Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review

Roussot, Mark; Vles, Georges; Oussedik, Sam

doi:10.1302/2058-5241.5.190093

Cited by 43 publications

(24 citation statements)

References 71 publications

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“…It is noted that the natural knee tends to have an increased medial pivot movement, where the medial condyle experiences less A-P movement than the lateral condyle. 8,21,22 When comparing wear scars between MA and AA alignment for the CR RP inserts, a similar pattern is found. Anatomic alignment PS inserts do not seem to exhibit the same wear pattern, and it is surmised that this may be due to PCL removal in the finite element simulations and/or post-cam interactions in the PS design.…”

Section: Discussionsupporting

confidence: 58%

Total knee replacement wear during simulated gait with mechanical and anatomic alignments

Maag

Cracaoanu

Langhorn

et al. 2021

Proc Inst Mech Eng H

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Total knee replacements (TKR) have historically been implanted perpendicular to the mechanical axis of the knee joint, with a commensurate external rotation of the femur in flexion relative to the posterior condylar axis (PCA). Although this mechanical alignment (MA) method has typically offered good long-term survivorship of implants, it may result in alignment of the implant that departs significantly from the native Joint Line (JL) in extension and flexion for a considerable portion of the patient population. There is a growing interest with surgeons to implant TKR components more closely aligned to the natural JL (Anatomic Alignment-AA) of the patient’s knee joint to reduce the need for soft tissue releases during surgery, potentially improving knee function and patient satisfaction. Using a previously-validated finite element model of the lower extremity, implant- and alignment-specific loading conditions were developed and applied in a wear experiment via a six-degree-of-freedom joint simulator. MA was defined as 0° Joint Line (JL), 0° varus hip-knee-ankle (HKA) angle, and 3° external femoral rotation. AA was defined as 5° varus JL, 3° varus HKA, and 0° femoral rotation. The experiment returned wear rates of 3.76 ± 0.51 mg/million cycles (Mcyc) and 2.59 ± 2.11 mg/Mcyc for ATTUNE® cruciate-retaining (CR) fixed bearing (FB) in MA and AA, respectively. For ATTUNE posterior-stabilized (PS) FB in AA, the wear rate was 0.97 ± 1.11 mg/Mcyc. For ATTUNE CR rotating platform (RP), the wear rates were 0.23 ± 0.19 mg/Mcyc, 0.48 ± 1.02 mg/Mcyc in MA and AA respectively. Using a two-way ANOVA, it was determined that there was no significantly difference in the wear rates between AA and MA ( p = 0.144) nor the wear rate of ATTUNE PS FB in AA significantly different from either ATTUNE CR FB or ATTUNE CR RP.

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Section: Discussionsupporting

confidence: 58%

Total knee replacement wear during simulated gait with mechanical and anatomic alignments

Maag

Cracaoanu

Langhorn

et al. 2021

Proc Inst Mech Eng H

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“…However, as this technique ignores the overall limb alignment in the coronal plane, there are fears that KA will create varus-valgus outliers and therefore contribute to early failure [25]. Although much research has been undertaken to identify which technique provides the optimal outcome for patients, no convincing conclusions regarding superiority have been drawn [26][27][28].…”

Section: Rationale For Sensor-assisted Total Knee Arthroplastymentioning

confidence: 99%

Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?

Yapp

Robinson

Clement

et al. 2021

Curr Rev Musculoskelet Med

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Purpose of Review Soft tissue imbalance, presenting as instability or stiffness, is an important cause of revision total knee arthroplasty (TKA). Traditional methods of determining soft tissue balance of the knee lack precision and are not reliable between operators. Use of intra-operative pressure sensors offers the potential to identify and avoid soft tissue imbalance following TKA. This review aims to summarise the literature supporting the clinical indication for the use of intra-articular pressure sensors during TKA. Recent Findings Analytical validation studies suggest that intra-operative pressure sensors demonstrate ‘moderate’ to ‘good’ intra-observer reliability and ‘good’ to ‘excellent’ interobserver reliability throughout the flexion arc. However, there are important errors associated with measurements when devices are used out-with the stated guidelines and clinicians should be aware of the limitations of these devices in isolation. Current evidence regarding patient benefit is conflicting. Despite positive early results, several prospective studies have subsequently failed to demonstrate significant differences in overall survival, satisfaction, and patient-reported outcome measures within 1 year of surgery. Summary Surgeon-defined soft tissue stability appears to be significantly different from the absolute pressures measured by the intra-operative sensor. Whilst it could be argued that this confirms the need for intra-articular sensor guidance in TKA; the optimal ‘target’ balance remains unclear and the relationship with outcome in patients is not determined. Future research should (1) identify a suitable reference standard for comparison; (2) improve the accuracy of the sensor outputs; and (3) demonstrate that sensor-assisted TKA leads to patient benefit in patient-reported outcome measures and/or enhanced implant survival.

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“…Ein optimales mechanisches Alignment führt jedoch nicht zu besseren klinischen (Langzeit‑)Resultaten. Aktuelle Reviews zeigen für das kinematische Alignment mindestens gleichwertige oder bessere funktionelle Ergebnisse und Komplikationsraten als für das mechanische Alignment [ 5 , 36 ]. Es ist jedoch zu berücksichtigen, dass gerade bei jüngeren Männern in etwa einem Drittel ein Genu varum vorliegt [ 7 ].…”

Section: Technische Besonderheiten Beim Jungen Patientenunclassified

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

Egloff¹,

Hirschmann

Moret

et al. 2021

Orthopäde

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ZusammenfassungDie Zahl der durchgeführten Knietotalendoprothesen (KTEP) nimmt jedes Jahr kontinuierlich zu. Ungefähr 10 % davon betreffen Patienten unter 55 Jahren, obwohl bekannt ist, dass in dieser Altersgruppe die Zufriedenheit und die funktionellen Ergebnisse geringer und die Revisionsrate höher ausfällt. Vermehrte Aktivität und erhöhtes Anspruchsdenken machen die Endoprothetik in dieser Altersgruppe zu einer besonderen Herausforderung. Gleichzeitig ist der Anteil posttraumatischer Gonarthrosen deutlich erhöht, was in Anbetracht ligamentärer und knöcherner Vorschäden eine schwierigere operative Versorgung bedeutet. Bei fortgeschrittenen Arthrosen in mehreren Kompartimenten mit/ohne begleitender ligamentärer Instabilität muss jedoch ein totalendoprothetischer Ersatz auch bei jüngeren Patienten erwogen werden. Die sorgfältige Indikationsstellung für die KTEP und die eingehende Patientenaufklärung (Chancen, Risiken, erreichbare Leistungsfähigkeit in Beruf und Alltag) sind gerade bei jüngeren Patienten starke Prädiktoren für ein gutes Resultat.

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Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review

Cited by 43 publications

References 71 publications

Total knee replacement wear during simulated gait with mechanical and anatomic alignments

Total knee replacement wear during simulated gait with mechanical and anatomic alignments

Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions?

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

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