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Malavolta M, Carrozzo A, Mezzari S, Lista G, Residori A. Calipered Kinematically Aligned Medial Unicompartmental Knee Arthroplasty: A Surgical Technique. Arthroplast Today 2024; 29:101470. [PMID: 39188577 PMCID: PMC11345933 DOI: 10.1016/j.artd.2024.101470] [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: 03/11/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 08/28/2024] Open
Abstract
This study presents a surgical technique for kinematically aligned medial unicompartmental knee arthroplasty with the MOTO (Medacta Corporate, Switzerland) partial knee implant. This technique aims to replicate the native medial femoral and tibial morphology by providing caliper-verified bone resections and kinematic alignment principles. The paper provides a comprehensive overview of the surgical steps and discusses the implications for implant longevity.
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Affiliation(s)
| | - Alessandro Carrozzo
- La Sapienza University, Dipartimento di Sanità Pubblica e Malattie Infettive, Rome, Italy
| | - Silvio Mezzari
- Department of Orthopedics, Casa di Cura Solatrix, Rovereto, Italy
- Department of Orthopedics and Trauma Surgery, Ospedale P. Pederzoli, Peschiera del Garda, Italy
| | - Gianpietro Lista
- Department of Orthopedics and Trauma Surgery, Ospedale P. Pederzoli, Peschiera del Garda, Italy
| | - Alberto Residori
- Department of Orthopedics and Trauma Surgery, Ospedale P. Pederzoli, Peschiera del Garda, Italy
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Sarzaeem MM, Movahedinia M, Mirahmadi A, Abolghasemian M, Tavakoli M, Amouzadeh Omrani F. Kinematic Alignment Technique Outperforms Mechanical Alignment in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2024; 39:2234-2240. [PMID: 38537837 DOI: 10.1016/j.arth.2024.03.045] [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: 05/18/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/24/2024] Open
Abstract
BACKGROUND The aim of this study was to compare the clinical results of kinematic alignment (KA) with those of mechanical alignment (MA) in single-stage bilateral total knee arthroplasty. METHODS In this double-blinded randomized controlled trial, 65 patients who had bilateral knee osteoarthritis underwent simultaneous bilateral total knee arthroplasty. One knee was randomly selected to be operated on with the calipered-KA technique and the other with MA. The participants were assessed via the Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, and visual analog scale before the surgery and the same plus the Forgotten Joint Score at their last follow-up visit, 2 years postoperatively. Maximum knee flexion and the time reaching maximum knee flexion, named the recovery time, were also recorded. Hip-knee-ankle angle, medial proximal tibial angle, and lateral distal femoral angle were measured before and after the surgery using 3-joint-view radiographs. RESULTS At 2 years, there were significant differences between the KA and MA techniques in terms of duration of surgery, recovery time, and final Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and maximum flexion range in favor of KA (P < .05), but no significant difference in visual analog scale score or Oxford Knee Score. In patients who have a preferred knee, the KA knee was preferred over the MA knee by most patients. No prosthetic failure or revision was reported in either group. CONCLUSIONS The KA technique yields acceptable functional outcomes compared to the MA technique. The KA technique was associated with a shorter surgery time, a faster recovery time, and higher patient satisfaction in 2-year follow-ups. Larger multicenter studies with longer follow-ups are warranted to confirm these findings. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic Surgery and Traumatology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Movahedinia
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mirahmadi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Tavakoli
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Farzad Amouzadeh Omrani
- Department of Orthopedic Surgery and Traumatology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Alhifzi Z. Systematic review and meta-analysis of long term outcomes and innovations in Total Knee Arthroplasty: KINEMATIC, PERSONALIZED KNEE vs. CONVENTIONAL. Orthop Rev (Pavia) 2024; 16:122318. [PMID: 39219731 PMCID: PMC11364552 DOI: 10.52965/001c.122318] [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: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 09/04/2024] Open
Abstract
Background Kinematic alignment is an emerging approach for total knee arthroplasty, with the aim to restore patient's individual pre-arthritic joint kinematics. In this systematic review and meta-analysis, we compared the kinematic alignment with the conventional mechanical alignment for total knee arthroplasty. Methods We searched PubMed, Web of Science, Cochrane Library, and Scopus on June 2, 2024. We screened the retrieved studies for eligibility. Then extracted the data from the included studies, and then pooled the data as mean difference (MD) or odds ratio (OR) with a 95% confidence interval using Review Manager Software (ver. 3.5). Results There was no significant difference between KA and MA in the different reported scores: combined KSS score at 6 months (P = 0.23) and 1 years (P = 0.60), KSS Patient satisfaction (P = 0.33), KSS function score (P = 0.07), Oxford score at 6 months (P = 0.45) and 2 years (P = 0.41), KOOS score (P = 0.26). Moreover, there was statistically significant difference in range of motion for flexion and extension at 1 and 2 years, incision length, the length of hospital stay, or the duration of surgery. Conclusion Although kinematic alignment showed slightly better clinical outcomes than mechanical alignment, the difference between the two techniques is not statistically significant.
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Affiliation(s)
- Zaki Alhifzi
- King Faisal medical city Department of Orthopedics
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Tsai HK, Bao Z, Wu D, Han J, Jiang Q, Xu Z. A new gap balancing technique with functional alignment in total knee arthroplasty using the MAKO robotic arm system: a preliminary study. BMC Surg 2024; 24:232. [PMID: 39143535 PMCID: PMC11323490 DOI: 10.1186/s12893-024-02524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Gap tension is an important factor influencing the clinical outcomes of total knee arthroplasty (TKA). Traditional mechanical alignment (MA) places importance on neutral alignment and often requires additional soft tissue releases, which may be related to patient dissatisfaction. Conversely, the functional alignment requires less soft tissue release to achieve gap balance. Conventional gap tension instruments present several shortcomings in practice. The aim of this study is to introduce a new gap balancing technique with FA using the modified spacer-based gap tool and the MAKO robotic arm system. METHODS A total of 22 consecutive patients underwent primary TKA using the MAKO robotic arm system. The gap tension was assessed and adjusted with the modified spacer-based gap tool during the operation. Patient satisfaction was evaluated post-operatively with a 5-point Likert scale. Clinical outcomes including lower limb alignment, Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were recorded before surgery, 3 months and 1 year after surgery. RESULTS The range of motion (ROM) was significantly increased (p < 0.001) and no patients presented flexion contracture after the surgery. KSS and WOMAC score were significantly improved at 3 months and 1 year follow-up (p < 0.001 for all). During the surgery, the adjusted tibial cut showed more varus than planned and the adjusted femoral cut presented more external rotation than planned (p < 0.05 for both). The final hip-knee-ankle angle (HKA) was also more varus than planned (p < 0.05). CONCLUSIONS This kind of spacer-based gap balancing technique accompanied with the MAKO robotic arm system could promise controlled lower limb alignment and improved functional outcomes after TKA.
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Affiliation(s)
- Hung-Kang Tsai
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Zhengyuan Bao
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Dengxian Wu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Jing Han
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China.
| | - Zhihong Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China.
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Gibbons JP, Zeng N, Bayan A, Walker ML, Farrington B, Young SW. No Difference in 10-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A Randomized Trial. Clin Orthop Relat Res 2024:00003086-990000000-01702. [PMID: 39145997 DOI: 10.1097/corr.0000000000003193] [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] [Received: 02/10/2024] [Accepted: 06/27/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND There is continuing debate about the ideal philosophy for component alignment in TKA. However, there are limited long-term functional and radiographic data on randomized comparisons of kinematic alignment versus mechanical alignment. QUESTIONS/PURPOSES We present the 10-year follow-up findings of a single-center, multisurgeon randomized controlled trial (RCT) comparing these two alignment philosophies in terms of the following questions: (1) Is there a difference in PROM scores? (2) Is there a difference in survivorship free from revision or reoperation for any cause? (3) Is there a difference in survivorship free from radiographic loosening? METHODS Ninety-nine patients undergoing primary TKA for osteoarthritis were randomized to either the mechanical alignment (n = 50) or kinematic alignment (n = 49) group. Eligibility for the study was patients undergoing unilateral TKA for osteoarthritis who were suitable for a cruciate-retaining TKA and could undergo MRI. Patients who had previous osteotomy, coronal alignment > 15° from neutral, a fixed flexion deformity > 15°, or instability whereby constrained components were being considered were excluded. Computer navigation was used in the mechanical alignment group, and patient-specific cutting blocks were used in the kinematic alignment group. At 10 years, 86% (43) of the patients in the mechanical alignment group and 80% (39) in the kinematic alignment group were available for follow-up performed as a per-protocol analysis. The PROMs that we assessed included the Knee Society Score, Oxford Knee Score, WOMAC, Forgotten Joint Score, and EuroQol 5-Dimension score. Kaplan-Meier analysis was used to assess survivorship free from reoperation (any reason) and revision (change or addition of any component). A single blinded observer assessed radiographs for signs of aseptic loosening (as defined by the presence of progressive radiolucent lines in two or more zones), which was reported as survivorship free from loosening. RESULTS At 10 years, there was no difference in any PROM score measured between the groups. Ten-year survivorship free from revision (components removed or added) likewise did not differ between the groups (96% [95% CI 91% to 99%] for the mechanical alignment group and 91% [95% CI 83% to 99%] for the kinematic alignment group; p = 0.38). There were two revisions in the mechanical alignment group (periprosthetic fracture, deep infection) and four in the kinematic alignment group (two secondary patella resurfacings, two deep infections). There was no statistically significant difference in reoperations for any cause between the two groups. There was no difference with regard to survivorship free from loosening on radiographic review (χ2 = 1.3; p = 0.52) (progressive radiolucent lines seen at 10 years were 0% for mechanical alignment and 3% for kinematic alignment). CONCLUSION Like the 2-year and 5-year outcomes previously reported, 10-year follow-up for this RCT demonstrated no functional or radiographic difference in outcomes between mechanical alignment and kinematic alignment TKA. Anticipated functional benefits of kinematic alignment were not demonstrated, and revision-free survivorship at 10 years did not differ between the two groups. Given the unknown long-term impact of kinematic alignment with regard to implant position (especially tibial component varus), we must conclude that mechanical alignment remains the reference standard for TKA. We could not demonstrate any advantage to kinematic alignment at 10-year follow-up. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- John P Gibbons
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Nina Zeng
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Ali Bayan
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Matthew L Walker
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Bill Farrington
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Ollivier B, Luyckx T, Stragier B, Vandenneucker H. Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39101252 DOI: 10.1002/ksa.12401] [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: 04/30/2024] [Revised: 07/14/2024] [Accepted: 07/17/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Patellofemoral pain, maltracking and instability remain common and challenging complications after total knee arthroplasty. Controversy exists regarding the effect of kinematic alignment on the patellofemoral joint, as it generally leads to more femoral component valgus and internal rotation compared to mechanical alignment. The aim of this systematic review is to thoroughly examine the influence of kinematic alignment on the third space. METHODS A systematic search of the Pubmed, Cochrane and Web of Science databases was performed to screen for relevant articles published before 7 April 2024. This led to the final inclusion of 42 articles: 2 cadaveric, 9 radiographic, 12 computer simulation and 19 clinical studies. The risk of bias was evaluated with the risk of bias in non-randomised studies - of interventions tool as the lowest level of evidence of the included clinical studies was IV. The effects of kinematic alignment on patellar kinematics and kinetics, trochlear anatomy reconstruction and patellofemoral complication rate were investigated. RESULTS Kinematic alignment closely restores native patellar kinematics and kinetics, better reproduces native trochlear anatomy than mechanical alignment and leads to a 0%-11.4% incidence of patellofemoral complications. A more valgus joint line of the distal femur can cause lateral trochlear undercoverage and a trochlear angle orientation medial to the quadriceps vector when applying kinematic alignment, both of which can be solved by using an adjusted design with a 20.5° valgus trochlea. CONCLUSION Kinematic alignment appears to be a safe strategy for the patellofemoral joint in most knees, provided that certain precautions are taken to minimize the risk of complications. LEVEL OF EVIDENCE Level IV clinical studies, in vitro research.
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Affiliation(s)
- Britt Ollivier
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Luyckx
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| | - Bruno Stragier
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Vandenneucker
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
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Nakagawa Y, Koga H, Sekiya I, Hasegawa S, Katagiri H, Watanabe T. Equivalent Clinical Outcomes Between Anatomical Alignment Versus Mechanical Alignment of Simultaneous Bilateral Total Knee Arthroplasty Using a Posterior-Stabilized Prosthesis During an Average Follow-Up of Five Years: A Prospective Randomized Clinical Trial. J Arthroplasty 2024:S0883-5403(24)00714-9. [PMID: 39025273 DOI: 10.1016/j.arth.2024.07.014] [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: 02/19/2024] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND This study aimed to investigate the differences in clinical outcomes between anatomical alignment and mechanical alignment in each knee, respectively, in patients who underwent bilateral total knee arthroplasty. METHODS Bilateral simultaneous total knee arthroplasty using a posterior-stabilized prosthesis was performed between June 2016 and May 2018, with one knee undergoing anatomical alignment and the contralateral knee undergoing mechanical alignment, which was randomized. There were 80 knees in 40 patients (mean age 75 years, range 60 to 87, with 4 men and 36 women) followed up for at least 2 years (mean follow-up 4.9 years, range 2 to 7 years). On the anatomical side, the distal femoral cut was set 2° more valgus to the mechanical axis, and the tibial cut was set to 2 or 3° varus using a specific guide. Implant position and lower extremity alignment were measured using postoperative radiographs and computed tomography images. The range of motion before and after surgery, Knee Society score, patient satisfaction, postoperative 2011 Knee Society questionnaire, and Knee Injury and Osteoarthritis Outcome Scores were evaluated. RESULTS A significant difference was observed in joint line orientation (0.6 versus 2.9°, P < .001), but not in the postoperative hip-knee-ankle angle between 2 groups. There was one knee in the mechanical alignment group that required revision surgery at 5 years due to implant loosening. Before surgery, the anatomical alignment group had a significantly lower knee extension angle (-7.2 versus -6.0°, P = .035) and Knee Society Score (46.1 versus 49.1, P = .046). No significant difference was observed between the groups except for the 2011 Knee Society Questionnaire satisfaction scores (26.7 versus 25.7, P = .035). More participants preferred the anatomical alignment side postoperatively. CONCLUSIONS Anatomical and mechanical alignments had similar clinical outcomes in patients undergoing bilateral total knee arthroplasty at a mean of 4.9 years follow-up. LEVELS OF EVIDENCE Level Ⅰ (Randomized control study).
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Affiliation(s)
- Yusuke Nakagawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Cartilage Regeneration, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Shoichi Hasegawa
- Department of Cartilage Regeneration, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Katagiri
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Toshifumi Watanabe
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
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Klasan A, Anelli-Monti V, Putnis SE, Neri T, Kammerlander C. The effect of different alignment strategies on trochlear orientation after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:1734-1742. [PMID: 38606595 DOI: 10.1002/ksa.12178] [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: 01/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE When planning and delivering total knee arthroplasty (TKA), there are multiple coronal alignment strategies such as functional alignment (FA), kinematic alignment (KA), mechanical and adjusted mechanical alignment (MA, aMA). Recent three-dimensional and robotic-assisted surgery (RAS) studies have demonstrated that KA potentially better restores the trochlear anatomy than MA. The purpose of this study was to compare the restoration of the native trochlear orientation in patients undergoing RAS TKA using four different alignment strategies. It was hypothesised that FA would result in the lowest number of outliers. METHODS This is a prospective study of 200 patients undergoing RAS-TKA with a single implant. All patients were analysed for MA and KA prebalancing, and 157 patients received aMA and 43 patients FA with intraoperative balancing. Preoperative transverse computed tomography scans were used to determine the posterior condylar axis (PCA), lateral trochlear inclination (LTI) angle, sulcus angle (SA) and anterior trochlear line (ATL) angle. Implant measurements were obtained using a photographic analysis. Intraoperative software data combined with implant data and preoperative measurements were used to calculate the differences. Outliers were defined as ≥3° of alteration. Trochlea dysplasia was defined as LTI < 12°. RESULTS Native transepicondylar PCA had a median of 2°, LTI 18°, SA 137°, ATL 4°. LTI outliers were observed in 47%-60% of cases, with KA < FA < aMA < MA. For ATL, the range of outliers was 40.5%-85%, KA < FA < aMA < MA. SA produced 81% of outliers. Of all median angle values, only LTI when using KA was not significantly altered compared to the native knee. CONCLUSION There is a significant alteration of trochlear orientation after TKA, regardless of the alignment strategy used. KA produced the lowest, but a substantial, number of outliers. The uniform design of implants causes the surgeon to compromise on balance in flexion versus trochlear position. The clinical relevance of this compromise requires further clinical investigations. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Antonio Klasan
- Department of Orthropedics and Traumatology, AUVA UKH Steiermark, Graz, Austria
- Department of Orthropedics and Traumatology, Johannes Kepler University Linz, Linz, Austria
| | | | - Sven E Putnis
- Department of Orthropedics and Traumatology, University Hospital Bristol, Bristol, UK
| | - Thomas Neri
- Department of Orthropedics and Traumatology, University Hospital St. Etienne, St. Etienne, France
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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.
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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
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Nedopil AJ, Howell SM, Hull ML, Hirschmann MT. A TKA can be kinematically aligned without restrictions: Current evidence. Knee Surg Sports Traumatol Arthrosc 2024; 32:1354-1358. [PMID: 38501289 DOI: 10.1002/ksa.12132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California at Davis, Davis, California, USA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California at Davis, Davis, California, USA
- Department of Mechanical Engineering, University of California at Davis, Davis, California, USA
- Department of Orthopaedic Surgery, University of California at Davis, Davis, California, USA
| | - Michael T Hirschmann
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, Basel, Switzerland
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Wang G, Chen L, Luo F, Luo J, Xu J. Superiority of kinematic alignment over mechanical alignment in total knee arthroplasty during medium- to long-term follow-up: A meta-analysis and trial sequential analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:1240-1252. [PMID: 38488220 DOI: 10.1002/ksa.12093] [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: 10/22/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To compare and determine the reliability and conclusiveness of the medium- and long-term efficacy in terms of patient-reported outcome measures and the risk of revisions or reoperations (RRRs) of kinematic alignment (KA) and mechanical alignment (MA) in total knee arthroplasty. METHODS A comprehensive search was conducted in Medline, EMBASE, Web of Science and Cochrane Database Library to identify relevant literature. Only randomised clinical trials (RCTs) published before July 2023 were included. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and RRR were compared. Additionally, OKS and RRR were subjected to a trial sequential analysis. RESULTS Seven RCTs involving 572 knees were identified. The pooled analysis of the included studies demonstrated that KA showed better medium-term WOMAC and OKS (mean difference [MD] = -6.3, 95% confidence interval [CI]: -9.52 to -2.99, p < 0.05 and MD = 1.1, 95% CI: 0.05-2.15, p < 0.05), respectively), but no significant differences were observed in the long-term follow-up (MD = 2.1, 95% CI: -3.21 to 7.31, not significant [n.s.] and MD = 0.01, 95% CI: -2.43 to 2.46, n.s., respectively). FJS (standardised MD = -0.03, 95% CI: -0.25 to 0.19, n.s.) and RRR (risk ratio = 1.0, 95% CI: 0.57 to 1.74, n.s.) showed no significant intergroup differences (n.s.). The evidence quality ranged from moderate to high, and the trial sequential analysis indicated the need for additional high-quality RCTs to draw more conclusive results. CONCLUSIONS KA showed better medium-term WOMAC and OKS, while KA and MA had similar FJS without increasing the RRR in medium- and long-term follow-up. Further research is needed for more conclusive results. LEVEL OF EVIDENCE Level II (meta-analyses).
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Affiliation(s)
- Guiguan Wang
- Shengli Clinical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, Fuzhou, Fujian, China
| | - Long Chen
- Shengli Clinical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, Fuzhou, Fujian, China
| | - Fenqi Luo
- Shengli Clinical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, Fuzhou, Fujian, China
| | - Jun Luo
- Shengli Clinical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, Fuzhou, Fujian, China
| | - Jie Xu
- Shengli Clinical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, Fujian, China
- Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, Fuzhou, Fujian, China
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12
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Won SH, Eim SH, Shen QH, Kim KK, Won YY. Caliper-verified unrestricted kinematically aligned total knee arthroplasty in Asian patients showed efficacious mid- to long-term results regardless of postoperative alignment categories. Knee Surg Sports Traumatol Arthrosc 2024; 32:941-952. [PMID: 38461403 DOI: 10.1002/ksa.12117] [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: 09/22/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE There have been insufficient data regarding the long-term results of unrestricted kinematically aligned total knee arthroplasty (unKATKA) in Asian patients. We investigated mid- to long-term clinical and radiological follow-up data of Korean patients after caliper-verified unKATKA of minimum 7.4-10 years including categorised data of postoperative tibial component, limb and knee alignment. Additionally, we analysed the preoperative distribution and postoperative restoration of coronal plane alignment of knee (CPAK) phenotypes. METHODS This study is a retrospective analysis of 63 patients: 96 osteoarthritic underwent consecutive caliper-verified unKATKA between October 2013 and May 2016 by a single surgeon. Implant survivorship was investigated for revision for any reason. Each knee was categorised into an in-range or outlier group by three postoperative alignment parameters: tibial component, knee and limb alignment. Statistical analyses were done for any significant differences in clinical scores and implant survival rates between groups. Finally, all knees were classified into CPAK classification postoperatively and postoperatively. The CPAK restoration rate was calculated. RESULTS Among 85 knees in the clinically confirmed group, implant survival was 98.8%. There was one case of revision due to periprosthetic fracture. The percentage postoperatively aligned in the varus (valgus) outlier range was 100% (0%) for tibial component, 16.7% (24.8%) for the knee alignment and 51% (0%) for the limb alignment. All three categories did not affect implant survival or clinical scores. Eighty one out of 96 knees (84.4%) were restored to their CPAK phenotype postoperatively. CONCLUSION With the limitation of a case series having a small number of patients and gender deviation, our study suggests that caliper-verified unKATKA could be a good option regardless of geographical variation of constitutional alignment in patients with osteoarthritis (OA). LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Seok-Hyung Won
- Department of Orthopedic Surgery, Ajou University Medical Center, Suwon, South Korea
| | - Seong-Hyuk Eim
- Department of Orthopedic Surgery, Ajou University Medical Center, Suwon, South Korea
| | - Quan-Hu Shen
- Department of Orthopedic Surgery, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Kwang-Kyoun Kim
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, South Korea
| | - Ye-Yeon Won
- Department of Orthopedic Surgery, Ajou University Medical Center, Suwon, South Korea
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13
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Dossett HG, Deckey DG, Clarke HD, Spangehl MJ. Individualizing a Total Knee Arthroplasty with Three-Dimensional Planning. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00010. [PMID: 38478756 PMCID: PMC10923344 DOI: 10.5435/jaaosglobal-d-24-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 03/17/2024]
Abstract
Total knee arthroplasty (TKA) is evolving from mechanical alignment to more individualized alignment options in an attempt to improve patient satisfaction. Thirteen-year survival of kinematically aligned prostheses has recently been shown to be similar to mechanically aligned TKA, allaying concerns of long-term failure of this newer individualized technique. There is a complex inter-relationship of three-dimensional knee and limb alignment for a TKA. This article will review planning parameters necessary to individualize each knee, along with a discussion of how these parameters are related in three dimensions. Future use of computer software and machine learning has the potential to identify the ideal surgical plan for each patient. In the meantime, the material presented here can assist surgeons as newer individual alignment planning becomes a reality.
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Affiliation(s)
- Harold Gene Dossett
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - David G. Deckey
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - Henry D. Clarke
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
| | - Mark J. Spangehl
- From the Department of Orthopaedics and, Phoenix Veterans Affairs Health Care System, Phoenix, AZ (Dr. Dossett), and the Department of Orthopaedics, Mayo Clinic, Phoenix, AZ (Dr. Deckey, Dr. Clarke, and Dr. Spangehl)
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14
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Niesen AE, Tirumalai PA, Howell SM, Hull ML. Risk of tibial baseplate loosening is low in patients following unrestricted kinematic alignment total knee arthroplasty using a cruciate-retaining medial conforming insert: A study using radiostereometric analysis at 2 years. Knee Surg Sports Traumatol Arthrosc 2024; 32:693-703. [PMID: 38415963 DOI: 10.1002/ksa.12089] [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: 11/09/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Assessing the risk of tibial baseplate loosening in patients after unrestricted kinematically aligned (unKA) total knee arthroplasty (TKA) using a medially conforming insert is important because baseplates generally are aligned in varus which has been linked to an increased incidence of aseptic loosening following mechanically aligned TKA. Two limits that indicate long-term stability in patients are a change in maximum total point motion between 1 and 2 years (ΔMTPM) < 0.2 mm and anterior tilt at 2 years < 0.8°. The purposes were to determine: (1) the number of patients with ΔMTPM > 0.2 mm, (2) the number of patients with anterior tilt > 0.8° and (3) whether increased varus baseplate and limb alignment were associated with increased migration. METHODS Thirty-five patients underwent cemented, caliper-verified, unKA TKA using a medially conforming tibial insert with posterior cruciate ligament (PCL) retention. Biplanar radiographs acquired on the day of surgery and at 1.5, 3, 6, 12 and 24 months were processed with model-based radiostereometric analysis (RSA) software to determine migration and the number of patients with migration above the two stability limits. Medial proximal tibial angle (MPTA), hip-knee-ankle angle (HKAA) and posterior slope angle (PSA) were analyzed for an association with migration in six degrees of freedom and in MTPM. RESULTS Thirty-two of 35 patients were available for analysis at 2 years. One patient exhibited ΔMTPM > 0.2 mm. The same patient exhibited anterior tilt > 0.8°. Varus rotation (p = 0.048, r ≤ 0.34) and medial translation (p = 0.0273, r ≤ 0.29) increased with increased varus baseplate alignment. CONCLUSION The results indicate low risk of long-term baseplate loosening in patients. Although varus rotation and medial translation increased with increased varus baseplate alignment, the magnitudes of the migrations were minimal and did not increase ΔMTPM and anterior tilt. LEVEL OF EVIDENCE Level II, therapeutic prospective cohort study.
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Affiliation(s)
- Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Pranav A Tirumalai
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, California, USA
- Department of Mechanical Engineering, University of California, Davis, California, USA
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California, USA
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15
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Kobayashi T, Kawaguchi K, Goto K, Suzuki H, Otsu M, Michishita K. Functional knee phenotypes: A helpful classification tool for visualizing potential femoral varus in restricted kinematic alignment total knee arthroplasty in Japan. Knee Surg Sports Traumatol Arthrosc 2024; 32:103-115. [PMID: 38226677 DOI: 10.1002/ksa.12028] [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: 10/10/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Restricted kinematic alignment (rKA) is a modified technique of kinematically aligned total knee arthroplasty (TKA) within a safe alignment range for long-term implant survivorship. The purpose of this study was to clarify (1) the distribution of functional knee phenotypes in patients who underwent TKA in Japan and (2) whether the application of this classification results in anatomically neutral alignment after rKA TKA. METHODS Overall, 114 TKA surgeries (mechanical alignment [MA]: 49; rKA: 65) were performed. The joint line orientation angle (JLOA), hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were obtained. The knees were categorized using a functional knee phenotype classification. Clinical evaluations, including the Knee Injury and Osteoarthritis Outcome, 12-question Forgotten Joint and Oxford Knee Scores, were performed 3 years postoperatively. Between-group comparisons were made. RESULTS The most common preoperative functional knee phenotype was VARHKA 3° + NEUFMA 0° + VARTMA 3° (11.4%). In the preoperative population, 51 knees (44.7%) had VARFMA ≥ 3°. Postoperatively, the most common functional knee phenotype was NEUHKA 0° + VARFMA 3° + VALTMA 3° (14 knees, 28.6%) in the MA and NEUHKA 0° + NEUFMA 0° + NEUTMA 0° in the rKA group. The percentage of postoperative JLOA within ±3° from the floor was 27% and 72% in the MA and rKA groups, respectively (p < 0.001). The functional knee phenotype after rKA TKA was neutrally reproduced, and the joint line was more parallel to the ground in the standing position than that of MA. Between-group differences in clinical outcomes were not significant. CONCLUSION The application of functional knee phenotyping to knee osteoarthritis in Japan suggested the presence of racial morphological characteristics. This classification could help better visualize potential femoral varus, contributing to protocol deviation in applying restricted KA TKA. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Takashi Kobayashi
- Department of Orthopedic Surgery, Yugawara Hospital, Yugawara, Kanagawa, Japan
| | - Kohei Kawaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Kazumi Goto
- Department of Sports Orthopedics Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Hayata Suzuki
- Department of Orthopedic Surgery, Yugawara Hospital, Yugawara, Kanagawa, Japan
| | - Masayoshi Otsu
- Department of Orthopedic Surgery, Yugawara Hospital, Yugawara, Kanagawa, Japan
| | - Kazuhiko Michishita
- Department of Orthopedic Surgery, Yugawara Hospital, Yugawara, Kanagawa, Japan
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16
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Lin CH, Wong CC. Letter to the Editor on "A Randomized Controlled Trial of Kinematically and Mechanically Aligned Total Knee Arthroplasties: Long-Term Follow-Up". J Arthroplasty 2023; 38:e24-e25. [PMID: 37573087 DOI: 10.1016/j.arth.2023.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 08/14/2023] Open
Affiliation(s)
- Chun-Hao Lin
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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17
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Dossett HG, Arthur JR, Makovicka JL, Mara KC, Clarke HD, Bingham JS, Spangehl MJ. Response to Letter; A Randomized Controlled Trial of Kinematically and Mechanically Aligned Total Knee Arthroplasties: Long-Term Follow-up. J Arthroplasty 2023; 38:e26-e27. [PMID: 37573088 DOI: 10.1016/j.arth.2023.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 08/14/2023] Open
Affiliation(s)
- H Gene Dossett
- Department of Orthopaedics, Carl T. Hayden Veterans' Administration Medical Center, Phoenix, Arizona
| | | | | | - Kristin C Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Henry D Clarke
- Department of Orthopaedics, Mayo Clinic, Phoenix, Arizona
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