Evidence map›Paper›PMID 31201441›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020

Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances.

William Blakeney, Yann Beaulieu, Benjamin Puliero, Marc-Olivier Kiss, Pascal-André Vendittoli

Abstract read
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In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

William BlakeneyDepartment of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.ORCID http://orcid.org/0000-0002-7789-5872
Yann BeaulieuDepartment of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
Benjamin PulieroDepartment of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
Marc-Olivier KissDepartment of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
Pascal-André VendittoliDepartment of Surgery, CIUSSS-de-L'Est-de-L'Ile-de-Montréal, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada. pa.vendittoli@me.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe objective of this study was to calculate bone resection thicknesses and resulting gap sizes, simulating a measured resection mechanical alignment (MA) technique for total knee arthroplasty (TKA).

methodsMA bone resections were simulated on 1000 consecutive lower limb CT scans from patients undergoing TKA. Femoral rotation was aligned with either the surgical trans-epicondylar axis (TEA) or with 3° of external rotation to the posterior condyles (PC). Imbalances in the extension space, flexion space, medial compartment and lateral compartment were calculated.

resultsExtension space imbalances (≥ 3 mm) occurred in 25% of varus and 54% of valgus knees and severe imbalances (≥ 5 mm) were present in up to 8% of varus and 19% of valgus knees. Higher flexion space imbalance rates were created with TEA versus PC (p < 0.001). Using TEA, only 49% of varus and 18% of valgus knees had < 3 mm of imbalance throughout the extension and flexion spaces, and medial and lateral compartments.

conclusionA systematic use of the simulated measured resection MA technique for TKA leads to many cases with imbalance. Some imbalances may not be correctable surgically and may result in TKA instability. Modified versions of the MA technique or other alignment methods that better reproduce knee anatomies should be explored. LEVEL OF EVIDENCE: 2.

Indexed as

Arthroplasty, Replacement, KneeBone MalalignmentFemurHumansKnee JointOsteoarthritis, KneeRange of Motion, ArticularTibiaAlignmentArthroplastyBone cutsGapKneeLigament balanceMechanicalTotal knee replacement

Identifiers

PMID31201441

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.