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Preoperative Joint Distraction Imaging and Planning Protocol for Total Knee Arthroplasty
Ishaan Jagota1, Joshua Twiggs2, Brad Miles2
1360 Med Care, Sydney, Australia; Flinders University, Adelaide, Australia.
The Journal of Arthroplasty
|November 25, 2023
Summary
New total knee arthroplasty (TKA) planning using joint distraction radiology provides a Distracted Alignment (DA) that better balances knee tissues than traditional methods, leading to optimized surgical outcomes.
Area of Science:
- Orthopedic surgery
- Biomechanical analysis
- Medical imaging
Background:
- Current total knee arthroplasty (TKA) planning relies on bone referencing, neglecting knee ligamentous laxity.
- This limits the optimization of joint alignment and soft tissue balance during surgery.
Purpose of the Study:
- To assess the mean Hip-Knee-Ankle (HKA) angle of the planned Distracted Alignment (DA) in TKA.
- To evaluate a novel joint distraction radiology and planning protocol that incorporates ligamentous laxity.
Main Methods:
- Retrospective analysis of 144 TKA cases.
- Utilized CT scans, weight-bearing AP radiographs, and distracted knee radiographs (extension/flexion).
- Developed preoperative DA plans focusing on medio-lateral and extension-flexion space balance.
Main Results:
- Mean HKA angles: Weight-bearing 4.8° varus, Arithmetic 0.4° varus, Planned DA 2.2° varus.
- Healthy adult HKA angle is 1.3° varus.
- 36% of patients showed >3° difference between planned DA and arithmetic HKA angles.
Conclusions:
- Planned DA HKA angle differs significantly from arithmetic HKA but aligns with healthy knee values.
- The joint distraction radiology protocol optimizes TKA preoperative planning by considering both hard and soft tissues.
- This protocol demonstrates clinical viability for improved TKA surgical planning.
