Higher satisfaction and function scores in restricted kinematic alignment versus mechanical alignment with medial pivot design total knee arthroplasty: A prospective randomised controlled trial.
coronal plane alignment of the knee
functional knee phenotype
kinematic alignment
mechanical alignment
medial pivot prothesis varus phenotypes
patient-specific instrumentation
total knee arthroplasty
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:
19 Mar 2024
19 Mar 2024
Historique:
revised:
28
01
2024
received:
19
11
2023
accepted:
04
02
2024
medline:
19
3
2024
pubmed:
19
3
2024
entrez:
19
3
2024
Statut:
aheadofprint
Résumé
Restricted kinematic alignment (rKA) in total knee arthroplasty (TKA) and medial pivot (MP) knee designs already showed superior outcomes in independent comparative studies. The objective of this study was to assess whether rKA with MP TKA provides better clinical and functional outcomes compared to mechanical alignment (MA) with MP TKA. This is a randomised, parallel two group study involving a total of 98 patients with end-stage knee osteoarthritis. Patients were randomly allocated to either rKA or MA TKA procedures conducted with a MP prothesis using patient-specific instruments between 2017 and 2020. Final follow-up was at 2 years postoperatively. Demographic data and clinical and functional scores (Oxford knee score, knee society score [KSS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], forgotten joint score [FJS]) were collected and compared preoperative, 1 year postoperative and 2 years postoperative. Coronal plane alignment of the knee and functional knee phenotype classification were recorded. A total of 47 patients (rKA) and 51 patients (MA) were included in final analysis. Superior joint awareness scores (FJS) were found at 1 year postoperative for rKA (62.2 vs. 52.4, p = 0.04). KSS subscores (expectation score, satisfaction score) improved with rKA with significant differences at both 1 and 2 years postoperatively. Major differences between rKA and MA were found in subgroup analysis of varus and neutral CPAK phenotypes. Both 1 year and 2 years postoperatively, FJS was significantly better in KA compared with MA in varus CPAK phenotypes (63.1 vs. 44.9, p = 0.03; 71.1 vs. 46.0, p = 0.005). Further clinical and functional scores showed improvement in the varus CPAK phenotypes with predominantly significant improvement in the expectation and satisfaction KSS subscores. No significant differences were found in the comparison of rKA and MA in neutral CPAK phenotypes. The rKA of MP TKA design shows superior patient satisfaction and self-reported function when compared to MA MP TKA. Furthermore, rKA MP TKA shows superior joint awareness at early postoperative stage. The most important clinical relevance of this study is the clear superiority of rKA in varus phenotypes. Level II.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Medacta International
Informations de copyright
© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
Références
Bauer L, Woiczinski M, Thorwächter C, Müller PE, Holzapfel BM, Niethammer TR, et al. Influence of kinematic alignment on femorotibial kinematics in medial stabilized TKA design compared to mechanical alignment. Arch Orthop Trauma Surg. 2022;143:4339-4347. https://doi.org/10.1007/s00402-022-04661-5
Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, et al. The Chetranjan Ranawat Award: tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Rel Res. 2004;428:26-34. https://doi.org/10.1097/01.blo.0000148578.22729.0e
Blakeney WG, Khan RJK, Palmer JL. Functional outcomes following total knee arthroplasty: a randomised trial comparing computer-assisted surgery with conventional techniques. Knee. 2014;21(2):364-368. https://doi.org/10.1016/j.knee.2013.04.001
Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc. 2017;25(6):1743-1748. https://doi.org/10.1007/s00167-016-4136-8
Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Joint J. 2014;96-B(7):907-913. https://doi.org/10.1302/0301-620X.96B7.32812
Dossett HG, Swartz GJ, Estrada NA, LeFevre GW, Kwasman BG. Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics. 2012;35(2):e160-e169. https://doi.org/10.3928/01477447-20120123-04
Eckhoff D, Hogan C, DiMatteo L, Robinson M, Bach J. An ABJS best paper: difference between the epicondylar and cylindrical axis of the knee. Clin Orthop Rel Res. 2007;461:238-244. https://doi.org/10.1097/BLO.0b013e318112416b
Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty. J Arthroplasty. 2009;24(6):39-43. https://doi.org/10.1016/j.arth.2009.04.034
Giesinger JM, Behrend H, Hamilton DF, Kuster MS, Giesinger K. Normative values for the forgotten joint score-12 for the US general population. J Arthroplasty. 2019;34(4):650-655. https://doi.org/10.1016/j.arth.2018.12.011
Hess S, Moser LB, Robertson EL, Behrend H, Amsler F, Iordache E, et al. Osteoarthritic and non-osteoarthritic patients show comparable coronal knee joint line orientations in a cross-sectional study based on 3D reconstructed CT images. Knee Surg Sports Traumatol Arthrosc. 2022;30(2):407-418. https://doi.org/10.1007/s00167-021-06740-3
Hinterwimmer F, Lazic I, Suren C, Hirschmann MT, Pohlig F, Rueckert D, et al. Machine learning in knee arthroplasty: specific data are key-a systematic review. Knee Surg Sports Traumatol Arthrosc. 2022;30(2):376-388. https://doi.org/10.1007/s00167-021-06848-6
Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclercq V, Hess S. Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1385-1393. https://doi.org/10.1007/s00167-019-05508-0
Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S. Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1394-1402. https://doi.org/10.1007/s00167-019-05509-z
Howell SM. Calipered kinematically aligned total knee arthroplasty: an accurate technique that improves patient outcomes and implant survival. Orthopedics. 2019;42(3):126-135. https://doi.org/10.3928/01477447-20190424-02
Howell SM, Papadopoulos S, Kuznik KT, Hull ML. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc. 2013;21(10):2271-2280. https://doi.org/10.1007/s00167-013-2621-x
Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty. 2018;33(12):3678-3684. https://doi.org/10.1016/j.arth.2018.07.020
Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res. 1985 Jan-Feb;(192):13-22.
Jenny J-Y, Baldairon F, Hirschmann MT. Functional knee phenotypes of OA patients undergoing total knee arthroplasty are significantly more varus or valgus than in a non-OA control group. Knee Surg Sports Traumatol Arthrosc. 2022;30(8):2609-2616. https://doi.org/10.1007/s00167-021-06687-5
Jeremić DV, Massouh WM, Sivaloganathan S, Rosali AR, Haaker RG, Rivière C. Short-term follow-up of kinematically vs. mechanically aligned total knee arthroplasty with medial pivot components: a case-control study. Orthop Traumatol Surg Res. 2020;106(5):921-927. https://doi.org/10.1016/j.otsr.2020.04.005
Kalavrytinos D, Koutserimpas C, Kalavrytinos I, Dretakis K. Expanding robotic arm-assisted knee surgery: the first attempt to use the system for knee revision arthroplasty. Case Rep Orthop. 2020;2020:1-5. https://doi.org/10.1155/2020/4806987
Kaneda K, Niki Y, Kuroyanagi Y, Kobayashi S, Harato K, Iwama Y, et al. Kinematically aligned total knee arthroplasty using medial pivot knee prosthesis enhances medial pivot motion: a comparative kinematic study with mechanically aligned total knee arthroplasty. Arthroplast Today. 2022;13:24-28. https://doi.org/10.1016/j.artd.2021.10.004
Karasavvidis T, Pagan Moldenhauer CA, Lustig S, Vigdorchik JM, Hirschmann MT. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA)-there is no winner yet. J Exp Orthop. 2023;10(1):120. https://doi.org/10.1186/s40634-023-00697-7
Li Z, Esposito CI, Koch CN, Lee Y, Padgett DE, Wright TM. Polyethylene damage increases with varus implant alignment in posterior-stabilized and constrained condylar knee arthroplasty. Clin Orthop Rel Res. 2017;475(12):2981-2991. https://doi.org/10.1007/s11999-017-5477-4
Luderer V, Strauch M, Hirschmann MT, Graichen H. Independent of the preoperative coronal deformity, adjusted mechanical alignment leads in a high percentage to non-anatomical tibial and femoral bone cuts. Knee Surg Sports Traumatol Arthrosc. 2023;31(9):3784-3791. https://doi.org/10.1007/s00167-023-07337-8
Luo Z, Zhou K, Peng L, Shang Q, Pei F, Zhou Z. Similar results with kinematic and mechanical alignment applied in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1720-1735. https://doi.org/10.1007/s00167-019-05584-2
Lützner J, Dexel J, Kirschner S. No difference between computer-assisted and conventional total knee arthroplasty: five-year results of a prospective randomised study. Knee Surg Sports Traumatol Arthrosc. 2013;21(10):2241-2247. https://doi.org/10.1007/s00167-013-2608-7
MacDessi SJ, Griffiths-Jones W, Chen DB, Griffiths-Jones S, Wood JA, Diwan AD, et al. Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial. Bone Joint J. 2020;102-B(1):117-124. https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-0674.R2
MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal plane alignment of the knee (CPAK) classification: a new system for describing knee phenotypes. Bone Joint J. 2021;103-B(2):329-337. https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-1050.R1
Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J. 2017;99-B(5):640-646. https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-0688.R2
McEwen PJ, Dlaska CE, Jovanovic IA, Doma K, Brandon BJ. Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery. J Arthroplasty. 2020;35(2):443-450. https://doi.org/10.1016/j.arth.2019.08.064
Miura T, Takahashi T, Watanabe J, Kataoka Y, Ae R, Saito H, et al. Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2023;24(1):322. https://doi.org/10.1186/s12891-023-06448-0
Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J. 2014;96-B(11 suppl A):96-100. https://doi.org/10.1302/0301-620X.96B11.34152
Parvizi J, Nunley RM, Berend KR, Lombardi AV, Ruh EL, Clohisy JC, et al. High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Rel Res. 2014;472(1):133-137. https://doi.org/10.1007/s11999-013-3229-7
Rak D, Klann L, Heinz T, Anderson P, Stratos I, Nedopil AJ, et al. Influence of mechanical alignment on functional knee phenotypes and clinical outcomes in primary TKA: A 1-year prospective analysis. J Pers Med. 2023;13(5):778. https://doi.org/10.3390/jpm13050778
Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Jt Surg. 2011;93(17):1588-1596. https://doi.org/10.2106/JBJS.J.00772
Rivière C, Iranpour F, Auvinet E, Aframian A, Asare K, Harris S, et al. Mechanical alignment technique for TKA: are there intrinsic technical limitations? Orthop Traumatol Surg Res. 2017;103(7):1057-1067. https://doi.org/10.1016/j.otsr.2017.06.017
Schelker BL, Moret CS, Sava MP, Von Eisenhart-Rothe R, Graichen H, Arnold MP, et al. The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1840-1850. https://doi.org/10.1007/s00167-023-07351-w
Shelton TJ, Gill M, Athwal G, Howell SM, Hull ML. Outcomes in patients with a calipered kinematically aligned TKA that already had a contralateral mechanically aligned TKA. J Knee Surg. 2021;34(1):87-93. https://doi.org/10.1055/s-0039-1693000
Shimmin A, Martinez-Martos S, Owens J, Iorgulescu AD, Banks S. Fluoroscopic motion study confirming the stability of a medial pivot design total knee arthroplasty. Knee. 2015;22(6):522-526. https://doi.org/10.1016/j.knee.2014.11.011
Srivastava A, Lee GY, Steklov N, Colwell CW, Ezzet KA, D'Lima DD. Effect of tibial component varus on wear in total knee arthroplasty. Knee. 2012;19(5):560-563. https://doi.org/10.1016/j.knee.2011.11.003
Tian G, Wang L, Liu L, Zhang Y, Zuo L, Li J. Kinematic alignment versus mechanical alignment in total knee arthroplasty: an up-to-date meta-analysis. J Orthop Surg. 2022;30(3):102255362211259. https://doi.org/10.1177/10225536221125952
Van Essen J, Stevens J, Dowsey MM, Choong PF, Babazadeh S. Kinematic alignment results in clinically similar outcomes to mechanical alignment: systematic review and meta-analysis. Knee. 2023;40:24-41. https://doi.org/10.1016/j.knee.2022.11.001
Vendittoli P-A, Martinov S, Blakeney WG. Restricted kinematic alignment, the fundamentals, and clinical applications. Front Surg. 2021;8:697020. https://doi.org/10.3389/fsurg.2021.697020
Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD. The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone Joint J. 2016;98-B(10):1360-1368. https://doi.org/10.1302/0301-620X.98B10.36862
Woon JTK, Zeng ISL, Calliess T, Windhagen H, Ettinger M, Waterson HB, et al. Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials. Arch Orthop Trauma Surg. 2018;138(9):1293-1303. https://doi.org/10.1007/s00402-018-2988-8
Yamagami R, Inui H, Taketomi S, Kono K, Kawaguchi K, Sameshima S, et al. Intraoperative femoral rotational kinematics are similar in varus and valgus knees during medial pivot total knee arthroplasty. Clin Biomech. 2023;101:105857. https://doi.org/10.1016/j.clinbiomech.2022.105857
Young SW, Sullivan NPT, Walker ML, Holland S, Bayan A, Farrington B. No difference in 5-year clinical or radiographic outcomes between kinematic and mechanical alignment in TKA: a randomized controlled trial. Clin Orthop Rel Res. 2020;478(6):1271-1279. https://doi.org/10.1097/CORR.0000000000001150
Young SW, Walker ML, Bayan A, Briant-Evans T, Pavlou P, Farrington B. The Chitranjan S. Ranawat Award: no difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial. Clin Orthop Rel Res. 2017;475(1):9-20. https://doi.org/10.1007/s11999-016-4844-x