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Kim YD, Lim D, Kwak DS, Cho N, Koh IJ. Kinematical alignment better restores native patellar tracking pattern than mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38932596 DOI: 10.1002/ksa.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to assess whether kinematic alignment (KA) outperforms mechanical alignment (MA) in restoring patellar tracking to native patterns by using a clustering algorithm. METHODS Twenty cadavers (40 knees) were evaluated. For each cadaver, one knee was randomly assigned to KA and the other to MA. KA total knee arthroplasty (TKA) procedures were performed using a caliper-verified technique, while MA TKA procedures utilized a measured resection technique. Subsequently, all specimens were mounted on a customized knee-testing system, and patellar tracking was measured using a motion analysis system. All patellar tracking data were clustered using the density-based spatial clustering of applications with noise algorithm. Differences in patellar tracking patterns and the restoration of native patellar tracking were compared between the two alignment strategies. RESULTS Patellar tracking patterns following KA were considerably different from MA. Pre- and post-TKA patellar tracking patterns following MA were grouped into separate clusters, whereas a substantial proportion of patellar tracking patterns following KA were grouped into the pre-TKA dominant cluster. Compared to MA, a greater proportion of patellar tracking patterns following KA showed similar patterns to native knees (p < 0.05) and more patellar tracking patterns following KA paired with preoperative patterns (p < 0.01). CONCLUSION KA restored native patellar tracking patterns more closely compared to MA. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Department of Anatomy, College of Medicine, Catholic Institute for Applied Anatomy, The Catholic University of Korea, Seoul, Republic of Korea
| | - Nicole Cho
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Sappey-Marinier E, Bini S. Unrestricted kinematic alignment corrects fixed flexion contracture in robotically aligned total knees without raising the joint line in extension. J Exp Orthop 2023; 10:114. [PMID: 37950808 PMCID: PMC10640542 DOI: 10.1186/s40634-023-00670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/09/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE Mechanically Aligned Total Knee Arthroplasty (MA TKA) typically addresses fixed flexion contractures (FFC) by raising the joint line during extension. However, in unrestricted Kinematically Aligned TKA (KA TKA) utilizing a caliper-based resection technique, the joint line is not raised. This study aims to determine the efficacy of KA TKA in restoring full extension in patients with FFC without increasing distal femoral resection, considering tibial bone resection and sagittal component positioning. METHODS A retrospective study was conducted by a single surgeon, involving patients who underwent primary robotically assisted cruciate retaining unrestricted KA TKA between June 1, 2021, and December 1, 2022. Complete intraoperative resection and alignment data were recorded, including the thickness of distal femoral and proximal tibial bone cuts. Patients with a preoperative FFC ≥ 5° (study group) were compared to those with FFC < 5° (control group). The impact of variations in tibial resection and sagittal component positioning was assessed by comparing the heights of medial and lateral resections, sagittal femoral component flexion, and tibial slope. Group comparisons were analyzed using the Wilcoxon Signed Rank Test, with a significance level set at p < 0.05. RESULTS A total of 48 KA TKA procedures met the inclusion criteria, with 24 performed on women. The mean preoperative FFC in the study group was 11.2° (range: 5-25°), while the control group exhibited 1° (range: 0-4°) (p < 0.001). There were no statistically significant differences observed between the study and control groups in terms of distal femoral resections, both medially (p = 0.14) and laterally (p = 0.23), as well as tibial resection heights, both medially (p = 0.66) and laterally (p = 0.74). The alignment of the femoral component flexion and tibial slope was comparable between the two groups (p = 0.31 and p = 0.54, respectively). All patients achieved within 5 degrees of full extension at closure. CONCLUSION Robotic arm-assisted unrestricted KA TKA effectively restores full extension without raising the joint line during extension for patients with a preoperative fixed flexion contracture. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, 69008, France.
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Stefano Bini
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Ishikawa M, Ishikawa M, Nagashima H, Ishizuka S, Michishita K, Soda Y, Hiranaka T. Effects of Unrestricted Kinematically Aligned Total Knee Arthroplasty with a Modified Soft-Tissue Respecting Technique on the Deformity of Limb Alignment in Japanese Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1969. [PMID: 38004019 PMCID: PMC10673030 DOI: 10.3390/medicina59111969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Unrestricted kinematic alignment total knee arthroplasty (KA-TKA) with a soft-tissue respecting technique (STRT) is a soft-tissue-dependent tibial resection entailing the restoration of the original soft-tissue tension using ligamentotaxis after resurfacing the femur, based on the concept of restoring the native or pre-osteoarthritis alignment in each patient. However, there is no consensus on the indications of unrestricted KA-TKA with the STRT. We modified the STRT, followed by an investigation of the effects of surgery on the postoperative hip-knee-ankle angle (HKAA). Materials and Methods: We retrospectively analyzed the clinical background data, including the preoperative and postoperative HKAA, of 87 patients who underwent unrestricted KA-TKA with the modified STRT. Univariate and multivariate analyses were performed to determine the factors affecting the postoperative HKAA. A receiver operating characteristic (ROC) curve was plotted to investigate the change in the cut-off values of preoperative HKAA with respect to the safe zone of the postoperative HKAA. We generated two regression models, the linear regression model and generalized additive model (GAM) using machine learning, to predict the postoperative HKAA. Results: Univariate and multivariate analyses revealed the preoperative HKAA as the factor most relevant to the postoperative HKAA. ROC analysis revealed that the preoperative HKAA exhibited a high predictive utility, with a cut-off value of -10°, when the safe range of postoperative HKAA was set at ±5°. The GAM was the superior machine learning model, indicating a non-linear association between the preoperative and postoperative HKAA. Patients with preoperative HKAAs ranging from -18° to 4° were more likely to fall within the ±5° safe range of the postoperative HKAA. Conclusions: The preoperative HKAA influences the postoperative HKAA in unrestricted KA-TKA with the modified STRT. Machine learning using the GAM may contribute to the selection of patients eligible for the surgical approach.
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Affiliation(s)
- Masahiro Ishikawa
- Department of Orthopedic Surgery, Nagahama Red Cross Hospital, Miyamae Nagahama, Nagahama 526-0053, Shiga, Japan;
| | - Masaaki Ishikawa
- Department of Otolaryngology, Head and Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwachou, Amagasaki 660-8550, Hyogo, Japan
| | - Hideaki Nagashima
- Department of Orthopedic Surgery, Nagahama Red Cross Hospital, Miyamae Nagahama, Nagahama 526-0053, Shiga, Japan;
| | - Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho Shouwaku Nagoya, Nagoya 466-8550, Aichi, Japan;
| | - Kazuhiko Michishita
- Department of Orthopedic Surgery, Japan Community Healthcare Organization, Yugawara Hospital, Yugawara 259-0396, Kanagawa, Japan;
| | - Yoshinori Soda
- Department of Joint Reconstruction and Arthroscopy Center, Midorii Orthopedics, 6-35-1 Midorii, Asaminami-ku, Hiroshima City 731-0103, Hiroshima, Japan;
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Osaka 569-1192, Osaka, Japan;
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Winnock de Grave P, Van Criekinge T, Luyckx T, Moreels R, Gunst P, Claeys K. Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments. Knee Surg Sports Traumatol Arthrosc 2023; 31:4692-4704. [PMID: 37311955 DOI: 10.1007/s00167-023-07464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Patient-specific alignment in total knee arthroplasty (TKA) has shown promising patient-reported outcome measures; however, the clinical and biomechanical effects of restoring the native knee anatomy remain debated. The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment-aMA) and a patient-specific alignment TKA cohort (inverse kinematic alignment-iKA). METHODS At two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case-control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients' demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON). Data collection was conducted by a blinded investigator. The primary outcomes were knee flexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS). RESULTS During walking, the maximum knee flexion did not differ between the iKA group (53.0°) and the control group (55.1°), whereas the aMA group showed lower amplitudes of sagittal motion (47.4°). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225 N mm/kg) compared to aMA group (276 N mm/kg). No significant differences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs differed significantly between patients receiving aMA and healthy controls. The OKS was significantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; p = 0.05. The FJS was significantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; p = 0.002. CONCLUSION At two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Philip Winnock de Grave
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium.
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium.
| | | | - Thomas Luyckx
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Louvain, Belgium
| | - Robin Moreels
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Gent, Ghent, Belgium
| | - Paul Gunst
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
| | - Kurt Claeys
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium
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Kwak DS, Kim YD, Cho N, Cho HJ, Ko J, Kim M, Choi JH, Lim D, Koh IJ. Guided-Motion Bicruciate-Stabilized Total Knee Arthroplasty Reproduces Native Medial Collateral Ligament Strain. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121751. [PMID: 36556953 PMCID: PMC9788414 DOI: 10.3390/medicina58121751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/11/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Guided-motion bicruciate-stabilized (BCS) total knee arthroplasty (TKA) includes a dual cam-post mechanism with an asymmetric bearing geometry that promotes normal knee kinematics and enhances anterior-posterior stability. However, it is unclear whether the improved biomechanics after guided-motion BCS TKA reproduce soft tissue strain similar to the strain generated by native knees. The purpose of this cadaveric study was to compare medial collateral ligament (MCL) strain between native and guided-motion BCS TKA knees using a video extensometer. Materials and Methods: Eight cadaver knees were mounted onto a customized knee squatting simulator to measure MCL strain during flexion in both native and guided-motion BCS TKA knees (Journey II-BCS; Smith & Nephew, Memphis, TN, USA). MCL strain was measured using a video extensometer (Mercury® RT RealTime tracking system, Sobriety s.r.o, Kuřim, Czech Republic). MCL strain level and strain distribution during knee flexion were compared between the native and guided-motion BCS TKA conditions. Results: The mean and peak MCL strain were similar between native and guided-motion BCS TKA knees at all flexion angles (p > 0.1). MCL strain distribution was similar between native and BCS TKA knees at 8 of 9 regions of interest (ROIs), while higher MCL strain was observed after BCS TKA than in the native knee at 1 ROI in the mid portion of the MCL at early flexion angles (p < 0.05 at ≤30° of flexion). Conclusions: Guided-motion BCS TKA restored the amount and distribution of MCL strain to the values observed on native knees.
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Affiliation(s)
- Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Nicole Cho
- Boston College, Morrissey College of Arts and Sciences, Chestnut Hill, MA 02467, USA
| | - Ho-Jung Cho
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaeryong Ko
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - Jae Hyuk Choi
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Republic of Korea
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-2-2030-2655; Fax: +82-2-2030-4629
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Kwak DS, Kim YD, Cho N, In Y, Kim MS, Lim D, Koh IJ. Restoration of the Joint Line Configuration Reproduces Native Mid-Flexion Biomechanics after Total Knee Arthroplasty: A Matched-Pair Cadaveric Study. Bioengineering (Basel) 2022; 9:bioengineering9100564. [PMID: 36290532 PMCID: PMC9598272 DOI: 10.3390/bioengineering9100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Recent evidence supports that restoration of the pre-arthritic condition via total knee arthroplasty (TKA) is associated with improved post-TKA performance and patient satisfaction. However, whether the restored pre-arthritic joint line simulates the native mid-flexion biomechanics remains unclear. Objective: We performed a matched-pair cadaveric study to explore whether restoration of the joint line via kinematically aligned (KA) TKA reproduced native knee biomechanics more accurately than the altered joint line associated with mechanically aligned (MA) TKA. Methods: Sixteen fresh-frozen cadaveric knees (eight pairs) were affixed onto a customized knee-squatting simulator for measurement of femoral rollback and medial collateral ligament (MCL) strain during mid-flexion. One knee from each cadaver was randomly designated to the KA TKA group (with the joint line restored to the pre-arthritic condition) and the other to the MA TKA group (with the joint line perpendicular to the mechanical axis). Optical markers were attached to all knees and rollback was analyzed using motion capture cameras. A video extensometer measured real-time variations in MCL strain. The kinematics and MCL strain prior to and following TKA were measured for all specimens. Results: KA TKA was better for restoring the knee kinematics to the native condition than MA TKA. The mid-flexion femoral rollback and axial rotation after KA TKA were consistently comparable to those of the native knee. Meanwhile, those of MA TKA were similar only at ≤40° of flexion. Furthermore, KA TKA better restored the mid-flexion MCL strain to that of the native knee than MA TKA. Over the entire mid-flexion range, the MCL strain of KA TKA and native knees were similar, while the strains of MA TKA knees were more than twice those of native knees at >20° of flexion. Conclusions: The restored joint line after KA TKA effectively reproduced the native mid-flexion rollback and MCL strain, whereas the altered joint line after MA TKA did not. Our findings may explain why patients who undergo KA TKA experience superior outcomes and more natural knee sensations during daily activities than those treated via MA TKA.
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Affiliation(s)
- Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Yong Deok Kim
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Nicole Cho
- Boston College, Morrissey College of Arts and Sciences, Chestnut Hill, MA 02467, USA
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, Seoul 06591, Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, Seoul 06591, Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul 05006, Korea
| | - In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary’s Hospital, Seoul 03312, Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2030-2655; Fax: +82-2-2030-4629
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Sappey-Marinier E, Meynard P, Shatrov J, Schmidt A, Cheze L, Batailler C, Servien E, Lustig S. Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs. Knee Surg Sports Traumatol Arthrosc 2022; 30:2915-2921. [PMID: 35013747 DOI: 10.1007/s00167-021-06832-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements. METHODS This is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing. RESULTS The mean FMA was 91.3 ± 2.2° (range 82°-97°), the mean TMA was 85.7 ± 2.5° (range 75°-98°), the mean aHKA was 177.0 ± 3.0° (range 164°-185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°-192°). No significant difference was observed between aHKA and vcHKA (p = 0.06). A significant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001). CONCLUSION This study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre-arthritic coronal alignment of the knee for the extension gap. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Sappey-Marinier
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France. .,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France.
| | - P Meynard
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France
| | - J Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.,University of Notre Dame Australia, Sydney, Australia.,Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - A Schmidt
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France
| | - L Cheze
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - C Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - E Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - S Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Li Z, Chen X, Wang X, Zhang B, Wang W, Fan Y, Yan J, Zhang X, Zhao Y, Lin Y, Liu J, Lin J. HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study. J Orthop Translat 2022; 33:31-40. [PMID: 35228995 PMCID: PMC8857449 DOI: 10.1016/j.jot.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 01/05/2023] Open
Abstract
Background The objective of this study was to compare the radiologic and clinical outcomes of HURWA robotic-assisted total knee arthroplasty (TKA) to those of conventional TKA. Methods A total of 150 patients were randomized into two groups – 73 and 77 patients underwent robotic-assisted TKA and conventional TKA, respectively. Preoperative and postoperative Western Ontario McMaster University Osteoarthritis Index (WOMAC) score, Hospital for Special Surgery (HSS) score, 36-item Short Form Health Survey (SF-36) score, Knee Society Score (KSS) and range of motion (ROM) were obtained and compared between these two groups. The preoperative and postoperative hip-knee-ankle (HKA) angle and the rate of HKA≤3° in the two groups were also compared. Results The postoperative mean HKA angle was 1.801° ± 1.608° of varus for the robotic-assisted TKA group and 3.017° ± 2.735° of varus for the conventional TKA group; these values were significantly different. The alignment rate for mechanical axis lower than 3° in the robotic-assisted TKA group and the conventional TKA group were 81.2% and 63.5%, respectively. Patients undergone robotic-assisted TKA or conventional TKA had similarly improved knee flexion and functional recovery reflected by WOMAC score, HSS score, SF-36 score and KSS. Conclusion HURWA robotic-assisted TKA is a safe and effective, resulting in better alignment for mechanical axis than conventional TKA. The improvement in knee flexion and functional recovery after HURWA robotic-assisted TKA were similar to those after conventional TKA. However, longer follow-up is needed to determine whether the improved alignment of mechanical axis will produce better long-term clinical outcomes. The translational potential of this article Recently, the robotic-assisted TKA system has been introduced to clinical practice for TKA. Several robotic-assisted TKA systems, including CASPAR, Tsolution, ROSA, ROBODOC and Mako, have been implemented into clinical application.However, the clinical application of these robotic systems was limited due to their technical complexity, insufficient versatility and increased operative time. Until now, there are still no robotic-assisted TKA systems approved by the National Medical Products Administration of China. Therefore, more robotic-assisted TKA systems need to be designed and improved, particularly in China. Through our randomized, multicenter, single blind and parallel controlled trial, we showed that HURWA robot-assisted TKA system is a safe and effective system for TKA, which had improved knee flexion.
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Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoquan Wang
- Department of Joint Surgery, Tianjin Hospital, Tianjin, 300211, PR China
| | - Bo Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Fan
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Yan
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Xiaofeng Zhang
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Yu Zhao
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Yuan Lin
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongren Tiyuchang Nanlu, Chaoyang, Beijing, 100020, China
- Corresponding author.
| | - Jun Liu
- Department of Joint Surgery, Tianjin Hospital, Tianjin, 300211, PR China
- Corresponding author.
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Corresponding author. Department of Orthopaedic Surgery, Peking Union Medical College Hospital, China.
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