Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning

4 pages•Published: December 13, 2022

David Liu, Ishaan Jagota, Joshua Twiggs and Brad Miles

Abstract

A key goal of all TKA alignment strategies is to achieve joint balance. This study aims to compare the alignments achieved by preoperatively planning to a novel distracted joint gap protocol to common alignment strategies as well as to the alignment of a healthy non-arthritic population.
A retrospective study comprised of 145 knees was performed. A long-leg supine CT scan, weightbearing AP knee X-ray and two distracted knee X-rays (one each in extension and flexion, making use of an ankle weight to open the joint) were taken pre-operatively. This imaging was used to perform segmentation, landmarking and 3D-to-2D registration. The medial and lateral joint gaps were determined in extension and flexion.
The mean weightbearing, KA planned and distracted joint planned HKA were 4.7° (±5.9°) varus, 0.3° (±3.2°) varus, and 2.2° (±3.5°) varus. This compares to a healthy adult HKA of 1.3° (±2.3°) varus. A patient level comparison between the planned KA and distracted joint HKA found that the coronal angles of the two alignments are within 3° of each other for 64% patients, within 3-5° for 26% of patients and greater than 5° for the remaining 10% of patients.
Of those compared, the planned distracted HKA was the closest to the constitutional varus HKA of a healthy population. Patient level analysis highlighted the fundamental differences between the planned KA and joint distracted alignments. By considering both hard and soft tissue, the planned joint distracted alignment allows for a more holistic foundation for pre-operative surgical planning for a given patient.

Keyphrases: joint distraction, preoperative planning, stress radiology, tka, total knee arthroplasty

In: Ferdinando Rodriguez Y Baena, Joshua W Giles and Eric Stindel (editors). Proceedings of The 20th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 5, pages 125-128.

Links:	https://easychair.org/publications/paper/Lmts3
	https://doi.org/10.29007/xfj7

BibTeX entry

@inproceedings{CAOS2022:Population_Level_Validation_Novel,
  author    = {David Liu and Ishaan Jagota and Joshua Twiggs and Brad Miles},
  title     = {Population Level Validation of a Novel Joint Distraction Radiology Protocol in Total Knee Arthroplasty Planning},
  booktitle = {Proceedings of The 20th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Ferdinando Rodriguez Y Baena and Joshua W Giles and Eric Stindel},
  series    = {EPiC Series in Health Sciences},
  volume    = {5},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {/publications/paper/Lmts3},
  doi       = {10.29007/xfj7},
  pages     = {125-128},
  year      = {2022}}

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