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MacDessi SJ, Cohen DA, Wood JA, Diwan AD, Harris IA. Does the Use of Intraoperative Pressure Sensors for Knee Balancing in Total Knee Arthroplasty Improve Clinical Outcomes? A Comparative Study With a Minimum Two-Year Follow-Up. J Arthroplasty 2021; 36:514-519. [PMID: 32928594 DOI: 10.1016/j.arth.2020.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is undetermined whether using sensors for knee balancing in total knee arthroplasty (TKA) improves patient outcomes. The purpose of this study was to compare clinical outcomes of sensor balance (SB) with manual balance (MB) TKA with a minimum two-year follow-up. METHODS A consecutive series of 207 MB TKAs was compared with 222 SB TKAs between April 2014 and April 2017. A single surgeon performed all surgeries, using the same prosthesis. The primary end point was the aggregated mean change in four subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS4) between preoperative and two-year time points. Secondary outcomes included mean differences between groups in all five KOOS subscales, proportions of knee balancing procedures, and rates of reoperations including revisions and manipulations for stiffness. RESULTS The mean changes in the KOOS4 aggregated means for MB TKA (42.4; standard deviation, 29.1) and SB TKA (41.5; standard deviation, 25.0) were not significantly different (mean difference, 0.9; 95% confidence interval: -2.6 to 4.4, P = .62). There were significantly more balancing procedures in the SB group (55.9% versus 16.9%; P < .01). There were no significant differences in the number of reoperations (1.4% SB versus 1.4% MB; P = .71) or manipulations for stiffness (3.7% SB versus 4.4% MB; P = .69). CONCLUSION The use of sensors in TKA to achieve knee balance did not result in improved clinical outcomes, despite significantly increasing the number of surgical interventions required to achieve a balanced knee. Sensors did not alter the rates of revision surgery or requirements for manipulation. It remains to be determined whether precise soft-tissue balancing improves prosthetic survivorship and joint biomechanics.
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Affiliation(s)
- Samuel J MacDessi
- Sydney Knee Specialists, Kogarah, NSW, Australia; St. George and Sutherland Clinical School, University of New South Wales, St George Hospital, Kogarah, NSW, Australia; Department of Orthopaedic Surgery, St George Private Hospital, Kogarah, NSW, Australia
| | | | - Jil A Wood
- Sydney Knee Specialists, Kogarah, NSW, Australia
| | - Ashish D Diwan
- St. George and Sutherland Clinical School, University of New South Wales, St George Hospital, Kogarah, NSW, Australia; Department of Orthopaedic Surgery, St George Private Hospital, Kogarah, NSW, Australia
| | - Ian A Harris
- Department of Orthopaedic Surgery, South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia; Whitlam Orthopaedic Research Centre, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
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A cruciate-retaining implant can treat both knees of most windswept deformities when performed with calipered kinematically aligned TKA. Knee Surg Sports Traumatol Arthrosc 2021; 29:437-445. [PMID: 32239272 DOI: 10.1007/s00167-020-05968-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Surgeons performing total knee arthroplasty (TKA) on the osteoarthritic valgus deformity often use a posterior stabilized (PS) and semi-constrained implants to substitute for the release of a contracted posterior cruciate ligament (PCL) instead of a cruciate retaining (CR) implant. Calipered kinematic alignment (KA) strives to retain the PCL and use a CR implant. The aim of this study of the windswept deformity was to determine whether the level of implant constraint, outcome scores, and alignment after bilateral calipered KA TKA are different between a pair of knees with a varus and valgus deformity in the same patient. METHODS A review of a prospectively collected database identified all patients with a windswept deformity treated with bilateral TKA (n = 19) out of 2430 consecutive primary TKAs performed between 2014 and 2019. Operative reports determined the level of implant constraint. Patient response to the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) assessed outcomes at a mean follow-up of 2.3 years. Postoperative alignment was measured on an A-P computer tomographic scanogram of the limb. RESULTS CR implants were used in 15 of 19 (79%) valgus deformities and 17 of 19 (89%) of varus deformities (n.s.). No knees required a semi-constrained implant. There was no difference in the median postoperative FJS and OKS (n.s.), and a 1° or less difference in the mean postoperative distal lateral femoral angle (p = 0.005) and proximal medial tibial angle (n.s.) between the paired varus and valgus knee deformity. CONCLUSION Based on this small series, surgeons that use calipered KA TKA can expect to use CR implants in most patients with windswept deformity and achieve comparable outcome scores and alignment between the paired varus and valgus deformity. LEVEL OF EVIDENCE IV.
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Haddad FS. Wishing everyone a happy and healthy 2021. Bone Joint J 2021; 103-B:1-2. [PMID: 33380186 DOI: 10.1302/0301-620x.103b1.bjj-2020-2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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104
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Chang JS, Kayani B, Wallace C, Haddad FS. Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology. Bone Joint J 2021; 103-B:507-514. [PMID: 33467917 DOI: 10.1302/0301-620x.103b.bjj-2020-0940.r1] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Total knee arthroplasty (TKA) using functional alignment aims to implant the components with minimal compromise of the soft-tissue envelope by restoring the plane and obliquity of the non-arthritic joint. The objective of this study was to determine the effect of TKA with functional alignment on mediolateral soft-tissue balance as assessed using intraoperative sensor-guided technology. METHODS This prospective study included 30 consecutive patients undergoing robotic-assisted TKA using the Stryker PS Triathlon implant with functional alignment. Intraoperative soft-tissue balance was assessed using sensor-guided technology after definitive component implantation; soft-tissue balance was defined as intercompartmental pressure difference (ICPD) of < 15 psi. Medial and lateral compartment pressures were recorded at 10°, 45°, and 90° of knee flexion. This study included 18 females (60%) and 12 males (40%) with a mean age of 65.2 years (SD 9.3). Mean preoperative hip-knee-ankle deformity was 6.3° varus (SD 2.7°). RESULTS TKA with functional alignment achieved balanced medial and lateral compartment pressures at 10° (25.0 psi (SD 6.1) vs 23.1 psi (SD 6.7), respectively; p = 0.140), 45° (21.4 psi (SD 5.9) vs 20.6 psi (SD 5.9), respectively; p = 0.510), and 90° (21.2 psi (SD 7.1) vs 21.6 psi (SD 9.0), respectively; p = 0.800) of knee flexion. Mean ICPD was 6.1 psi (SD 4.5; 0 to 14) at 10°, 5.4 psi (SD 3.9; 0 to 12) at 45°, and 4.9 psi (SD 4.45; 0 to 15) at 90° of knee flexion. Mean postoperative limb alignment was 2.2° varus (SD 1.0°). CONCLUSION TKA using the functional alignment achieves balanced mediolateral soft-tissue tension through the arc of knee flexion as assessed using intraoperative pressure-sensor technology. Further clinical trials are required to determine if TKA with functional alignment translates to improvements in patient satisfaction and outcomes compared to conventional alignment techniques. Cite this article: Bone Joint J 2021;103-B(3):507-514.
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Affiliation(s)
- Justin S Chang
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London.,Department of Trauma and Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London.,Department of Trauma and Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Charles Wallace
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London.,Department of Trauma and Orthopaedic Surgery, The Princess Grace Hospital, London, UK
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105
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Hsu CE, Huang JT, Tong KM, Huang KC. Total knee arthroplasty according to the original knee phenotypes with kinematic alignment surgical technique-early clinical and functional outcomes. BMC Musculoskelet Disord 2020; 21:839. [PMID: 33308196 PMCID: PMC7731459 DOI: 10.1186/s12891-020-03862-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients’ demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed. Results The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P < 0.05). Conclusion The early outcomes of this phenotype-oriented KA-TKA using generic total knee instruments are promising. Setting individualized alignment target according to original knee phenotype is rational and practical. The residual varus alignment did not cause any aseptic loosening in the 3 years follow-up. Long-term survivorship and functional outcomes need to be evaluated in future studies.
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Affiliation(s)
- Cheng-En Hsu
- Sports Recreation and Health Management Continuing Studies-Bachelor's Degree Completion Program, Tunghai University, Taichung, 407, Taiwan.,Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Ting Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kwok-Man Tong
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - Kui-Chou Huang
- Department of Orthopedics Surgery, Asia University Hospital, 222 Fuxin Rd., Wufeng District, Taichung City, 41354, Taiwan. .,Department of Occupational Therapy, Asia University, Taichung, Taiwan.
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Gao ZX, Long NJ, Zhang SY, Yu W, Dai YX, Xiao C. Comparison of Kinematic Alignment and Mechanical Alignment in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Clinical Trials. Orthop Surg 2020; 12:1567-1578. [PMID: 33099892 PMCID: PMC7767667 DOI: 10.1111/os.12826] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/31/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to estimate whether kinematic alignment (KA) improves knee function or clinical outcomes compared with mechanical alignment (MA) in the short term after total knee arthroplasty (TKA). We searched the literature for randomized controlled trials published before January 2020 from PubMed, EMBASE, Google, Web of Science, Cochrane Library, and other databases. The observation markers included "The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index," "Knee Society Score (KSS)," "Oxford Knee Score (OKS)," "combined Knee Society Score (KSS)," "Knee injury and Osteoarthritis Outcome Score (KOOS)," "European Quality of Life Measure-5 Domain-5-Level (EQ-5D-5L)," range of motion (ROM), lower limb alignment, ligament release, and complications. A total of 11 randomized controlled trial studies were included in the study. During the follow-up of 6-24 months, the KA-TKA group was superior to the MA-TKA group in terms of WOMAC scores, combined KSS, KSS, knee function scores, and knee range of flexion, but there was no significant difference in EQ-5D-5L, KOOS, KOOS (symptoms, pain, ADL, sports, and quality of life), complications, knee range of extension, hip-knee-ankle (HKA) angle, tibial component slope angle, lateral distal femoral angle (LDFA) or medial proximal tibial angle (MPTA) angle between the MA-TKA group and the MA-TKA group (P > 0.05). Our meta-analysis revealed that the incidence of ligament release in the MA-TKA group was higher than that in the KA-TKA group. This meta-analysis shows that the KA-TKA group had better clinical outcomes and knee range of flexion than the MA-TKA group at short-term follow-up.
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Affiliation(s)
- Zhi-Xiang Gao
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Neng-Ji Long
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Shao-Yun Zhang
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Wei Yu
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Yi-Xin Dai
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Cong Xiao
- Department of Orthopaedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
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107
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Roussot MA, Vles GF, Oussedik S. Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review. EFORT Open Rev 2020; 5:486-497. [PMID: 32953134 PMCID: PMC7484715 DOI: 10.1302/2058-5241.5.190093] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although mechanical alignment (MA) has traditionally been considered the gold standard, the optimal alignment strategy for total knee arthroplasty (TKA) is still debated. Kinematic alignment (KA) aims to restore native alignment by respecting the three axes of rotation of the knee and thereby producing knee motion more akin to the native knee. Designer surgeon case series and case control studies have demonstrated excellent subjective and objective clinical outcomes as well as survivorship for KA TKA with up to 10 years follow up, but these results have not been reproduced in high-quality randomized clinical trials. Gait analyses have demonstrated differences in parameters such as knee adduction, extension and external rotation moments, the relevance of which needs further evaluation. Objective improvements in soft tissue balance using KA have not been shown to result in improvements in patient-reported outcomes measures. Technologies that permit accurate reproduction of implant positioning and objective measurement of soft tissue balance, such as robotic-assisted TKA and compartmental pressure sensors, may play an important role in improving our understanding of the optimum alignment strategy and implant position.
Cite this article: EFORT Open Rev 2020;5:486-497. DOI: 10.1302/2058-5241.5.190093
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Affiliation(s)
- Mark Anthony Roussot
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK.,Department of Orthopaedic Surgery, University of Cape Town, South Africa
| | - Georges Frederic Vles
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
| | - Sam Oussedik
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
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108
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Jeremić DV, Massouh WM, Sivaloganathan S, Rosali AR, Haaker RG, Rivière C. Short-term follow-up of kinematically vs. mechanically aligned total knee arthroplasty with medial pivot components: A case-control study. Orthop Traumatol Surg Res 2020; 106:921-927. [PMID: 32522532 DOI: 10.1016/j.otsr.2020.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/29/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The kinematic alignment (KA) technique for total knee arthroplasty (TKA) and the medial pivot (MP) component design are two options promoting a physiologic prosthetic knee kinematics when used in combination that could improve TKA outcomes. Case-control study is initiated to compare the 1-year radio-clinical outcomes between kinematic alignment medial pivot total knee arthroplasty (KA MP-TKAs) and mechanical alignment medial pivot total knee arthroplasty (MA MP-TKA). Goal of a study was to answer the following questions: Do KA MP-TKAs patients have improved functional outcomes compared to MA MP-TKAs patients? (Q1); Do prosthetic knee and lower limb alignments differ between KA and MA patients (Q2)? And does kinematic implantation of MP TKA has higher risk of reoperations and revisions (Q3)? MATERIAL AND METHODS A case-control study was carried out to compare the 1-year clinical and radiographic outcomes between 24 consecutive KA-TKA patients and 24 matched MA-TKA patients. All patients had implantation with manual instruments and a cemented medial pivot TKA with excision of the PCL. All data were collected prospectively, and outcome scores were patient reported. RESULTS KA patients had superior values in Forgotten Joint Score (FJS) at 1-year (KA 77 vs. MA 51) (p=0.05) follow-up. After one year KA patients scored better in objective section of the new Knee Society Score (KSS) (p=0.02), and in sport section of the Knee Osteoarthritis Outcome Score (KOOS) (p=0.01). Eleven out of 24 patients (46%) in KA group and 7/24 patients (29%) in MA group had limb alignment out of 180°±3°, whereas 17/24 (70%) of KA patients, and 14/24 (58%) of MA patients had orientation of tibial component with more than 3° of varus. No reoperation or revision occurred in either group. DISCUSSION/CONCLUSION The KA of MP TKA design seems to have a good efficacy at early-term, with some 1-year functional performance higher to the ones from MA MP TKAs. Further research is needed to define if those early results will last over time. LEVEL OF EVIDENCE III, case-controlled study.
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Affiliation(s)
- Dragan V Jeremić
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany.
| | - Wissam M Massouh
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany
| | | | - Almeric R Rosali
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany
| | - Rolf G Haaker
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany
| | - Charles Rivière
- MSK Lab - Imperial College London, White City Campus, The Lister Hospital, Chelsea Bridge, London, UK; Centre de l'Arthrose, Bordeaux-Mérignac, France
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Abstract
Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival.
Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010
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Affiliation(s)
- Sohail Nisar
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, UK.,Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals Trust, UK
| | | | - Charles Rivière
- MSK Lab - Imperial College London, White City Campus, London, UK.,The Lister Hospital, Chelsea Bridge, London, UK.,Centre de l'Arthrose - Clinique du Sport, Bordeaux-Mérignac, France
| | | | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, UK.,Leeds Teaching Hospitals Trust, UK
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110
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Clement ND, Deehan DJ. Minimum reporting criteria for robotic assisted total knee arthroplasty studies: alignment and balancing techniques should both be defined. Bone Joint Res 2020; 9:279-281. [PMID: 32728427 PMCID: PMC7376305 DOI: 10.1302/2046-3758.96.bjr-2020-0033.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - David J Deehan
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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111
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MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. The arithmetic HKA (aHKA) predicts the constitutional alignment of the arthritic knee compared to the normal contralateral knee: a matched-pairs radiographic study. Bone Jt Open 2020; 1:339-345. [PMID: 33215122 PMCID: PMC7659698 DOI: 10.1302/2633-1462.17.bjo-2020-0037.r1] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS An algorithm to determine the constitutional alignment of the lower limb once arthritic deformity has occurred would be of value when undertaking kinematically aligned total knee arthroplasty (TKA). The purpose of this study was to determine if the arithmetic hip-knee-ankle angle (aHKA) algorithm could estimate the constitutional alignment of the lower limb following development of significant arthritis. METHODS A matched-pairs radiological study was undertaken comparing the aHKA of an osteoarthritic knee (aHKA-OA) with the mechanical HKA of the contralateral normal knee (mHKA-N). Patients with Grade 3 or 4 Kellgren-Lawrence tibiofemoral osteoarthritis in an arthritic knee undergoing TKA and Grade 0 or 1 osteoarthritis in the contralateral normal knee were included. The aHKA algorithm subtracts the lateral distal femoral angle (LDFA) from the medial proximal tibial angle (MPTA) measured on standing long leg radiographs. The primary outcome was the mean of the paired differences in the aHKA-OA and mHKA-N. Secondary outcomes included comparison of sex-based differences and capacity of the aHKA to determine the constitutional alignment based on degree of deformity. RESULTS A total of 51 radiographs met the inclusion criteria. There was no significant difference between aHKA-OA and mHKA-N, with a mean angular difference of -0.4° (95% SE -0.8° to 0.1°; p = 0.16). There was no significant sex-based difference when comparing aHKA-OA and mHKA-N (mean difference 0.8°; p = 0.11). Knees with deformities of more than 8° had a greater mean difference between aHKA-OA and mHKA-N (1.3°) than those with lesser deformities (-0.1°; p = 0.009). CONCLUSION This study supports the arithmetic HKA algorithm for prediction of the constitutional alignment once arthritis has developed. The algorithm has similar accuracy between sexes and greater accuracy with lesser degrees of deformity.Cite this article: Bone Joint Open 2020;1-7:339-345.
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Affiliation(s)
- Samuel J MacDessi
- CPAK Research Group, Sydney, Australia
- St George Private Hospital Specialist Consulting Suites, Kogarah, New South Wales, Australia
- St George & Sutherland Clinical School, University of New South Wales, Kogarah, New South Wales, Australia
| | | | - Ian A Harris
- CPAK Research Group, Sydney, Australia
- Ingham Institute for Applied Medical Research; South Western Sydney Clinical School, University of New South Wales, Kogarah, New South Wales, Australia
| | - Johan Bellemans
- CPAK Research Group, Sydney, Australia
- Hasselt University, Department of Orthopaedic Surgery; ZOL Hospitals, Genk; and ArthroClinic, Leuven, Belgium
| | - Darren B Chen
- CPAK Research Group, Sydney, Australia
- St George Private Hospital Specialist Consulting Suites, Kogarah, New South Wales, Australia
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112
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Current evidence base for kinematic alignment. DER ORTHOPADE 2020; 49:584-592. [PMID: 32507940 DOI: 10.1007/s00132-020-03932-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Kinematic alignment recently became an alternative alignment option for total knee arthroplasty (TKA). Beside previous studies assessing mechanical alignment in comparison to unintentional malalignment of TKA in terms of implant survival and clinical outcome, more and more studies have focused on the direct comparison of intentional kinematic alignment with mechanical alignment of the prosthesis. In the past 5 years the number of studies with respect to kinematic alignment has risen from 11 to 91 studies. AIM The aim of this review article is to give a narrative overview of the current literature in the debate concerning kinematic and mechanical alignment in TKA.
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113
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CORR Insights®: No Difference in 5-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A Randomized Controlled Trial. Clin Orthop Relat Res 2020; 478:1280-1282. [PMID: 32118601 PMCID: PMC7319378 DOI: 10.1097/corr.0000000000001202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET, and NIHR University College London Hospitals Biomedical Research Centre, UK
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