Better restoration of joint line obliquity in tibia first restricted kinematic alignment versus mechanical alignment TKA.
Joint line obliquity
Knee osteoarthritis
Mechanical alignment
Restoration
Restricted inverse kinematic alignment
Total knee arthroplasty
Journal
Archives of orthopaedic and trauma surgery
ISSN: 1434-3916
Titre abrégé: Arch Orthop Trauma Surg
Pays: Germany
ID NLM: 9011043
Informations de publication
Date de publication:
11 Sep 2024
11 Sep 2024
Historique:
received:
05
06
2024
accepted:
03
09
2024
medline:
11
9
2024
pubmed:
11
9
2024
entrez:
11
9
2024
Statut:
aheadofprint
Résumé
In total knee arthroplasty (TKA), suboptimal restoration of joint line obliquity (JLO) and joint line height (JLH) may lead to diminished implant longevity, increased risk of complications, and reduced patient reported outcomes. The primary objective of this study is to determine whether restricted kinematic alignment (rKA) leads to improved restoration of JLO and JLH compared to mechanical alignment (MA) in TKA. This retrospective study assessed patients who underwent single implant design TKA for primary osteoarthritis, either MA with manual instrumentation or rKA assisted with imageless navigation robotic arm TKA. Pre- and post-operative long standing AP X-ray imaging were used to measure JLO formed between the proximal tibial joint line and the floor. JLH was measured as the distance from the femoral articular surface to the adductor tubercle. Overall, 200 patients (100 patients in each group) were included. Demographics between the two groups including age, sex, ASA, laterality, and BMI did not significantly differ. Distribution of KL osteoarthritis classification was similar between the groups. For the MA group, pre- to post-operative JLO significantly changed (2.94° vs. 2.31°, p = 0.004). No significant changes were found between pre- and post-operative JLH (40.6 mm vs. 40.6 mm, p = 0.89). For the rKA group, no significant changes were found between pre- and post-operative JLO (2.43° vs. 2.30°, p = 0.57). Additionally, no significant changes were found between pre- and post-operative JLH (41.2 mm vs. 42.4 mm, p = 0.17). Pre- to post-operative JLO alteration was five times higher in the MA group compared to the rKA group, although this comparison between groups did not reach statistical significance (p = 0.09). rKA-TKA results in high restoration accuracy of JLO and JLH, and demonstrates less pre- and post-operative JLO alteration compared to MA-TKA. With risen interest in joint line restoration accuracy with kinematic alignment, these findings suggest potential advantages compared to MA. Future investigation is needed to correlate between joint line restoration accuracy achieved by rKA and enhanced implant longevity, reduced risk of post-operative complications, and heightened patient satisfaction.
Identifiants
pubmed: 39259312
doi: 10.1007/s00402-024-05551-8
pii: 10.1007/s00402-024-05551-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Soda Y, Nakamura M, Adachi N (2021) Coronal alignment of three different types of implants in kinematically aligned total knee arthroplasty: a comparative study. Open J Orthop 11:183–198
doi: 10.4236/ojo.2021.116018
Varacallo M, Luo TD, Johanson NA (2023) Total knee arthroplasty techniques. StatPearls. StatPearls Publishing, Treasure Island (FL)
Koshire S, Mohanty SS, Keny SA, Rai AK, Rathod TN, Kamble P (2022) The influence of joint line restoration on functional outcome after primary total knee arthroplasty: a prospective study. J Clin Orthop Trauma 34:102023. https://doi.org/10.1016/j.jcot.2022.102023
doi: 10.1016/j.jcot.2022.102023
pubmed: 36161062
pmcid: 9490095
Fornalski S, McGarry MH, Bui CN, Kim WC, Lee TQ (2012) Biomechanical effects of joint line elevation in total knee arthroplasty. Clin Biomech (Bristol Avon) 27(8):824–829. https://doi.org/10.1016/j.clinbiomech.2012.05.009
doi: 10.1016/j.clinbiomech.2012.05.009
pubmed: 22727620
Liow MH, 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(12):2373–2377. https://doi.org/10.1016/j.arth.2013.12.010
doi: 10.1016/j.arth.2013.12.010
pubmed: 24439796
Bieger R, Huch K, Kocak S, Jung S, Reichel H, Kappe T (2014) The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods. Arch Orthop Trauma Surg 134(4):537–541. https://doi.org/10.1007/s00402-014-1953-4
doi: 10.1007/s00402-014-1953-4
pubmed: 24509940
MacDessi SJ, Allom RJ, Griffiths-Jones W, Chen DB, Wood JA, Bellemans J (2022) The importance of joint line obliquity: a radiological analysis of restricted boundaries in normal knee phenotypes to inform surgical decision making in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30(9):2931–2940. https://doi.org/10.1007/s00167-022-06872-0
doi: 10.1007/s00167-022-06872-0
pubmed: 35075509
Sappey-Marinier E, Batailler C, Swan J, Schmidt A, Cheze L, MacDessi SJ, Servien E, Lustig S (2022) 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(8):2806–2814. https://doi.org/10.1007/s00167-021-06674-w
doi: 10.1007/s00167-021-06674-w
pubmed: 34291311
Popat R, Albelooshi A, Mahapatra P, Bollars P, Ettinger M, Jennings S, Van den Berg JL, Nathwani D (2022) Improved joint line and posterior offset restoration in primary total knee replacement using a robotic-assisted surgical technique: an international multi-centre retrospective analysis of matched cohorts. PLoS ONE 17(8):e0272722. https://doi.org/10.1371/journal.pone.0272722
doi: 10.1371/journal.pone.0272722
pubmed: 36006969
pmcid: 9409519
Ma R, Chen X, Li H, Wang Y, Li S, Li S, Qian W (2023) Computer navigation assisted restricted kinematic alignment improves short-term outcomes in total knee arthroplasty: an ambispective cohort study. Orthop Surg 15(2):460–470. https://doi.org/10.1111/os.13603
doi: 10.1111/os.13603
pubmed: 36453440
Nisar S, Palan J, Rivière C, Emerton M, Pandit H (2020) Kinematic alignment in total knee arthroplasty. EFORT open rev 5(7):380–390. https://doi.org/10.1302/2058-5241.5.200010
doi: 10.1302/2058-5241.5.200010
pubmed: 32818065
pmcid: 7407864
Woon JTK, Zeng ISL, Calliess T, Windhagen H, Ettinger M, Waterson HB, Toms AD, Young SW (2018) 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 138(9):1293–1303. https://doi.org/10.1007/s00402-018-2988-8
doi: 10.1007/s00402-018-2988-8
pubmed: 29961093
Almaawi AM, Hutt JRB, Masse V, Lavigne M, Vendittoli PA (2017) The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty. J Arthroplasty 32(7):2133–2140. https://doi.org/10.1016/j.arth.2017.02.028
doi: 10.1016/j.arth.2017.02.028
pubmed: 28302462
Winnock de Grave P, Luyckx T, Claeys K, Tampere T, Kellens J, Müller J, Gunst P (2022) Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment. Knee Surg Sports Traumatol Arthrosc 30(2):488–499. https://doi.org/10.1007/s00167-020-06165-4
doi: 10.1007/s00167-020-06165-4
pubmed: 32737528
Ji HM, Han J, Jin DS, Seo H, Won YY (2016) Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 24(8):2436–2441. https://doi.org/10.1007/s00167-016-3995-3
doi: 10.1007/s00167-016-3995-3
pubmed: 26811035
Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R (2017) Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 99-B 5640–646. https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-0688.R2
Liu B, Feng C, Tu C (2022) Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials. J Orthop Surg Res 17(1):201. https://doi.org/10.1186/s13018-022-03097-2
doi: 10.1186/s13018-022-03097-2
pubmed: 35379289
pmcid: 8981671
Kwak DS, Kim YD, Cho N, In Y, Kim MS, Lim D, Koh IJ (2022) Restoration of the joint line configuration reproduces native mid-flexion biomechanics after total knee arthroplasty: a matched-pair cadaveric study. Bioeng (Basel Switzerland) 9(10):564. https://doi.org/10.3390/bioengineering9100564
doi: 10.3390/bioengineering9100564
Lim D, Kwak DS, Kim M, Kim S, Cho HJ, Choi JH, Koh IJ (2022) Kinematically aligned total knee arthroplasty restores more native medial collateral ligament strain than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30(8):2815–2823. https://doi.org/10.1007/s00167-021-06680-y
doi: 10.1007/s00167-021-06680-y
pubmed: 34312712
Richards JA, Williams MD, Gupta NA, Smith LS, Malkani AL (2023) Neutral mechanical alignment alters the native distal femoral joint line: a virtual three-dimensional planning total knee arthroplasty study. J Arthroplasty 38(3):484–490. https://doi.org/10.1016/j.arth.2022.09.013
doi: 10.1016/j.arth.2022.09.013
pubmed: 36122689
Cortina G, Za P, Papalia GF, Gregori P, Condello V, Vasta S, Franceschetti E, Campi S, Madonna V, Papalia R (2023) Restricted kinematic alignment is clinically non-inferior to mechanical alignment in the short and mid-term: a systematic review. Knee 45:137–146. https://doi.org/10.1016/j.knee.2023.10.003
doi: 10.1016/j.knee.2023.10.003
pubmed: 37925804
Winnock de Grave P, Kellens J, Luyckx T, Tampere T, Lacaze F, Claeys K (2022) Inverse kinematic alignment for total knee arthroplasty. Orthop Traumatol Surg Res 108(5):103305. https://doi.org/10.1016/j.otsr.2022.103305
doi: 10.1016/j.otsr.2022.103305
pubmed: 35513224
Kohn MD, Sassoon AA, Fernando ND (2016) Classifications in brief: kellgren-lawrence classification of osteoarthritis. Clin Orthop Relat Res 474(8):1886–1893. https://doi.org/10.1007/s11999-016-4732-4
doi: 10.1007/s11999-016-4732-4
pubmed: 26872913
pmcid: 4925407
Hallgren KA (2012) Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8(1):23–34. https://doi.org/10.20982/tqmp.08.1.p023
doi: 10.20982/tqmp.08.1.p023
pubmed: 22833776
pmcid: 3402032
Murgier J, Clatworthy M (2022) Variable rotation of the femur does not affect outcome with patient specific alignment navigated balanced TKA. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06226-8 . 2022;30
doi: 10.1007/s00167-020-06226-8
pubmed: 34981160
Minoda Y (2023) Alignment techniques in total knee arthroplasty. J Joint Surg Res 1(1):108–116. https://doi.org/10.1016/j.jjoisr.2023.02.003
doi: 10.1016/j.jjoisr.2023.02.003
Corban LE, van de Graaf VA, Chen DB, Wood JA, Diwan AD, MacDessi SJ (2024) How often do we alter constitutional limb alignment, joint line obliquity, and coronal plane alignment of the knee (CPAK) phenotype when performing mechanically aligned TKA? Bone Jt Open 5(2):109–116. https://doi.org/10.1302/2633-1462.52.BJO-2023-0122
doi: 10.1302/2633-1462.52.BJO-2023-0122
pubmed: 38325412
pmcid: 10849801
Cozzarelli NF, DeSimone CA, D’Amore T, Sherman MB, Lonner JH (2024) Joint line position change in primary total knee arthroplasty: a radiographic analysis comparing conventional and robotic techniques. Int Orthop 48(4):1023–1030. https://doi.org/10.1007/s00264-023-06031-1
doi: 10.1007/s00264-023-06031-1
pubmed: 37946052
Orsi AD, 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. https://doi.org/10.1016/j.artd.2022.101090
doi: 10.1016/j.artd.2022.101090
pubmed: 36688096
pmcid: 9851873
Tuecking LR, Savov P, Zander M, Jeremic D, Windhagen H, Ettinger M (2023) Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques. Knee Surg Sports Traumatol Arthrosc 31(9):3871–3879. https://doi.org/10.1007/s00167-023-07360-9
doi: 10.1007/s00167-023-07360-9
pubmed: 36917247