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Updated: May 25, 2026

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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Conventional or navigated total knee arthroplasty affects sagittal component alignment.

Ryo Sugama1, Yukihide Minoda, Akio Kobayashi

  • 1Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku, Osaka 545-8585, Japan.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|January 21, 2012
PubMed
Summary

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Sagittal alignment in total knee arthroplasty (TKA) differs between conventional methods and navigation systems in women. Reference point selection on the femur significantly impacts sagittal plane alignment during TKA.

Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Medical Imaging

Background:

  • Total knee arthroplasty (TKA) relies on precise prosthetic alignment for optimal outcomes.
  • Sagittal plane alignment in TKA is less reliable than coronal plane alignment, even with navigation systems.
  • Previous studies on TKA sagittal alignment focused on men, with limited data on women, the primary TKA candidates.

Purpose of the Study:

  • To compare sagittal prosthetic alignments in TKA achieved by conventional techniques versus navigation systems in elderly women.
  • To evaluate the impact of different femoral reference points on sagittal alignment using navigation systems.
  • To determine if alignment tendencies in women mirror those observed in men.

Main Methods:

  • Retrospective analysis of standing lower extremity radiographs from 20 elderly women.

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  • Planning of TKA sagittal prosthetic alignments using the conventional technique and three distinct navigation approaches.
  • Comparison of alignment differences resulting from each technique and reference point variation.

    • Main Results:

    • Significant differences in simulated sagittal alignments were observed between the conventional technique and navigation systems (mean difference: 3.2° to 6.3°).
    • Varying reference points on the distal femur (e.g., intramedullary rod insertion, condyle center) led to sagittal plane differences up to 3.0°.
    • Navigation systems tended to result in a more hyperextended position between femoral and tibial components compared to the conventional technique.

    Conclusions:

    • Targeted sagittal prosthetic alignments in TKA differ between conventional techniques and navigation systems in elderly women.
    • The choice of reference points on the distal femur significantly influences sagittal plane alignment outcomes in navigated TKA.
    • The study indicates that sagittal alignment tendencies in women are comparable to those previously reported in men.