Dr anuj nigam paper presentation ioacon goa 2021

1. - Guided & Co- Authored by
Dr Pramod P. Neema
Dr Murtuza Rassiwala
A Study To Assess Rotational Alignment Of Femoral Component
& Its Functional Outcome In Computerized Navigated
Total Knee Arthroplasty
Presenting Author:
Dr Anuj Nigam
PG Resident
DNB Orthopaedic Surgery
Unique Super Speciality Centre
INDORE (M.P)

2.  Osteoarthritis of the knee is a debilitating condition that affects most of the people in the age
more than 45 years. After the failure of conservative treatment to contain the pain and
function of the limb, total knee arthroplasty is the only solution that is left.
 The functional and clinical results of total knee arthroplasty too depend on the proper
alignment of the mechanical axis. So many advances have been done in this field to improve
the mechanical axis alignment.
 In the present study we have evaluated the rotational alignment of femoral component and
its functional outcome in computerized navigated total knee arthroplasty using Knee Society
Score and Knee Functional Score.
INTRODUCTION:
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3.  AIM: To evaluate the rotational alignment of femoral component and its functional
outcome in computerized navigated total knee arthroplasty.
 OBJECTIVES:
1. To assess the accuracy (in relation to rotational alignment of femoral component)
of computerized
navigated Total knee Arthroplasty by radiological examination
2. To assess the functional outcome of computerized navigated total knee
Arthroplasty clinically by
using knee society scores.
AIMS &
OBJECTIVES:
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4.  Study Site: Department of Orthopedics, Unique Super Specialty Center
Indore (M.P.)
 Study Design: Prospective Observational Study
 Study Period: June 2019 to May 2020
 Sample Size: 30 patients
 Preoperative CT scan was done to assess the alignment. The Brainlab® Knee
Navigation System was used with same implants in all patients.
MATERIALS & METHODS:
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5.  Surgery was done by the single surgeon. Patients were followed-up at 3rd,6th
and 12th month after the surgery.
 Knee Society Score was used for assessment of functional outcome.
 Serial X-rays were taken. Postoperative CT scan of the knee joint was used for
final assessment of the femoral component rotation.
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6. SAMPLING CRITERIA
 the sample size was calculated.
 Sample Size, n = N x/((N-1)E2 + x) Where, N is the population size
r is the fraction of responses
margin of error E, E = Sqrt[(N - n)x/n(N-1)] Z is the critical value for the confidence
level c.
Constant, x = Z(c/100)2 r(100-r)
 But putting N=20000, r=4.23% and Z=1.96 in the above formula, we obtained a sample
size of 63 at the confidence interval of 95%
 Due to COVID Pandemic, We could obtain 31 patients for the present study, but for
convenience of calculation, we had finally included 30 patients in the present study and
these were used for final analysis.
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7. INCLUSION CRITERIA
1. Patient of age between 50-80 years of either gender
2. Patient with Kellgren-Lawrence osteoarthritis knee grade III and IV
3. Patient with rheumatic arthritis with varus deformity
4. Patients with post traumatic arthritis
5. Patient and/or his/her legally acceptable representative willing to provide their voluntary
written informed consent for participation in the study
EXCLUSION CRITERIA
1. Patient of age less than 50 years and more than 80 years
2. Patient with fracture Type C according to Insall et al criteria
3. Patient with complex primary total knee replacement: Range Of Motion 10⁰, FFD >30⁰,
neurovascular problems
4. Patient who had undergone revision arthroplasty / any previous knee surgery
5. Patient with a BMI of more than 40 kg/m2
6. Patient with ASA grade more than II
7. Patient and/or his/her legally acceptable representative not willing to provide their
voluntary written informed consent for participation in the study
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8. Measurements For Rotational Alignment Of Femoral Component
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9. STATISTIC
S
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13. 0
10
20
30
40
50
60
70
80
90
100
3-3.5 3.6-4 4.1-4.5
37.5 33.3
0
62.5
66.7
100
Percentage Of Patients Vs Rotational Alignment
Showing Outcomes Of Knee Clinical Score
EXCELLENT GOOD
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15. 0
10
20
30
40
50
60
70
80
90
100
3.0-3.5 3.6-4.0 4.1-4.5
62.5 61.9
100
Percentage Of Patients Vs Rotational Alignment
Showing Outcomes Of Knee Functional Score
EXCELLENT GOOD
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17.  The mean age of the patients was 65.83 ± 5.31 years with an equal distribution of males
and females.
 Right side involvement was more (66.7%).
 Varus deformity was seen in 70% of the patients.
 93.3% patients underwent total knee arthroplasty due to osteoarthritis.
 There was significant improvement in the mean KCS score and mean KFS score over a
period of 12 months (p<0.05).
 The rotational alignment of the femoral component (in external rotation) was achieved
between 3.0 to 4.2 degree, which was excellent.
RESULTS:
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18.  According to KCS score, 33.3% patients had “Excellent” outcome and 66.7% patients
had “Good” outcome.
 According to KFS, 63.3% patients had “Excellent” outcome and 36.7% patients had
“Good” outcome.
 8 patients had rotational alignment of femoral component between 3.0-3.5, 21 patients
had between 3.6-4.0 and 1 patients had between 4.1-4.5.
 Complications such as knee pain (6.7%), superficial infection (6.7%) and serous
discharge (3.3%) were seen in our study.
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19.  We found that using computer-assisted navigation system for total knee arthroplasty
provided excellent results.
 The rotational alignment of femoral component in external rotation was found to be
excellent in terms of KCS & KFS
.
 There were no major complications encountered in the present study.
 We conclude that computer-assisted total knee arthroplasty should be advised for total
knee
Arthroplasty, which will provide excellent mechanical axis alignment and accurate
rotational
alignments, giving extra life to the prosthesis with better clinical and functional outcome.
CONCLUSION:
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20.  Due to the ongoing pandemic of novel corona virus, COVID 19.
 The study was conducted over limited number of patients and thus may lead to an
alteration in the
overall result if the sample size increase.
LIMITATIONS:
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23. 1 Year Post Surgery Follow up
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28. THANK YOU !!!
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