Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques.
Accuracy
Functional alignment
Joint line
Kinematic alignment
PSI
RA-TKA
Robotic TKA
Total knee arthroplasty
Unrestricted KA
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
29
10
2022
accepted:
21
02
2023
medline:
18
8
2023
pubmed:
15
3
2023
entrez:
14
3
2023
Statut:
ppublish
Résumé
A key part of kinematic alignment (KA) and functional alignment (FA) is to restore the natural femoral joint line, in particular the medial joint line. KA is known to reproduce the femoral joint line accurately; however, direct comparisons with other surgical techniques such as FA are currently lacking. The purpose of this study was to evaluate differences of alignment parameters in KA and FA techniques with a special focus given to the femoral joint line. We performed a retrospective radiological analysis of pre- and postoperative long leg radiographs of 221 consecutive patients with varus or neutral leg alignment, who underwent primary total knee arthroplasty (TKA) procedures from 2018 to 2020. Patients were assigned to one of four groups: (1) FA: image-based robotic-assisted TKA, (2) FA: imageless robotic-assisted TKA, (3): restricted KA: 3D cutting block-assisted (patient-specific instruments, PSI) TKA, (4): unrestricted KA: calipered technique. Patients' radiographs were (re)-analyzed for overall limb alignment, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), as well as medial and lateral femoral joint line alteration. Statistical significance was determined using unpaired t testing (FA vs. KA group) and one-way ANOVA (subgroup analyses). Comparisons of KA vs. FA, as well as individual subgroups of KA and FA did not show any differences in the accuracy of medial joint line reconstruction (< 2 mm, p = 0.384, p = 0.744, respectively) and LDFA alteration (< 2°, p = 0.997, 0.921, respectively). Correction of MPTA (3.4° vs. 2.2°) and lateral femoral joint line (2.1 mm vs. 1.5 mm) was higher for FA and FA subgroups compared to KA and KA subgroups (both p < 0.001). Kinematic and functional alignments showed a comparable accuracy in reconstruction of the medial femoral joint line and femoral joint line orientation. Increased correction of MPTA and lateral femoral joint line was recorded with FA techniques. III.
Identifiants
pubmed: 36917247
doi: 10.1007/s00167-023-07360-9
pii: 10.1007/s00167-023-07360-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3871-3879Informations de copyright
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Références
Agrawal VO, Gadekar AP, Vaidya N (2022) Does robotic technology successfully restore the joint line after total knee arthroplasty? A retrospective analysis. Arthroplasty 4:6
doi: 10.1186/s42836-021-00103-6
pubmed: 35236508
pmcid: 8796510
Chang JS, Kayani B, Wallace C, Haddad FS (2021) Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology. Bone Jt J 103-B:507–514
doi: 10.1302/0301-620X.103B.BJJ-2020-0940.R1
D’Amato M, Kosse NM, Wymenga AB (2021) Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 29:3170–3177
doi: 10.1007/s00167-020-06097-z
pubmed: 32556430
Eckhoff D, Hogan C, DiMatteo L, Robinson M, Bach J (2007) An ABJS BEST PAPER: difference between the epicondylar and cylindrical axis of the knee. Clin Orthop 461:238–244
doi: 10.1097/BLO.0b013e318112416b
pubmed: 17549027
Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG (1993) The axes of rotation of the knee. Clin Orthop 290:259–268
doi: 10.1097/00003086-199305000-00033
Howell SM (2019) Calipered kinematically aligned total knee arthroplasty: an accurate technique that improves patient outcomes and implant survival. Orthopedics 42:126–135
doi: 10.3928/01477447-20190424-02
pubmed: 31099877
Howell SM, Nedopil AJ, Hull ML (2022) Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments. Knee Surg Sports Traumatol Arthrosc 30:2966–2974
doi: 10.1007/s00167-022-06939-y
pubmed: 35366075
pmcid: 9418297
Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS (2019) Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 4:611–617
doi: 10.1302/2058-5241.4.190022
pubmed: 31754467
pmcid: 6836078
Kim J-T, Han J, Lim S, Shen QH, Won YY (2019) Kinematically aligned TKA aligns the ankle joint line closer to those of the native ankle than mechanically aligned TKA in bipedal stance. J Knee Surg 32:1033–1038
doi: 10.1055/s-0039-1694796
pubmed: 31434142
Li G, Park SE, DeFrate LE, Schutzer ME, Ji L, Gill TJ, Rubash HE (2005) The cartilage thickness distribution in the tibiofemoral joint and its correlation with cartilage-to-cartilage contact. Clin Biomech Bristol Avon 20:736–744
doi: 10.1016/j.clinbiomech.2005.04.001
pubmed: 15963613
Liow MHL, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL (2014) Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 29:2373–2377
doi: 10.1016/j.arth.2013.12.010
pubmed: 24439796
Luyckx T, Vandenneucker H, Ing LS, Vereecke E, Ing AV, Victor J (2018) Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees. Clin Orthop 476:601–611
doi: 10.1007/s11999.0000000000000067
pubmed: 29443845
pmcid: 6260050
MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB (2021) Coronal plane alignment of the knee (CPAK) classification: a new system for describing knee phenotypes. Bone Jt J 103-B:329–337
doi: 10.1302/0301-620X.103B2.BJJ-2020-1050.R1
Nedopil AJ, Howell SM, Hull ML (2020) Deviations in femoral joint lines using calipered kinematically aligned TKA from virtually planned joint lines are small and do not affect clinical outcomes. Knee Surg Sports Traumatol Arthrosc 28:3118–3127
doi: 10.1007/s00167-019-05776-w
pubmed: 31768572
Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K (2018) Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1629–1635
doi: 10.1007/s00167-017-4788-z
pubmed: 29204861
Oussedik S, Abdel MP, Victor J, Pagnano MW, Haddad FS (2020) Alignment in total knee arthroplasty: what’s in a name? Bone Jt J 102-B:276–279
doi: 10.1302/0301-620X.102B3.BJJ-2019-1729
Rivière C, Harman C, Boughton O, Cobb J (2020) The kinematic alignment technique for total knee arthroplasty. In: Rivière C, Vendittoli P-A (eds) Pers hip knee jt replace. Springer International Publishing, Cham, pp 175–195
doi: 10.1007/978-3-030-24243-5_16
Rivière C, Iranpour F, Harris S, Auvinet E, Aframian A, Chabrand P, Cobb J (2017) The kinematic alignment technique for TKA reliably aligns the femoral component with the cylindrical axis. Orthop Traumatol Surg Res 103:1069–1073
doi: 10.1016/j.otsr.2017.06.016
pubmed: 28870873
Sappey-Marinier E, Batailler C, Swan J, Schmidt A, Cheze L, MacDessi SJ, Servien E, Lustig S (2021) Mechanical alignment for primary TKA may change both knee phenotype and joint line obliquity without influencing clinical outcomes: a study comparing restored and unrestored joint line obliquity. Knee Surg Sports Traumatol Arthrosc 30:2806–2814
doi: 10.1007/s00167-021-06674-w
pubmed: 34291311
Shah RF, Martinez AM, Pedoia V, Majumdar S, Vail TP, Bini SA (2019) Variation in the thickness of knee cartilage. The use of a novel machine learning algorithm for cartilage segmentation of magnetic resonance images. J Arthroplasty 34:2210–2215
doi: 10.1016/j.arth.2019.07.022
pubmed: 31445869
pmcid: 7251923
Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S (2022) Functional alignment philosophy in total knee arthroplasty—rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT-J 8:11
doi: 10.1051/sicotj/2022010
pubmed: 35363136
pmcid: 8973302
Shepherd DET, Seedhom BB (1999) Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis 58:27–34
doi: 10.1136/ard.58.1.27
pubmed: 10343537
pmcid: 1752762
Tuecking L-R, Ettinger M, Nebel D, Welke B, Schwarze M, Windhagen H, Savov P (2021) 3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty. J Exp Orthop 8:16
doi: 10.1186/s40634-021-00330-5
pubmed: 33634333
pmcid: 7907296
Vaidya NV, Deshpande AN, Panjwani T, Patil R, Jaysingani T, Patil P (2020) Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 30:621–626
doi: 10.1007/s00167-020-06353-2
pubmed: 33165631