Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta‐analysis

Wan, Xufeng; Yang, Yang; Xu, Hong; Huang, Chao; Zhou, Kai; Xu, Jin

doi:10.1111/os.13155

Cited by 16 publications

(10 citation statements)

References 63 publications

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“…The defined target safe zones for final HKA are not yet resolved. Whilst limited residual varus alignment in TKA has been shown to be a safe approach [ 61 , 62 ], little data is available regarding the effect of residual valgus alignment. Lee et al demonstrated that beyond 3° of residual valgus alignment, patella femoral incongruence and lateral tilt were observed [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Functional Alignment Philosophy in Total Knee Arthroplasty—Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning

Shatrov

Foissey

Kafelov

et al. 2023

JPM

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Functional alignment (FA) is a novel philosophy to deliver a total knee arthroplasty (TKA) that respects individual bony and soft tissue phenotypes within defined limitations. The purpose of this paper is to describe the rationale and technique of FA in the valgus morphotype with the use of an image-based robotic-platform. For the valgus phenotype the principles are personalized pre-operative planning, reconstitution of native coronal alignment without residual varus or valgus of more than 3°, restoration of dynamic sagittal alignment within 5° of neutral, implant sizing to match anatomy, and achievement of defined soft tissue laxity in extension and flexion through implant manipulation within the defined boundaries. An individualized plan is created from pre-operative imaging. Next, a reproducible and quantifiable assessment of soft tissue laxity is performed in extension and flexion. Implant positioning is then manipulated in all three planes if necessary to achieve target gap measurements and a final limb position within a defined coronal and sagittal range. FA is a novel TKA technique that aims to restore constitutional bony alignment and balance the laxity of the soft tissues by placing and sizing implants in a manner that respects variations in individual anatomy and soft tissues within defined limits.

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Section: Discussionmentioning

confidence: 99%

Functional Alignment Philosophy in Total Knee Arthroplasty—Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning

Shatrov

Foissey

Kafelov

et al. 2023

JPM

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show abstract

“…Moreover, the clinical importance of these findings and their impact on patient outcomes and satisfaction remains uncertain. A recent review [ 41 ], despite including studies of lower evidence levels, suggests that both neutral (0°–3°) and mild varus (3°–6°) alignments post-TKA result in similar patient outcomes in patients with preoperative varus knees. This highlights the necessity for a more comprehensive exploration of the role alignment plays in the success of TKA.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Alrajeb,

Zarti,

Shuia

et al. 2023

Eur J Orthop Surg Traumatol

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Objectives Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes. Methods We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR − 0.82; 95% CI, − 1.027 to − 0.58, p value < 0.00001) and mechanical restoration (OR − 0.95; 95% CI, − 1.49 to − 0.41, p value < 0.0006). While knee range of motion (OR − 2.23; 95% CI − 4.89–0.43, p value 0.1) and femoral prosthesis position (OR − 0.98; 95% CI, − 2.03–0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries. Conclusion This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries. Level of evidence I.

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“…Restoration of the neutral mechanical alignment of the overall lower limb is one of the goals of TKA. According to most studies, the alignment of the lower limb should be within 0 ± 3° of the neutral mechanical axis after TKA 27 , 28 . In this study, the postoperative HKA of the MR, GB, and hybrid groups were 178.7° ± 1.4°, 179.2° ± 1.5°, and 179.4° ± 1.1°, respectively, which showed that the mechanical alignment could be accurately restored using any of the three techniques.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Imaging and Clinical Outcomes among the Measured Resection, Gap Balancing, and Hybrid Techniques in Primary Total Knee Arthroplasty

Hao

Wei

et al. 2022

Orthopaedic Surgery

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Objective Although many studies have compared the measured resection (MR) technique to the gap balancing (GB) technique, few studies have investigated the hybrid technique. In this study, we compared imaging and clinical outcomes of the MR, GB, and hybrid techniques in primary total knee arthroplasty (TKA). Methods From January 2016 to January 2019, we conducted a retrospective study on 90 patients who underwent unilateral primary TKA; 30 received the MR technique, 30 received the GB technique, and 30 received the hybrid technique. Radiological outcomes, including joint line level, mechanical alignment of the lower limb, positions of the femoral and tibial components, and rotation of the femoral component, and clinical outcomes, including the visual analog scale score for pain, the Knee Society Score, and the range of motion, were assessed among the three groups. One‐way analysis of variance and Dunnett's test were performed for normally distributed data. Kruskal–Wallis H test and Dunn–Bonferroni test were conducted for non‐normally distributed data. Results No significant difference in the mechanical alignment (p = 0.151) and the positions of the tibial and femoral components (p = 0.230 for α angle, p = 0.517 for β angle, p = 0.686 for femoral flexion angle, and p = 0.918 for tibial slope angle) was found among the three groups. No significant difference in the elevation of the joint line between the MR and the hybrid groups was found (2.1 ± 0.3 mm vs 2.1 ± 0.1 mm, p = 0.627), but the GB group (2.8 ± 0.2 mm) differed significantly from the other two groups (p < 0.001). Although rotation of the femoral component in the GB group was larger than that of the MR and hybrid groups, the difference was not significant (1.8° ± 0.2° vs 1.7° ± 0.3° vs. 1.7° ± 0.2°, p = 0.101). The clinical outcomes were not significantly different (p > 0.05), although the results in the hybrid group were slightly higher. Conclusion The hybrid technique helped to restore the mechanical alignment of the lower limb and realize optimal positions of the femoral and tibial components without significant differences relative to the MR and GB techniques. The hybrid technique was more helpful for maintaining the original height of the joint line, which was similar to the MR technique. Additionally, although the improvement in the clinical outcomes in the hybrid group was slightly higher, it was not significantly different among the three groups.

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Comparison of Outcomes After Total Knee Arthroplasty Involving Postoperative Neutral or Residual Mild Varus Alignment: A Systematic Review and Meta‐analysis

Cited by 16 publications

References 63 publications

Functional Alignment Philosophy in Total Knee Arthroplasty—Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning

Functional Alignment Philosophy in Total Knee Arthroplasty—Rationale and Technique for the Valgus Morphotype Using an Image Based Robotic Platform and Individualized Planning

Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Comparison of the Imaging and Clinical Outcomes among the Measured Resection, Gap Balancing, and Hybrid Techniques in Primary Total Knee Arthroplasty

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