1
|
Russell SP, Keyes S, Hirschmann MT, Harty JA. Conventionally instrumented inverse kinematic alignment for total knee arthroplasty: How is it done? J Exp Orthop 2024; 11:e12055. [PMID: 38868128 PMCID: PMC11167404 DOI: 10.1002/jeo2.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose For primary total knee arthroplasty (TKA), there is an increasing trend towards patient-specific alignment strategies such as kinematic alignment (KA) and inverse kinematic alignment (iKA), which by restoring native joint mechanics may yield higher patient satisfaction rates. Second, the most recent Australian joint registry report describes favourable revision rates for conventionally instrumented TKA compared to technology-assisted techniques such as those using navigation, robotics or custom-cutting blocks. The aim of this technique article is to describe in detail a surgical technique for TKA that: (1) utilises the principles of iKA and (2) uses conventionally instrumented guided resections thereby avoiding the use of navigation, robotics or custom blocks. Methods A TKA technique is described, whereby inverse kinematic principles are utilised and patient-specific alignment is achieved. Additionally, the patellofemoral compartment of the knee is restored to the native patellofemoral joint line. The sequenced technical note provided may be utilised for cemented or cementless components; cruciate retaining or sacrificing designs and for fixed or rotating platforms. Results An uncomplicated, robust and reproducible technique for TKA is described. Discussion Knee arthroplasty surgeons may wish to harness the emerging benefits of both a conventionally instrumented technique and a patient-specific alignment strategy. Level of Evidence Level V.
Collapse
Affiliation(s)
- Shane P. Russell
- Department of Orthopaedic SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Department of Orthopaedic SurgeryBon Secours Hospital CorkCorkIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
- Department of Orthopaedic SurgeryRoyal College of Surgeons in IrelandDublinIreland
| | - Sara Keyes
- Department of Orthopaedic SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Department of Orthopaedic SurgeryBon Secours Hospital CorkCorkIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
| | - Michael T. Hirschmann
- Department of Orthopedic Surgery and TraumatologyKantonsspital BasellandBruderholzSwitzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & BiomechanicsUniversity of BaselBaselSwitzerland
| | - James A. Harty
- Department of Orthopaedic SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Department of Orthopaedic SurgeryBon Secours Hospital CorkCorkIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
| |
Collapse
|
2
|
Spitzer A, Gorab R, Barrett W, Nassif N, Hunter M, Leslie I, Lesko J, Dalury D. Robotic-assisted total knee arthroplasty reduces soft-tissue releases which improves functional outcomes: A retrospective study. Knee 2024; 49:52-61. [PMID: 38848658 DOI: 10.1016/j.knee.2024.05.008] [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: 08/11/2023] [Revised: 01/03/2024] [Accepted: 05/18/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND There is increasing use of Robotic-Assisted (RA) and personalized alignment techniques in total knee arthroplasty (TKA). The hypothesis of this study was that RA TKA would result in fewer soft-tissue releases, and that fewer soft-tissue releases would be associated with improved clinical outcomes. METHODS A retrospective review of an internal company registry was conducted for all primary TKAs performed from Jan 1, 2014, through a database extract date of Nov 4, 2022. These were grouped by whether there was an intentional soft-tissue release performed (STR) during the surgery or not (NSTR) and whether RA was utilized. The incidence of STR was compared between RA-TKAs and those performed with manual instrumentation. Knee Society Score (KSS) and Knee Society Function Scores (KSFS) were collected at 6 months, 1 year and 2 years. Kaplan-Meier survivorship was performed. RESULTS The incidence of STR was significantly lower for RA vs. Manual (43.81% Vs 86.62%, p < 0.0001). The TKAs with NSTR had higher KSFS compared to those with STR at 6 months (84.73 Vs. 77.51, p < 0.0001), 1 year (89.87 Vs. 83.54, p < 0.0001) and 2 years (90.09 Vs. 82.65, p < 0.0001). There was no difference in survivorship, or KSS at any time point. However, the NSTR group had improved KSS pain sub score at 2 years. CONCLUSION The results of this observational, retrospective analysis found that the incidence of soft-tissue release was lower with RA-TKA. Further, regardless of if RA was used, avoiding releases was associated with improved KSFS and KSS pain scores through 2 years post-operatively.
Collapse
|
3
|
Keyes S, Russell SP, Bertalan Z, Harty JA. Inverse kinematic total knee arthroplasty using conventional instrumentation restores constitutional coronal alignment. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38829243 DOI: 10.1002/ksa.12306] [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: 03/04/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Restricted inverse kinematic alignment (iKA) is a contemporary alignment strategy for total knee arthroplasty (TKA), commonly performed with robotic assistance. While superior clinical results are reported for kinematic-type alignment strategies, registry data indicate no survivorship benefit for navigation or robotic assistance. This study aimed to determine the efficacy of an instrumented, restricted iKA technique for achieving patient-specific alignment. METHODS Seventy-nine patients undergoing 84 TKAs (five bilateral procedures) using an iKA technique were included for preoperative and postoperative lower limb alignment analysis. The mean age was 66.5 (range: 43-82) with 33 male and 51 female patients. Artificial intelligence was employed for radiographic measurements. Alignment profiles were classified using the Coronal Plane Alignment of the Knee (CPAK) system. Preoperative and postoperative alignment profiles were compared with subanalyses for preoperative valgus, neutral and varus profiles. RESULTS The mean joint-line convergence angle (JLCA) reduced from 2.5° to -0.1° postoperatively. The mean lateral distal femoral angle (LDFA) remained unchanged postoperatively, while the mean medial proximal tibial angle (MPTA) increased by 2.5° (p = 0.001). By preservation of the LDFA and restoration of the MPTA, the mean hip knee ankle angle (HKA) moved through 3.5° varus to 1.2° valgus. The CPAK system was used to visually depict changes in alignment profiles for preoperative valgus, neutral and varus knees; with 63% of patients observing an interval change in classification. CONCLUSION Encouraged by the latest evidence supporting both conventional instrumentation and kinematic-type TKA strategies, this study describes how a restricted, conventionally instrumented iKA technique may be utilised to restore constitutional lower limb alignment. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Sarah Keyes
- South Infirmary Victoria University Hospital, Cork, Ireland
- Bon Secours Hospital Cork, Cork, Ireland
- Department of Orthopaedic Surgery, University College Cork, Cork, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shane P Russell
- South Infirmary Victoria University Hospital, Cork, Ireland
- Bon Secours Hospital Cork, Cork, Ireland
- Department of Orthopaedic Surgery, University College Cork, Cork, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - James A Harty
- South Infirmary Victoria University Hospital, Cork, Ireland
- Bon Secours Hospital Cork, Cork, Ireland
- Department of Orthopaedic Surgery, University College Cork, Cork, Ireland
| |
Collapse
|
4
|
Ollivier M, Gulagaci F, Sahbat Y, Kim Y, Ehlinger M. Should I optimize joint line obliquity in my knee procedure? Orthop Traumatol Surg Res 2024; 110:103882. [PMID: 38583703 DOI: 10.1016/j.otsr.2024.103882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - Firat Gulagaci
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Yavuz Sahbat
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Youngji Kim
- Institut du mouvement et de l'appareil locomoteur (IML), hôpital Sainte-Marguerite, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Matthieu Ehlinger
- Service de chirurgie orthopédique et de traumatologie du membre inférieur, pôle Locomax, hôpital de Hautepierre II, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| |
Collapse
|
5
|
Grosso MJ, Wakelin EA, Plaskos C, Lee GC. Alignment is only part of the equation: High variability in soft tissue distractibility in the varus knee undergoing primary TKA. Knee Surg Sports Traumatol Arthrosc 2024; 32:1516-1524. [PMID: 38488243 DOI: 10.1002/ksa.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The purpose of this study is to evaluate the in vivo medial and lateral joint laxities across various total knee arthroplasty (TKA) alignment categories correlated to (1) hip-knee-ankle angle, (2) proximal tibial angle and (3) distal femoral angle in a consecutive group of patients undergoing robotic-assisted TKA. METHODS Using ligament tensions acquired during 805 robotic-assisted TKA with a dynamic ligament tensor under a load of 70-90 N, the relationship between medial and lateral collateral ligament laxity and overall limb alignment was established. Only knees with neutral or mechanical varus alignment were included and divided into five groups: neutral (0°-3°), varus 3°-5°, varus 6°-9°, varus 10°-13° and varus ≥14°. Groups were further subdivided by the intraoperative medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA). The distraction of the medial and lateral sides was compared across the various alignments using an analysis of variance. RESULTS The ability to distract the medial collateral ligament in extension and flexion was proportional to the degree of varus deformity, increasing from 4.0 ± 2.3 mm in the neutral group to 8.7 ± 3.2 mm in the varus ≥14° group (p < 0.0001). On the lateral side, the distraction of the lateral collateral ligament decreased in both extension (2.2 ± 2.4 vs. 1.2 ± 2.7, p < 0.0001) and flexion (2.8 ± 2.8 to 1.7 ± 3.0, p < 0.0001) with increasing native varus deformity. MPTA and LDFA had similar effects, where increasing MPTA varus and LDFA valgus increased medial distractibility in extension and flexion. There was significant variability of the stretch of the ligaments within and across all alignment categories, in which the standard deviation of the groups ranged from 2.0 to 3.0 mm. CONCLUSION This study demonstrates increased medial ligament distractibility with increasing varus deformity. However, there was significant variability in ligamentous laxity within various limb alignment categories suggesting the anatomy and soft tissue identity of the knee is complex and highly variable. TKAs seeking to be more anatomic will not only need to restore alignment but also native soft tissue tensions. LEVEL OF EVIDENCE Level III, prognostic.
Collapse
Affiliation(s)
- Matthew J Grosso
- Connecticut Joint Replacement Institute, Hartford, Connecticut, USA
| | | | | | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
6
|
Jagota I, Twiggs J, Miles B, Liu D. Preoperative Joint Distraction Imaging and Planning Protocol for Total Knee Arthroplasty. J Arthroplasty 2024; 39:1259-1265. [PMID: 38007203 DOI: 10.1016/j.arth.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Current preoperative total knee arthroplasty (TKA) planning strategies are bone-referencing and do not consider the ligamentous profile of the knee. This study assessed the mean Hip-Knee-Ankle (HKA) angle of the planned Distracted Alignment (DA), an alignment output using a joint distraction radiology and planning protocol, which incorporates preoperative evaluation of ligament laxity. METHODS A retrospective study of 144 knees undergoing TKA was performed. Each patient received a preoperative computer tomograph scan, a weight-bearing antero-posterior knee radiograph, and distracted knee radiographs in extension and flexion. The imaging was used to develop a preoperative DA plan aiming for medio-lateral and extension-flexion space balance. The mean DA, weight-bearing, and arithmetic HKA angles were compared to each other, and to the HKA of a healthy nonarthritic population. RESULTS The mean weight-bearing, arithmetic, and planned DA HKA angles were 4.8° (interquartile range [IQR] 6.5°) varus, 0.4° (IQR 4.5°) varus, and 2.2° (IQR 4.0°) varus, respectively. This compares to a healthy adult HKA angle of 1.3° varus. The difference between the planned DA and arithmetic HKA angles was greater than 3° for 36% of the patients in the study population. CONCLUSIONS The planned DA HKA angle was fundamentally different from the arithmetic HKA angle, but comparable to a healthy population. Considering both hard and soft tissue information of the knee, we believe the planned DA resulting from the joint distraction radiology protocol allows for optimized preoperative surgical planning in TKA. This protocol has been shown to be clinically viable.
Collapse
Affiliation(s)
- Ishaan Jagota
- 360 Med Care, Sydney, Australia; Flinders University, Adelaide, Australia
| | | | | | - David Liu
- The Gold Coast Centre for Bone and Joint Surgery, Palm Beach, Queensland, Australia
| |
Collapse
|
7
|
Liu K, Liu Y, Ma X, Fu D, Fan Z. Effect of cognitive behavioral therapy on pain, knee function, and psychological status in patients after primary total knee arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:280. [PMID: 38605391 PMCID: PMC11007994 DOI: 10.1186/s12891-024-07413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE The clinical efficacy of cognitive behavioral therapy (CBT) after Total knee arthroplasty (TKA) is still controversial, and the purpose of this meta-analysis was to evaluate the effect of CBT on pain, knee function, and psychological status of patients after TKA. METHODS We systematically searched electronic databases such as CNKI, CBM, VIP, PubMed, Cochrane Library, and EMBASE for randomized controlled studies up to February 30, 2023. Screening against inclusion criteria to select valid studies and extract data. The quality of included studies was evaluated by the Cochrane Collaboration risk-of-bias 2 (RoB 2) tool for randomized trials. Statistical analysis of the data from this study was carried out using Stata 15.1 software. RESULTS Finally, our meta-analysis incorporated seven randomized controlled studies of high quality, including 608 patients. The findings of the meta-analysis demonstrated a noteworthy decrease in kinesiophobia levels during the early postoperative phase in the CBT group as compared to the usual care group (WMD = -6.35, 95% CI: -7.98 to -4.72, Z = 7.64, P < 0.001). However, no statistically significant difference between the CBT and usual care groups in terms of postoperative pain as well as knee function. CONCLUSION CBT may effectively reduce the level of kinesiophobia in the short term after TKA, but did not significantly relieve knee pain or improve knee function.
Collapse
Affiliation(s)
- Kun Liu
- Fuyang People's Hospital, Anhui Medical University, Fuyang, Anhui, 236000, China
| | - Yuandong Liu
- Fuyang People's Hospital, Anhui Medical University, Fuyang, Anhui, 236000, China
| | - Xukai Ma
- Weifang Medical University, Weifang, Shandong, 261053, China
| | - Donglin Fu
- Fuyang People's Hospital, Anhui Medical University, Fuyang, Anhui, 236000, China.
| | - Zongqing Fan
- Fuyang People's Hospital, Anhui Medical University, Fuyang, Anhui, 236000, China.
| |
Collapse
|
8
|
Agarwal S, Ayeni FE, Sorial R. Impact of change in coronal plane alignment of knee (CPAK) classification on outcomes of robotic-assisted TKA. ARTHROPLASTY 2024; 6:15. [PMID: 38570879 PMCID: PMC10993496 DOI: 10.1186/s42836-024-00239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/30/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Mechanical alignment with total knee arthroplasty (TKA) has been widely used since the implantation of the first prosthetic knee. Multiple studies have reported 80% patient satisfaction with TKA. However, the reported patients' dissatisfaction is believed to be caused by having to convert different knee alignments to neutral alignments. It is postulated that a change in the CPAK classification of knees leads to patient dissatisfaction. Thus, we hypothesized that a change in CPAK classification with robot-assisted TKA with mechanical alignment does not significantly lead to patient dissatisfaction. METHODS We retrospectively analyzed 134 patients who underwent robot-assisted mechanical alignment total knee arthroplasty (MA-TKA) using cementless implants and classified them into CPAK system pre- and post-operatively. One year after TKA surgery, we recorded binary responses to patients' satisfaction with the outcome of surgery and analyzed if a change in CPAK classification is associated with the outcome of surgery. RESULTS We found that 125 out of 134 patients (93.28%) were happy with the outcome of surgery. CPAK classification was changed in 116 patients (86.57%) and maintained in 18 patients (13.43%). Our results also showed that 111 (95.7%) out of 116 patients who had a change in CPAK and 14 (77.8%) out of 18 patients who maintained their CPAK post-surgery were happy with the outcome of surgery (OR = 6.3, CI 1.741-25.17, P value = 0.019). CONCLUSION We concluded that changing the patient's native joint line and CPAK classification does not significantly change the outcome of surgery in terms of satisfaction. The dissatisfaction rate of 20% as published by previous researchers may be confounded by other reasons and not just due to changes in alignment and joint line.
Collapse
Affiliation(s)
- Sarang Agarwal
- Department of Orthopaedics, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.
| | - Rami Sorial
- Department of Orthopaedics, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
| |
Collapse
|
9
|
Lee JH, Kwon SC, Hwang JH, Lee JK, Kim JI. Functional alignment maximises advantages of robotic arm-assisted total knee arthroplasty with better patient-reported outcomes compared to mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2024; 32:896-906. [PMID: 38454836 DOI: 10.1002/ksa.12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Robotic arm-assisted total knee arthroplasty (RTKA) enables adjustment of implant position to achieve the surgeon's preferred alignment. However, the alignment concept that most effectively enhances patient satisfaction remains unclear. This study compares the clinical outcomes of patients who underwent functionally aligned RTKA (FA-RTKA), mechanically aligned conventional TKA (MA-CTKA) and mechanically aligned RTKA (MA-RTKA). METHODS A prospectively collected database was retrospectively reviewed for patients who underwent primary TKA for knee osteoarthritis. One hundred and forty-seven knees were performed with MA-CTKA, followed by 72 consecutive knees performed with MA-RTKA, and subsequently, 70 consecutive knees performed with FA-RTKA were enrolled. After 1:1 propensity score matching of patient demographics, 70 knees were finally included in each group. The extent of additional soft tissue release during surgery was identified, and the Coronal Plane Alignment of the Knee classification was utilised to categorise the alignment. At the 1-year follow-up, patient-reported outcomes, including the pain Visual Analogue Scale, Knee Society Score, Western Ontario and McMaster Universities Arthritis Index and Forgotten Joint Score-12, were also compared among the groups. RESULTS The FA-RTKA group showed significantly less additional soft tissue release than the MA-CTKA and MA-RTKA groups (15.7%, 38.6% and 35.7%, respectively; p = 0.006). Statistically significant differences in functional scores were observed in the postoperative 1-year clinical outcomes in favour of the FA-RTKA group, which had a significantly larger percentage of knees that maintained constitutional alignment and joint line obliquity than those of the other groups. CONCLUSIONS Functionally aligned TKA showed superior 1-year postoperative patient-reported outcomes compared with those of conventional and robotic arm-assisted mechanically aligned TKA. Therefore, the advantage of RTKA is maximised when the implant positioning is based on functional alignment. The application of RTKA with mechanical alignment has been proven ineffective in improving the clinical outcomes of patients. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seung Cheol Kwon
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Edelstein AI, Orsi AD, Plaskos C, Coffey S, Suleiman LI. Imageless robotic total knee arthroplasty determines similar coronal plane alignment of the knee (CPAK) parameters to long leg radiographs. ARTHROPLASTY 2024; 6:14. [PMID: 38431650 PMCID: PMC10909262 DOI: 10.1186/s42836-024-00231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/01/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The coronal plane alignment of the knee (CPAK) classification was first developed using long leg radiographs (LLR) and has since been reported using image-based and imageless robotic total knee arthroplasty (TKA) systems. However, the correspondence between imageless robotics and LLR-derived CPAK parameters has yet to be investigated. This study therefore examined the differences in CPAK parameters determined with LLR and imageless robotic navigation using either generic or optimized cartilage wear assumptions. METHODS Medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were determined from the intraoperative registration data of 61 imageless robotic TKAs using either a generic 2 mm literature-based wear assumption (Navlit) or an optimized wear assumption (Navopt) found using an error minimization algorithm. MPTA and LDFA were also measured from preoperative LLR by two observers and intraclass correlation coefficients (ICCs) were calculated. MPTA, LDFA, joint line obliquity (JLO), and arithmetic hip-knee-ankle angle (aHKA) were compared between the robotic and the average LLR measurements over the two observers. RESULTS ICCs between observers for LLR were over 0.95 for MPTA, LDFA, JLO, and aHKA, indicating excellent agreement. Mean CPAK differences were not significant between LLR and Navlit (all differences within 0.6°, P > 0.1) or Navopt (all within 0.1°, P > 0.83). Mean absolute errors (MAE) between LLR and Navlit were: LDFA = 1.4°, MPTA = 2.0°, JLO = 2.1°, and aHKA = 2.7°. Compared to LLR, the generic wear classified 88% and the optimized wear classified 94% of knees within one CPAK group. Bland-Altman comparisons reported good agreement for LLR vs. Navlit and Navopt, with > 95% and > 91.8% of measurements within the limits of agreement across all CPAK parameters, respectively. CONCLUSIONS Imageless robotic navigation data can be used to calculate CPAK parameters for arthritic knees undergoing TKA with good agreement to LLR. Generic wear assumptions determined MPTA and LDFA with MAE within 2° and optimizing wear assumptions showed negligible improvement.
Collapse
Affiliation(s)
- Adam I Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | | | - Simon Coffey
- Department of Orthopaedics, Nepean Hospital, Penrith, NSW, 2750, Australia
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| |
Collapse
|
11
|
Roche M, Law TY. Correction of Coronal Deformity and Intercompartmental Imbalance through Bone Resection. J Knee Surg 2024; 37:104-113. [PMID: 37852287 DOI: 10.1055/a-2194-0970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
This review discusses the correction of coronal deformity and intercompartmental imbalance through bone resection in total knee arthroplasty (TKA). To achieve functional knee balance, coronal, rotational, and sagittal alignment are critical to successful patient outcomes. Though variations in coronal alignment are debated as a correlate to positive results, advancements in utilizing implant position, alignment, and soft tissue balance to improve patient outcomes and function are an evolving discussion. This study draws upon existing literature, clinical studies, and surgical techniques related to TKA, including advancements in navigation and robotics. The study highlights the importance of individualized alignment strategies for varus and valgus knees. While mechanical neutral alignment has shown excellent long-term data, reevaluating the anatomic recreation of the patient's joint line obliquity is now being studied extensively. Sensor data and navigation systems contribute to improved outcomes and patient satisfaction. The evolution of navigation and robotics has led surgeons to achieve their target angles consistently and accurately; now, the discussion is around the most effective alignment targets. The classification of various phenotypes assists in the proposed starting points for implant position, but soft tissue tension is required in the input data to achieve global balance and stable motion. Each approach's advantages and limitations are considered. In conclusion, achieving optimal coronal alignment, joint line obliquity, and soft tissue balance is crucial for successful TKA outcomes. Personalized alignment philosophies, supported by three-dimensional data and sensor technology, are evolving to minimize critical errors and enhance functional results. Robotic assistance and future advancements in artificial intelligence and machine learning hold promise for further improving TKA outcomes in the quest for soft tissue stabilization.
Collapse
Affiliation(s)
- Martin Roche
- Department of Orthopedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Tsun Yee Law
- Department of Orthopedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| |
Collapse
|
12
|
Masilamani ABS, Jayakumar T, Mulpur P, Gandhi V, Kikkuri RR, Reddy AVG. Functional alignment is associated with increased incidence of pre-balance, reduced soft-tissue release, and post-operative pain compared to mechanical alignment in patients undergoing simultaneous bilateral robotic-assisted TKA. J Robot Surg 2023; 17:2919-2927. [PMID: 37831402 DOI: 10.1007/s11701-023-01732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
This study aimed to compare two alignment strategies in the same patient undergoing simultaneous bilateral robotic-assisted TKA (SB-RATKA): mechanical alignment (MA), the gold-standard, and functional alignment (FA), a balance-driven, personalized alignment strategy. The outcome measures included quantitative assessment of soft-tissue release, incidence of knee balance, and post-operative pain. This was a prospective, self-controlled, randomized-controlled trial involving 72 patients who underwent SB-RATKA using the MAKO® robotic system with comparable grades of deformity and pain in both knees. 65 patients were finally included with one alignment strategy done per knee, with the patients blinded to the strategy used. The study recorded the additional soft-tissue releases required, incidence of pre-balance, and daily post-operative VAS pain scores. The mean age of the study population was 57.95 years, with a female preponderance (N = 53, 81.6%). MA group had significantly more medial compartment tightness in both flexion (MA-15.6 ± 1.8; FA-17 ± 1.3) and extension (MA-14.9 ± 1.9; FA-17 ± 1.1) (p < 0.0001) compared to the FA group after dynamic balancing. 66% of knees in the FA group (N = 43) achieved pre-balance compared to 32.3% in the MA group (N = 21) (p < 0.0001). VAS scores showed a significant reduction in pain in the FA group up to 72 h post-surgery (p < 0.0001). The requirement for posteromedial release (PM), posterior capsular (PC) release, tibial reduction osteotomy (TRO), and superficial MCL pie crusting (sMCL) were significantly lower in FA (PM-22, PC-13, TRO-8, sMCL-2) compared to MA (PM-44, PC-29, TRO-18, sMCL-8). Functional alignment strategy consistently resulted in a higher incidence of knee balance with a significant reduction in soft-tissue releases and immediate post-operative pain when compared to MA in the same patient undergoing SB-RATKA. Therapeutic Level 1.
Collapse
Affiliation(s)
| | - Tarun Jayakumar
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India.
| | - Praharsha Mulpur
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Vibhav Gandhi
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - A V Gurava Reddy
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| |
Collapse
|
13
|
Rak D, Rügamer T, Klann L, Nedopil AJ, Rudert M. Setting the distal and posterior condyle of the femoral component to restore the medial pre-arthritic femoral articular surface results in better outcomes after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5319-5331. [PMID: 37741934 PMCID: PMC10719128 DOI: 10.1007/s00167-023-07576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/04/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE The present study of total knee arthroplasty (TKA) describes an intra-operative method that determines the direction and quantifies the magnitude of deviation of the distal and the posterior medial and lateral (DM, PM, DL, and PL) condyle of the femoral component relative to the pre-arthritic femoral articular surface. For each femoral condyle, the deviations were categorized, and an analysis determined which had better or worse Forgotten Joint Score (FJS), Oxford Knee Score (OKS), and WOMAC scores at 1-year follow-up. METHODS Four academic arthroplasty surgeons supervised a cemented primary CR TKA (Triathlon, Stryker) on 120 consecutive patients. 103 that completed patient-reported outcome measures (PROMs) were analyzed. The surgeon determined the direction and the magnitude of deviation of the condyle of the femoral component by intraoperatively measuring the thickness of the femoral resection, adding compensations of 1 mm for the saw kerf and 2 mm for worn cartilage, and then subtracting the thickness of the femoral component's condyle. For each femoral condyle, a Kruskal-Wallis test determined the categories of deviation with clinically important and significantly different 1-year PROMs. RESULTS A 1 to 2.5 mm and 3 mm or more proximal deviation of the DM condyle of the femoral component worsened the median FJS by 35 and 40 points, OKS by 9 and 14 points, and WOMAC score by 9 and 17 points, respectively, relative to those with a -0.5 to 0.5 mm deviation (p < 0.01). A 1 to 2.5 mm and 3 mm or more anterior deviation of the PM condyle of the femoral component worsened the FJS by 34 and 48 points, OKS by 7 and 13 points, and WOMAC scores by 8 and 16 points, respectively (p < 0.01). Deviations of the DL and PL condyle of the femoral component did not affect PROMs (p ≥ 0.13). CONCLUSIONS Although many factors can affect PROM, such as patient expectations, the surgeon should understand that setting the DM and the PM condyles of the femoral component within 1 mm of the patient's pre-arthritic femoral articular surface can potentially result in better FJS, OKS, and WOMAC scores at 1 year. LEVEL OF EVIDENCE II, Prospective cohort study.
Collapse
Affiliation(s)
- Dominik Rak
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | - Thorsten Rügamer
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | - Lukas Klann
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | - Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany.
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| |
Collapse
|
14
|
Wakelin EA, Ponder CE, Randall AL, Koenig JA, Plaskos C, DeClaire JH, Lawrence JM, Keggi JM. Intra-operative laxity and balance impact 2-year pain outcomes in TKA: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:5535-5545. [PMID: 37837574 DOI: 10.1007/s00167-023-07601-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The objective of this study was to determine if intra-operatively measured joint gaps are associated with 2-year pain outcomes in total knee arthroplasty (TKA) and whether balance and laxity windows could be defined throughout flexion to optimize 2-year pain outcomes. Our hypothesis is that intra-operative joint gaps are associated with 2 year post-operative pain outcome. METHODS A prospective study investigating 310 robotically assisted TKAs was performed. Final intra-operative joint gap data were recorded using a digital tensioner and component alignment data were recorded by the robotics system. Patient demographics and Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded pre-operatively and KOOS and Hospital for Special Surgery (HSS) satisfaction were recorded at 2 years post-op. A random search Simulated Annealing (SANN) optimisation algorithm was used to determine global optimum laxity and balance windows at different flexion angles which maximized the 2-year KOOS pain scores. The windows were combined to determine the impact of achieving optimal laxity and balance throughout flexion. To improve clinical utility, boundaries identified by the SANN algorithm were rounded to the nearest 0.5 mm before statistical analysis. RESULTS Laxity and balance windows were defined in extension (Med lax: -2.0 to 2.5 mm, Lat lax: -0.5 to 2.5 mm, Balance: -3.0 to 0.0 mm), mid-flexion (Med lax: -1.0 to 2.5 mm, Lat lax: -0.5 to 3.0 mm, Balance: -2.0 to 2.0 mm), and flexion (Med lax: -2.0 to 3.5 mm, Lat lax: -2.0 to 1.5 mm, Balance: -3.0 to 3.0 mm). When all windows were satisfied, the greatest difference in KOOS pain score was observed (100.0 vs 94.4, p < 0.0001). The highest percentage of knees satisfying the Patient Acceptable Symptom State (PASS) for KOOS pain was also observed in knees which satisfied all windows compared to knees which did not (93% vs 71%, p = 0.0009). The proportion of knees which satisfy the PASS threshold decreased in knees which only satisfied 1-3 (29%) or 4-6 (69%) windows (p ≤ 0.0018). No optimal windows were found between component alignment and KOOS pain outcome (p ≥ 0.1180). High satisfaction was found across all groups (≥ 95%). CONCLUSION Intra-operatively measured joint gaps are associated with all KOOS sub-score outcomes at 2 years after TKA. Optimal windows for a clinically relevant improvement in post-operative KOOS pain were defined for laxity and balance but not for alignment indicating balance may have a greater impact on outcome than alignment. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
| | - Corey E Ponder
- Oklahoma Sports and Orthopedics Institute, Edmond, OK, USA
| | | | - Jan A Koenig
- Department of Orthopedic Surgery, NYU Langone Hospital, Long Island, NY, USA
| | | | | | | | | |
Collapse
|
15
|
Edelstein AI, Wakelin EA, Plaskos C, Suleiman LI. Laxity, Balance, and Alignment of a Simulated Kinematic Alignment Total Knee Arthroplasty. Arthroplast Today 2023; 23:101204. [PMID: 37745959 PMCID: PMC10514418 DOI: 10.1016/j.artd.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/23/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background Kinematic alignment (KA) and related personalized alignment strategies in total knee arthroplasty (TKA) target restoration of native joint line obliquity and alignment. In practice, deviations from exact restoration of the prearthritic joint surface are tolerated for either the femur or tibia to achieve ligamentous balance. It remains unknown what laxity, balance, and alignment would result if a pure resurfacing of both femur and tibia were performed in a KA TKA technique. Methods We used data from 382 robot-assisted TKA performed with a digital joint tensioner to simulate TKA with a pure resurfacing KA technique for both femur and tibia. All knees had the posterior cruciate ligament retained. Knees were subdivided into 4 groups based on preoperative coronal alignment: valgus, neutral, varus, and high varus. Medial and lateral laxity in extension and flexion, balance in extension and flexion, and coronal plane alignment were compared between groups using analysis of variance testing. Results In simulated pure resurfacing KA TKA across a range of preoperative coronal plane deformities, only 11%-31% of knees would have mediolateral extension ligament balance within ±1 mm, and 20%-41% would have a medial flexion gap that is looser than the lateral flexion gap. Over 45% of knees would have coronal hip-knee-ankle angle >3 degrees from mechanical neutral. Conclusions In simulations of pure resurfacing KA TKA, there was wide variability in the resulting laxity and alignment outcomes. Most knees had alignment and balance outcomes outside of normally accepted ranges. Techniques that deviate from pure resurfacing in order to achieve balance appear favorable.
Collapse
Affiliation(s)
- Adam I. Edelstein
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Linda I. Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
16
|
Clark G, Steer R, Khan RN, Collopy D, Wood D. Maintaining joint line obliquity optimizes outcomes of functional alignment in total knee arthroplasty in patients with constitutionally varus knees. J Arthroplasty 2023:S0883-5403(23)00349-2. [PMID: 37061140 DOI: 10.1016/j.arth.2023.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/18/2023] [Accepted: 04/03/2023] [Indexed: 04/17/2023] Open
Abstract
INTRODUCTION Functional alignment (FA) strives to balance the knee soft-tissue envelope during total knee arthroplasty (TKA) using implant alignment adjustments rather than soft-tissue releases. There is debate on how best to achieve FA. We compared minimum two-year outcomes between FA with a mechanical alignment plan [FA(m)] and FA with a kinematic alignment plan [FA(k)]. The null hypothesis was that there would be no difference in outcomes between FA(m) and FA(k). METHODS Prospective data was collected from 300 consecutive robotic assisted (RA) FA TKAs [135 FA(m) and 165 FA(k)]. Patient reported outcomes were obtained pre-operatively and two years post-operatively. The coronal plane alignment of the knee (CPAK) classification was used to classify knee alignment phenotypes. RESULTS Overall limb alignment was equivalent between groups. Final implant alignment was different between FA(m) and FA(k) groups, with FA(k) TKAs having higher tibial varus (P<0.01), higher femoral valgus (P<0.01), and higher joint line obliquity (P<0.01). Patients reported higher FJS-12 scores with FA(k) TKAs (79.4 versus 71.6, P=0.018), and greater range of motion (125 versus 121°; P=0.003). Patients who had constitutional varus reported the greatest improvement with FA(k) technique (FJS at minimum two years of 89 versus 65; P<0.001). CONCLUSION Utilizing an individualized alignment plan (FA(k)) led to a final implant position with greater joint line obliquity, yet the same overall limb alignment. This was associated with improved outcomes at two years post TKA in patients who had constitutional varus. Three-dimensional component position and joint line obliquity affect outcomes following TKA independent of coronal limb alignment.
Collapse
Affiliation(s)
- Gavin Clark
- St John of God Hospital, Salvado Rd, Subiaco, Western Australia, Australia; Perth Hip and Knee Clinic, 1 Wexford St, Subiaco, Western Australia, Australia; University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia.
| | - Richard Steer
- Gold Coast University Hospital, Department of Orthopaedic Surgery, 1 Hospital Boulevard, Southport, Queensland, Australia; University of Queensland, School of Medicine, St Lucia, Queensland, Australia
| | - R Nazim Khan
- University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| | - Dermot Collopy
- St John of God Hospital, Salvado Rd, Subiaco, Western Australia, Australia; Perth Hip and Knee Clinic, 1 Wexford St, Subiaco, Western Australia, Australia
| | - David Wood
- University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, Australia
| |
Collapse
|
17
|
Young SW, Gavin W C, Esposito CI, Carter M, Walker M. The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty. J Arthroplasty 2023; 38:S238-S245. [PMID: 36933677 DOI: 10.1016/j.arth.2023.03.009] [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: 11/13/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Ideal goals for alignment and balance in total knee arthroplasty (TKA) remain controversial. We aimed to compare initial alignment and balance using mechanical alignment (MA) and kinematic alignment (KA) techniques, and to analyze the percentage of knees that could achieve balance using limited adjustments to component position. METHODS Prospective data on 331 primary robotic TKAs (115 MA and 216 KA) were analyzed. Medial and lateral virtual gaps were recorded in both flexion and extension. A computer algorithm was used to calculate potential (theoretical) implant alignment solutions to achieve balance within 1 millimeter (mm) without soft tissue release given an alignment philosophy (MA or KA), angular boundaries (±1, ±2, or ±3°), and gap targets (equal gaps or lateral laxity allowed). The percentage of knees that could theoretically achieve balance was compared. RESULTS Less than 5% of TKAs were initially balanced. Limited adjustments to component position increased the percentage of TKAs that could be balanced in a graduated manner, with no difference between MA and KA start points: adjustments of ±1 (10 vs 6% P=0.17), or ±2 (42 vs 39% P=0.61) or of ±3 (54 vs 51% P=0.66). A higher percentage of TKAs could be balanced when a greater range for lateral gap laxity was allowed. Balancing from KA resulted in increased joint line obliquity in the final implant alignment. CONCLUSION A high percentage of TKAs can be balanced without soft-tissue release using minor adjustments to component position. Surgeons should consider the relationship between alignment and balance goals when optimizing component positioning in TKA.
Collapse
Affiliation(s)
- Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand.
| | - Clark Gavin W
- Department of Orthopaedic Surgery, St. John of God Subiaco Hospital, Perth, Australia
| | | | | | - Matthew Walker
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| |
Collapse
|
18
|
Aflatooni JO, Wininger AE, Park KJ, Incavo SJ. Alignment options and robotics in total knee arthroplasty. Front Surg 2023; 10:1106608. [PMID: 36843989 PMCID: PMC9947398 DOI: 10.3389/fsurg.2023.1106608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Total knee arthroplasty is one of the most widely performed surgical procedures today. Its widespread popularity has helped drive innovation and improvement in the field. Different schools of thought have developed regarding the best way to perform this operation. Specifically, there are controversaries regarding the best alignment philosophy for the femoral and tibial components to optimize implant stability and longevity. Traditionally, neutral mechanical alignment has been the preferred alignment target. More recently, some surgeons advocate for alignment matching the patient's pre-arthritic anatomic alignment ("physiologic" varus or valgus), which has been described as kinematic alignment. Functional alignment is a hybrid technique that focuses on the coronal plane minimizing soft tissue releases. To date, there is no evidence demonstrating superiority of one method over another. There is growing popularity of robotic surgical techniques to improve accuracy of implant position and alignment. The choice of alignment philosophy is an important aspect of robotic assisted TKA surgery and has the potential to clarify the optimal alignment technique.
Collapse
Affiliation(s)
- Justin O. Aflatooni
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Austin E. Wininger
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Kwan J. Park
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | | |
Collapse
|
19
|
Orsi AD, Wakelin E, Plaskos C, McMahon S, Coffey S. Restricted Inverse Kinematic Alignment Better Restores the Native Joint Line Orientation While Achieving Similar Balance, Laxity, and Arithmetic Hip-Knee-Ankle Angle to Gap Balancing Total Knee Arthroplasty. Arthroplast Today 2023; 19:101090. [PMID: 36688096 PMCID: PMC9851873 DOI: 10.1016/j.artd.2022.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/29/2022] [Accepted: 12/17/2022] [Indexed: 01/17/2023] Open
Abstract
Background Both restricted inverse kinematic alignment (iKA) and gap balancing aim for a balanced total knee arthroplasty by adjusting femoral component position based on ligamentous gaps. However, iKA targets a native tibial joint line vs resecting perpendicular to the mechanical axis. This study compares how these 2 techniques impact the balance and laxity throughout flexion and joint line obliquity (JLO), arithmetic hip-knee-ankle angle (aHKA), and the coronal plane alignment of the knee (CPAK). Methods Two surgeons performed 75 robot-assisted iKA total knee arthroplasties. A digital joint tensioner collected laxity data throughout flexion before femoral resection. The femoral component position was determined using predictive gap-planning to optimize the balance throughout flexion. Planned gap balancing (pGB) simulations were performed for each case using neutral tibial resections. Mediolateral balance, laxity, and CPAK were compared among pGB, planned iKA (piKA), and final iKA. Results Both piKA and pGB had similar mediolateral balance and laxity, with mean differences <0.4 mm. piKA had a lower mean absolute difference from native JLO than pGB (3 ± 2° vs 7 ± 4°, P < .001). aHKA was similar (P > .05) between pGB and piKA. piKA recreated a more native CPAK distribution, with types I-V being the most common ones, while most pGB knees were of type V, VII, and III. Final iKA and piKA had similar mediolateral balance and laxity, with a root-mean-square error <1.4 mm. Conclusions Although balance, laxity, and aHKA were similar between piKA and pGB, piKA better restored native JLO and CPAK phenotypes. The neutral tibial resection moved most pGB knees into types V, VII, and III. Surgeons should appreciate how the alignment strategy affects knee phenotypes.
Collapse
Affiliation(s)
- Alexander D. Orsi
- Corin Clinical Research, Raynham, MA, USA,Corresponding author. Corin Clinical Research, 480 Paramount Drive, Raynham MA, 02767, USA. Tel.: +1 617 877 1474.
| | | | | | - Stephen McMahon
- Department of Orthopaedics, The Avenue Hospital, Windsor, Victoria, Australia
| | - Simon Coffey
- Department of Orthopaedics, Nepean Hospital, Penrith, New South Wales, Australia
| |
Collapse
|