A new technique for determining proper mechanical axis alignment during total knee arthroplasty: progress toward computer-assisted TKA.

Successful total knee arthroplasty (TKA) relies on proper positioning of prosthetic components to restore the mechanical axis of the lower extremity. This report presents and analyzes a new noninvasive method using the Optotrack (Northern Digital Inc, Ontario, Canada) to accurately determine the center of the femoral head. This method, together with direct digitization of the bony landmarks of the knee and ankle intraoperatively, permits placement of the lower extremity in proper alignment intraoperatively. It also permits the surgeon to follow all the angles of movement or rotation and all displacements that occur at each step of the operative procedure. knee intraoperatively via a customized Windows-based program. In addition to presenting our first case, which, importantly, represents the first computer-assisted TKA in a patient, we report on the accuracy and reproducibility of the technique for locating the center of the femoral head obtained during an extensive series of cadaver studies. Location of the femoral head, a major aspect of effecting neutral mechanical axis alignment, appears to be possible to within 2-4 mm, which corresponds to an angular accuracy of better than 1 degree. This method requires no computed tomography scans or other preliminary marker placement. The only basic requirement other than the instrumentation described is a freely mobile hip, which is generally present in TKA patients.

Comparison of total hip and knee component weights.

Weights of total hip and total knee components from 4 major orthopaedic device manufacturers are compared. These data provide surgeons with information that is not readily available and may serve as a reference for patient information or possibly biomechanical studies in the future.

Effect of protoporphyrin IX limitation on porphyromonas gingivalis.

Porphyromonas gingivalis has been shown to require hemin or hemoglobin for in vitro growth. We have previously shown that protoporphyrin IX and inorganic iron can replace the hemin requirement, suggesting that the hemin requirement of this microorganism is actually a porphyrin requirement. We examined the effect of protoporphyrin IX limitation to P. gingivalis strain A7A1-28 in the presence of sufficient iron on growth characteristics, proteolytic enzyme production, virulence in a mouse abscess model, and expression of membrane proteins. Bacterial cells were grown in medium varying between 0 to 5 microM reduced growth by at least 50%. Protoporphyrin IX availability did not affect proteolytic enzyme production or virulence in a mouse abscess model. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of membrane preparations demonstrated that protoporphyrin IX limitation induced the expression of new proteins at 42, 34, 30, 29, and 18 kDa and suppressed the production of proteins at 47, 27, 17, and 15 kDa. These studies suggest that in vivo protoporphyrin availability may modulate membrane protein expression and in turn affect host immune responses against P. gingivalis.