Introduction Important consideration pre-op planning component insertion ligament balancing prosthetic design selection Normal anatomy distal femur is ~9 degrees of valgus (anatomic axis compared to joint line) 5-7 deg valgus of femur refers to difference of anatomic axis to mechanical axis proximal tibia is 2-3 degrees of varus (anatomic axis to joint line) Technical goals restore mechanical alignment (mechanical alignment of 0°) restore joint line ( allows proper function of preserved ligaments. e.g., pcl) balanced ligaments (correct flexion and extension gaps) maintain normal Q angle (ensures proper patellar femoral tacking) Mechanical axis of Limb axis from center of femoral head to center of ankle Preoperative Evaluation Radiographs standing AP and lateral of knee to evaluate for joint space narrowing collateral ligament insufficiency lateral gapping in varus & medial gapping in valgus deformities subluxation of femur on tibia bone defects standing full-length radiographs (AP and Lateral) are indicated to determine an accurate valgus cut angle when the patient has femoral or tibial deformity very tall or short stature extension and flexion laterals sunrise view Femoral Alignment Anatomic axis femur (AAF) a line that bisects the medullary canal of the femur determines entry point of femoral medullary guide rod intramedullary femoral guide goes down anatomic axis of the femur Mechanical axis femur defined by line connecting center of femoral head to point where anatomic axis meets intercondylar notch obtaining a neutral mechanical axis allows even load sharing between the medial and lateral condyles of a knee prosthesis Valgus cut angle (~5-7° from AAF ) difference between AAF and MAF perpendicular to mechanical axis jig measures 6 degrees from femoral guide (anatomic axis) will vary if people are very tall (VCA < 5°) or very short (VCA > 7°) can measure on a standing full length AP x-ray Tibial alignment Anatomic axis of tibia (AAT) a line that bisects medullary canal tibia medullary guide (internal or external) runs parallel to it determines entry point for tibial medullary guide rod Mechanical axis of tibia line from center of proximal tibia to center of talus proximal tibia is cut perpendicular to mechanical axis of tibia usually mechanical axis and anatomic axis of tibia are coincident and therefore you can usually can cut the proximal tibia perpendicular to anatomic axis (an axis determined by an intramedullary jig) if there is a tibia deformity and the mechanical and anatomic axis are not the same, then the proximal tibia must be cut perpendicular to the mechanical axis (therefore an extramedullary tibial guide must be used) Patellofemoral Alignment Q angle Abnormal patellar tracking, although not the most serious, is the most common complication of TKA. The most important variable in proper patellar tracking is preservation of a normal Q angle (11 +/- 7°) the Q angle is defined as angle between axis of extensor mechanism (ASIS to center of patella) and axis of patellar tendon(center of patella to tibial tuberosity) Any increase in the Q angle will lead to increased lateral subluxation forces on the patella relative to the trochlear groove, which can lead to pain and mechanical symptoms, accelerated wear, and even dislocation. It is critical to avoid techniques that lead to an increased Q angle. Common errors include: internal rotation of the femoral prosthesis medialization of the femoral component internal rotation of the tibial prosthesis placing the patellar prosthesis lateral on the patella Q angle management in TKA Joint Line Preservation Goal is to restore the joint line by inserting a prosthesis that is the same thickness as the bone and cartilage that was removed this preserves appropriate ligament tension if there are bone defects they must be addressed so the joint line is not jeopardized elevating the joint line (> 8mm leads to motion problems) and can lead to mid-flexion instability patellofemoral tracking problems an "equivalent" to patella baja never elevate joint line in a valgus knee until after balancing to obtain full extension lowering joint line can lead to lack of full extension flexion instability
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek T. Bernstein Stephen Incavo Recon - High Tibial Osteotomy Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Derek T. Bernstein Stephen Incavo Recon - TKA Axial Alignment Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA with Computer Navigation & Sensor-Guided Assessment for Soft Tissue Balancing - Dr. William Gall William Gallivan Recon - TKA Axial Alignment
QUESTIONS 1 of 2 1 2 Previous Next (OBQ07.209) Which of the following describes the mechanical axis of a normally aligned limb? QID: 870 Type & Select Correct Answer 1 A vertical line drawn from the femoral head through the center of the knee down to the center of the ankle 71% (2764/3910) 2 A valgus angle of 5-7 degrees created by two lines drawn down the shaft of the femur and tibia 5% (203/3910) 3 A varus angle of 3 degrees created by two lines drawn down the shaft of the femur and tibia 1% (52/3910) 4 A vertical line drawn from the femoral head passing 1.5 centimeters lateral to the center of the knee down to the center of the ankle 7% (276/3910) 5 A vertical line drawn from the femoral head passing 1.5 centimeters medial to the center of the knee down to the center of the ankle 15% (601/3910) L 3 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ05.136) A 67 year-old woman sustained an ACL tear while playing basketball when she was 35 years-old. She has noted progressive leg deformity and episodes of giving way, and now has pain preventing activity. Non-operative management has failed to provide relief. Treatment should consist of? QID: 1022 FIGURES: A Type & Select Correct Answer 1 Opening wedge high tibial osteotomy with autograft 3% (143/4858) 2 Closing wedge proximal tibial osteotomy 2% (82/4858) 3 Medial interpositional arthroplasty 0% (16/4858) 4 Medial unicompartmental knee arthroplasty 9% (441/4858) 5 Total knee arthroplasty 86% (4155/4858) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (3) Podcasts (1) Login to View Community Videos Login to View Community Videos Orthopaedic Summit Evolving Techniques 2021 Pro: Precision Alignment Technology: Forget The Robot - Handheld Smart Devices Win The Day - Michael P. Ast, MD Michael P. Ast Recon - TKA Axial Alignment 11/21/2022 26 views 0.0 (0) Login to View Community Videos Login to View Community Videos ISTA: New Early-Career Webinar Series 2020 How Robotics Foster (R)Evolution of Alignment in Total Knee Arthroplasty – Inverse Kinematic Alignment - Philip Winnock De Grave Recon - TKA Axial Alignment B 3/3/2021 42 views 4.0 (1) Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques Pro: Kinematic Alignment Is All That Matters! - Stephen M. Howell, MD Stephen Howell Recon - TKA Axial Alignment A 4/25/2018 921 views 5.0 (5) Recon⎪TKA Axial Alignment Orthobullets Team Recon - TKA Axial Alignment Listen Now 10:28 min 6/4/2020 380 plays 5.0 (1)
Osteoarthritis knees with distal femoral deformity (C101203) Rohit Vikas Recon - TKA Axial Alignment E 7/13/2019 59 7 1