, 2016, 31(5): 1096-1101.
10.	Jung KA, Kim SJ, Lee CS, et al. Accuracy of implantation during computer-assisted minimally invasive Oxford unicompartmental knee arthroplasty: a comparison with a conventional instrumented technique. Knee, 2010, 17(6): 387-391.
11.	Kang KT, Son J, Baek C, et al. Femoral component alignment in unicompartmental knee arthroplasty leads to biomechanical change in contact stress and collateral ligament force in knee joint. Arch Orthop Trauma Surg, 2018, 138(4): 563-572.
12.	White SH, Roberts S, Kuiper JH. The twin peg Oxford knee-Medium term survivorship and surgical principles. Knee, 2018, 25(2): 314-322.
13.	賈笛, 李彥林, 王國梁, 等. 利用計算機輔助技術分析膝關節單髁置換術翻修原因. 中國修復重建外科雜志, 2016, 30(1): 119-122.
14.	Novotny J, Gonzalez MH, Amirouche FM, et al. Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty. J Arthroplasty, 2001, 16(5): 641-647.
15.	Bell SW, Anthony I, Jones B, et al. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: Data from a prospective, randomized controlled study. J Bone Joint Surg (Am), 2016, 98(8): 627-635.
16.	Gulati A, Weston-Simons S, Evans D, et al. Radiographic evaluation of factors affecting bearing dislocation in the domed lateral Oxford unicompartmental knee replacement. Knee, 2014, 21(6): 1254-1257.
17.	Dunn AS, Petterson SC, Plancher KD. Unicondylar knee arthroplasty: intramedullary technique. Clin Sports Med, 2014, 33(1): 87-104.

1. 涂意輝, 薛華明, 蔡珉巍, 等. 微創單髁置換術治療膝內側間室骨性關節炎的早期并發癥. 中國矯形外科雜志, 2011, 19(17): 1416-1418.
2. Clarius M, Hauck C, Seeger JB, et al. Correlation of positioning and clinical results in Oxford UKA. Int Orthop, 2010, 34(8): 1145-1151.
3. KimJG, Kasat NS, Bae JH, et al. The radiological parameters correlated with the alignment of the femoral component after Oxford phase 3 unicompartmental knee replacement. J Bone Joint Surg (Br), 2012, 94(11): 1499-1505.
4. Hurst JM, Berend KR. Mobile-bearing unicondylar knee arthroplasty: the Oxford experience. Orthop Clin North Am, 2015, 46(1): 113-124.
5. Tu Y, Xue H, Ma T, et al. Superior femoral component alignment can be achieved with Oxford microplasty instrumentation after minimally invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2017, 25(3): 729-735.
6. 趙東方, 孔祥朋, 王毅, 等. 第三代 Oxford 單髁假體安放位置對人工單髁關節置換術近期療效的影響. 中國修復重建外科雜志, 2018, 32(12): 1518-1523.
7. Hurst JM, Berend KR, Adams JB, et al. Radiographic comparison of mobile-bearing partial knee single-peg versus twin-peg design. J Arthroplasty, 2015, 30(3): 475-478.
8. Morris MJ, Frye BM, Ekpo TE, et al. Unicompartmental knee replacement with new Oxford instruments. Operative Techniques in Orthopaedics, 2012, 22(4): 189-195.
9. Tsai TY, Dimitriou D, Liow MH, et al. Three-dimensional imaging analysis of unicompartmental knee arthroplasty evaluated in standing oosition: component alignment and in vivo articular contact. J Arthroplasty, 2016, 31(5): 1096-1101.
10. Jung KA, Kim SJ, Lee CS, et al. Accuracy of implantation during computer-assisted minimally invasive Oxford unicompartmental knee arthroplasty: a comparison with a conventional instrumented technique. Knee, 2010, 17(6): 387-391.
11. Kang KT, Son J, Baek C, et al. Femoral component alignment in unicompartmental knee arthroplasty leads to biomechanical change in contact stress and collateral ligament force in knee joint. Arch Orthop Trauma Surg, 2018, 138(4): 563-572.
12. White SH, Roberts S, Kuiper JH. The twin peg Oxford knee-Medium term survivorship and surgical principles. Knee, 2018, 25(2): 314-322.
13. 賈笛, 李彥林, 王國梁, 等. 利用計算機輔助技術分析膝關節單髁置換術翻修原因. 中國修復重建外科雜志, 2016, 30(1): 119-122.
14. Novotny J, Gonzalez MH, Amirouche FM, et al. Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty. J Arthroplasty, 2001, 16(5): 641-647.
15. Bell SW, Anthony I, Jones B, et al. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: Data from a prospective, randomized controlled study. J Bone Joint Surg (Am), 2016, 98(8): 627-635.
16. Gulati A, Weston-Simons S, Evans D, et al. Radiographic evaluation of factors affecting bearing dislocation in the domed lateral Oxford unicompartmental knee replacement. Knee, 2014, 21(6): 1254-1257.
17. Dunn AS, Petterson SC, Plancher KD. Unicondylar knee arthroplasty: intramedullary technique. Clin Sports Med, 2014, 33(1): 87-104.

Chinese Journal of Reparative and Reconstructive Surgery

Imaging study on effect of femoral intramedullary guide on the alignment of femoral prosthesis in unicompartmental knee arthroplasty

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