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Lower limb alignment and laxity measures before, during and after total knee arthroplasty: A prospective cohort study

      Highlights

      • Knee alignment and laxity before, during and after knee arthroplasty were determined.
      • No difference in coronal alignment was evident.
      • Greater knee extension occurred intra-operatively than in the clinic.

      Abstract

      Background

      This study compared knee alignment and laxity in patients before, during and after total knee arthroplasty, using methodologically similar procedures, with an aim to help inform pre-operative planning.

      Methods

      Eighteen male and 13 female patients were recruited, mean age 66 years (51–82) and mean body mass index of 33 (23–43). All were assessed pre- and postoperatively using a non-invasive infrared position capture system and all underwent total knee arthroplasty using a navigation system. Knee kinematic data were collected and comparisons made between preoperative clinical and intraoperative measurements for osteoarthritic knees, and between postoperative clinical and intraoperative measurements for prosthetic knees.

      Findings

      There was no difference in unstressed coronal mechanical femoral-tibial angles for either osteoarthritic or prosthetic knees. However, for sagittal alignment the knees were in greater extension intraoperatively (osteoarthritic 5.2° p < 0.001, prosthetic 7.2° p < 0.001). For osteoarthritic knees, both varus and valgus stress manoeuvres had greater angular displacements intraoperatively by a mean value of 1.5° for varus (p = 0.002) and 1.6° for valgus (p < 0.001). For prosthetic knees, only valgus angular displacement was greater intraoperatively (0.9°, p = 0.002).

      Interpretation

      Surgeons performing total knee arthroplasties should be aware of potential differences in alignment and laxity measured under different conditions to facilitate more accurate operative planning and follow-up.

      Keywords

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