RESUMO
Purpose: This study aimed to investigate whether the Akagi line is a reliable anatomic landmark for adjusting the rotational axis of the tibial component in patients with patellofemoral (PF) malalignment. Materials and methods: This retrospective case-control study included 86 patients with PF instability and 129 controls. On the superimposed axial CT images, TT-TG, TT-PCL, nTT-TG, nTT-PCL, knee joint rotation, and the angle between the Akagi line and surgical transepicondylar axis (Akagi/sTEA angle) were measured. In addition, a modified Akagi line, drawn 1 cm medial to the patellar tendon attachment, was defined, and the angle between the new Akagi line and sTEA (mAkagi/sTEA angle) was also measured and compared between groups. Results: There were 86 patients (47 females, 39 males) in the case group and 129 patients (56 females, 73 males) in the control group with a mean age of 35.7 ± 17.9 years and 41.1 ± 18.8 years, respectively (p < 0.001). Radiologic variables of PF alignment (TT-TG, TT-PCL, nTT-TG, nTT-PCL, and knee joint rotation) were significantly abnormal in the case group (p < 0.001 for all variables). The Akagi/sTEA angle was significantly higher in the case group, resulting in 89.5% external malrotation of the tibial component (> 10°). However, the tibial component was 96.5% aligned correctly (between 10° external and 3° internal rotation) in the control group. Using the modified Akagi line significantly improved the rotational alignment, and normal tibial rotation increased to 93.3% of the case group. The Akagi/sTEA angle strongly correlated with the knee rotation (rho: 0.735, p: 0.001), TT-TG (rho: 0.715, p: 0.001) and nTT-TG (rho: 0.783, p: 0.001). But the TT-PCL (rho: 0.459, p: 0.001) and nTT-PCL (rho: 0.589, p: 0.001) had a medium correlation. Conclusions: The Akagi line might cause unacceptable external rotation of the tibial component in patients with PF malalignment. The use of the modified Akagi line described in this study may be a solution for the rotational mismatch between femoral and tibial components in TKA. Level of evidence: Level III, retrospective case-control study.
RESUMO
PURPOSE: The purpose of this randomized controlled study was to examine the effect of sealing the intramedullary canal with a bone or cement plug or leaving it empty on postoperative bleeding and pain MATERIALS AND METHODS: A total of 120 patients with knee osteoarthritis who underwent unilateral TKA participated in the trial and were assigned to one of three groups. The femoral canal was sealed with an autogenous bone plug (Group I) or cement plug (Group II), or it was left open (Group III). Estimated blood loss, Hemoglobin decline, bleeding into the drain, and postoperative pain w compared between groups. RESULTS: Six patients were excluded due to various reasons, and the remaining 114 patients were included in the final analysis. There were no significant variations in baseline clinical characteristics between the three groups (p > 0.05). Hemoglobin reduction between preoperative and 72 h after the surgery (p: 0.034) and estimated blood loss (p: 0.003) were significantly different between groups. The cement plug group showed the least bleeding. Although there was a significant difference between the cement and empty canal groups (p: 0.03 and p: 0.002, respectively), the difference between the cement and bone groups was similar regarding both hemoglobin reduction and estimated blood loss. The blood volume in the suction drain (p: 0.598) and transfusion rate (p: 0.087) were similar between the groups. VAS at the 12 h after the surgery was similarly high in each group (p: 0.676). It declined at 36 h after surgery, but no significant difference was determined between groups (p: 0.815). CONCLUSIONS: This study showed that estimated blood loss and hemoglobin reduction were significantly lower in the cement plug group than in the empty canal group. But bone plug group did not show any difference with both empty canal and cement plug groups. Sealing the IM canal or leaving it open did not change the bleeding into the drain, transfusion rate, and postoperative pain between groups. Based on these findings, sealing the IM canal with a cement plug might be recommended to diminish bleeding during TKA despite similar transfusion rates. LEVEL OF EVIDENCE: Level I, randomized controlled trial.
