Inverse kinematic total knee arthroplasty using conventional instrumentation restores constitutional coronal alignment.
conventionally instrumented TKA
coronal alignment
iKA
kinematic
navigated TKA
robotic TKA
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:
03 Jun 2024
03 Jun 2024
Historique:
revised:
01
05
2024
received:
04
03
2024
accepted:
06
05
2024
medline:
3
6
2024
pubmed:
3
6
2024
entrez:
3
6
2024
Statut:
aheadofprint
Résumé
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. 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. 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. 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 III.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : University College Cork Research Fund
Informations de copyright
© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
Références
Abdel, M.P., Ollivier, M., Parratte, S., Trousdale, R.T., Berry, D.J. & Pagnano, M.W. (2018) Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise follow‐up at 20 years. Journal of Bone and Joint Surgery, 100, 472–478. Available from: https://doi.org/10.2106/JBJS.16.01587
Beckers, G., Meneghini, R.M., Hirschmann, M.T., Kostretzis, L., Kiss, M.O. & Vendittoli, P.A. (2023) Ten flaws of systematic mechanical alignment total knee arthroplasty. The Journal of Arthroplasty, 39, 591–599. Available from: https://doi.org/10.1016/j.arth.2023.11.023
Bellemans, J., Colyn, W., Vandenneucker, H. & Victor, J. (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clinical Orthopaedics & Related Research, 470, 45–53. Available from: https://doi.org/10.1007/s11999-011-1936-5
Bellemans, J., Colyn, W., Vandenneucker, H. & Victor, J. (2012) The Chitranjan Ranawat Award: is neutral mechanical alignment normal for all patients?: the concept of constitutional varus. Clinical Orthopaedics & Related Research, 470, 45–53. Available from: https://doi.org/10.1007/s11999-011-1936-5
Blakeney, W., Clément, J., Desmeules, F., Hagemeister, N., Rivière, C. & Vendittoli, P.A. (2019) Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment. Knee Surgery, Sports Traumatology, Arthroscopy, 27, 1410–1417. Available from: https://doi.org/10.1007/s00167-018-5174-1
Bourne, R.B., Chesworth, B.M., Davis, A.M., Mahomed, N.N. & Charron, K.D.J. (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clinical Orthopaedics & Related Research, 468, 57–63. Available from: https://doi.org/10.1007/s11999-009-1119-9
Cooke, D., Scudamore, A., Li, J., Wyss, U., Bryant, T. & Costigan, P. (1997) Axial lower‐limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis and Cartilage, 5, 39–47. Available from: https://doi.org/10.1016/S1063-4584(97)80030-1
CreativeCommons. (2024) Available from: creativecommons.org/licenses/by-nc/4.0/
Dossett, H.G., Estrada, N.A., Swartz, G.J., LeFevre, G.W. & Kwasman, B.G. (2014) A randomised controlled trial of kinematically and mechanically aligned total knee replacements. The Bone & Joint Journal, 96‐B, 907–913. Available from: https://doi.org/10.1302/0301-620X.96B7.32812
Dossett, H.G., Swartz, G.J., Estrada, N.A., LeFevre, G.W. & Kwasman, B.G. (2012) Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics, 35, e160–e169. Available from: https://doi.org/10.3928/01477447-20120123-04
Freeman, M.A.R., Swanson, S.A.V. & Todd, R.C. (1973) Total Replacement of the knee Using the Freeman‐Swanson knee prosthesis. Clinical Orthopaedics and Related Research, 153–170. Available from: https://doi.org/10.1097/00003086-197307000-00020
Hess, S., Moser, L.B., Robertson, E.L., Behrend, H., Amsler, F., Iordache, E. et al. (2022) Osteoarthritic and non‐osteoarthritic patients show comparable coronal knee joint line orientations in a cross‐sectional study based on 3D reconstructed CT images. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 407–418. Available from: https://doi.org/10.1007/s00167-021-06740-3
Hirschmann, M.T., Hess, S., Behrend, H., Amsler, F., Leclercq, V. & Moser, L.B. (2019) Phenotyping of hip–knee–ankle angle in young non‐osteoarthritic knees provides better understanding of native alignment variability. Knee Surgery, Sports Traumatology, Arthroscopy, 27, 1378–1384. Available from: https://doi.org/10.1007/s00167-019-05507-1
Hirschmann, M.T., Moser, L.B., Amsler, F., Behrend, H., Leclercq, V. & Hess, S. (2019) Phenotyping the knee in young non‐osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surgery, Sports Traumatology, Arthroscopy, 27, 1385–1393. Available from: https://doi.org/10.1007/s00167-019-05508-0
Hirschmann, M.T., Moser, L.B., Amsler, F., Behrend, H., Leclerq, V. & Hess, S. (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non‐osteoarthritic patients. Knee Surgery, Sports Traumatology, Arthroscopy, 27, 1394–1402. Available from: https://doi.org/10.1007/s00167-019-05509-z
Howell, S.M., Howell, S.J., Kuznik, K.T., Cohen, J. & Hull, M.L. (2013) Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clinical Orthopaedics & Related Research, 471, 1000–1007. Available from: https://doi.org/10.1007/s11999-012-2613-z
Howell, S.M., Hull, M.L. & Mahfouz, M. (2012) Kinematic alignment in total knee arthroplasty. Insall and scott surgery of the knee. Philadelphia, PA: Elsevier. pp. 1255–1268. Available from: https://doi.org/10.1302/2058-5241.5.200010
Howell, S.M., Papadopoulos, S., Kuznik, K.T. & Hull, M.L. (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surgery, Sports Traumatology, Arthroscopy, 21, 2271–2280. Available from: https://doi.org/10.1007/s00167-013-2621-x
Howell, S.M., Shelton, T.J. & Hull, M.L. (2018) Implant survival and function ten years after kinematically aligned total knee arthroplasty. The Journal of Arthroplasty, 33, 3678–3684. Available from: https://doi.org/10.1016/j.arth.2018.07.020
Karasavvidis, T., Pagan Moldenhauer, C.A., Lustig, S., Vigdorchik, J.M. & Hirschmann, M.T. (2023) Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) ‐ there is no winner yet. Journal of Experimental Orthopaedics, 10, 120. Available from: https://doi.org/10.1186/s40634-023-00697-7
Kirchner, G.J., Stambough, J.B., Jimenez, E. & Nikkel, L.E. (2024) Robotic‐assisted TKA is not associated with decreased odds of early revision: an analysis of the American Joint Replacement Registry. Clinical Orthopaedics & Related Research, 482, 303–310. Available from: https://doi.org/10.1097/CORR.0000000000002783
MacDessi, S.J., Griffiths‐Jones, W., Chen, D.B., Griffiths‐Jones, S., Wood, J.A., Diwan, A.D. et al. (2020) Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft‐tissue balance in total knee arthroplasty: a randomized controlled trial. The Bone & Joint Journal, 102, 117–124. Available from: https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-0674.R2
MacDessi, S.J., Griffiths‐Jones, W., Harris, I.A., Bellemans, J. & Chen, D.B. (2021) Coronal Plane Alignment of the Knee (CPAK) classification: a new system for describing knee phenotypes. The Bone & Joint Journal, 103‐B, 329–337. Available from: https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-1050.R1
Micicoi, G., Khakha, R., Kley, K., Wilson, A., Cerciello, S. & Ollivier, M. (2020) Managing intra‐articular deformity in high Tibial osteotomy: a narrative review. Journal of Experimental Orthopaedics, 7, 65. Available from: https://doi.org/10.1186/s40634-020-00283-1
Orsi, A.D., Wakelin, E., Plaskos, C., McMahon, S. & Coffey, S. (2023) 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. Arthroplasty Today, 19, 101090. Available from: https://doi.org/10.1016/j.artd.2022.101090
Parratte, S., Pagnano, M.W., Trousdale, R.T. & Berry, D.J. (2010) Effect of postoperative mechanical axis alignment on the fifteen‐year survival of modern, cemented total knee replacements. The Journal of Bone and Joint Surgery‐American Volume, 92, 2143–2149. Available from: https://doi.org/10.2106/JBJS.I.01398
Rivière, C., Iranpour, F., Auvinet, E., Howell, S., Vendittoli, P.A., Cobb, J. et al. (2017) Alignment options for total knee arthroplasty: a systematic review. Orthopaedics & Traumatology: Surgery & Research, 103, 1047–1056. Available from: https://doi.org/10.1016/j.otsr.2017.07.010
Schelker, B.L., Moret, C.S., Sava, M.P., von Eisenhart‐Rothe, R., Graichen, H., Arnold, M.P. et al. (2023) The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 1840–1850. Available from: https://doi.org/10.1007/s00167-023-07351-w
Schelker, B.L., Nowakowski, A.M. & Hirschmann, M.T. (2022) What is the “safe zone” for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 419–427. Available from: https://doi.org/10.1007/s00167-021-06811-5
Schwarz, G.M., Simon, S., Mitterer, J.A., Frank, B.J.H., Aichmair, A., Dominkus, M. et al. (2022) Artificial intelligence enables reliable and standardized measurements of implant alignment in long leg radiographs with total knee arthroplasties. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 2538–2547. Available from: https://doi.org/10.1007/s00167-022-07037-9
Smith, P.N.G.D., McAuliffe, M.J., McDougall, C., Stoney, J.D., Vertullo, C.J., Wall, C.J., et al. (2023) Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, Knee & Shoulder Arthroplasty Annual Report, 2023, 6. Available from: https://doi.org/10.25310/YWQZ9375
Vanlommel, L., Vanlommel, J., Claes, S. & Bellemans, J. (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surgery, Sports Traumatology, Arthroscopy, 21, 2325–2330. Available from: https://doi.org/10.1007/s00167-013-2481-4
Vigdorchik, J.M., Wakelin, E.A., Koenig, J.A., Ponder, C.E., Plaskos, C., DeClaire, J.H. et al. (2022) Impact of component alignment and soft tissue release on 2‐year outcomes in total knee arthroplasty. The Journal of Arthroplasty, 37,2035–2040. Available from: https://doi.org/10.1016/j.arth.2022.04.042
Wang, G., Chen, L., Luo, F., Luo, J. & Xu, J. (2024) 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 Surgery, Sports Traumatology, Arthroscopy, 32, 1240–1252. Available from: https://doi.org/10.1002/ksa.12093
Winnock de Grave, P., Kellens, J., Luyckx, T., Tampere, T., Lacaze, F. & Claeys, K. (2022) Inverse kinematic alignment for total knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research, 108, 103305. Available from: https://doi.org/10.1016/j.otsr.2022.103305
Winnock de Grave, P., Luyckx, T., Claeys, K., Tampere, T., Kellens, J., Müller, J. et al. (2022) Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment. Knee Surgery, Sports Traumatology, Arthroscopy, 30, 488–499. Available from: https://doi.org/10.1007/s00167-020-06165-4
Winnock de Grave, P., Luyckx, T., Van Criekinge, T., Müller, J.H., Ollivier, B., Van Eecke, E. et al. (2023) Inverse kinematic alignment accommodates native coronal knee alignment better in comparison to adjusted mechanical alignment and restricted kinematic alignment. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 3765–3774. Available from: https://doi.org/10.1007/s00167-023-07326-x