Decoupling the trochlea from the condyles in total knee arthroplasty: The end of a curse?

Bonnin, Michel; Saffarini, Mo; Lustig, Sébastien; Hirschmann, Michael T.

doi:10.1002/ksa.12267

Knee surg. sports traumatol. arthrosc.

2024

DOI: 10.1002/ksa.12267

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Decoupling the trochlea from the condyles in total knee arthroplasty: The end of a curse?

Michel Bonnin,

Mo Saffarini,

Sébastien Lustig

et al.

Abstract: Benefits of using individualised total knee arthroplasty (TKA) with kinematic alignment. With individualised TKA, the trochlea and condyles are designed independently. In the coronal plane (above), the prosthetic trochlear axis (PTA) remains aligned with the quadriceps line of force (QLF) whatever the orientation of the joint line (JL). In the axial plane (below), the prosthetic trochlea (PT) also remains aligned with the native trochlea (NT) whatever the orientation of the posterior condylar line (PCL).

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Cited by 4 publications

References 43 publications

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Same same but different—Image‐based versus imageless robotic‐assisted total knee arthroplasty!

Hirschmann,

Avram,

Graichen

et al. 2024

J. exp. orthop.

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Robotic‐assisted total knee arthroplasty (RTKA) has gained widespread acceptance due to its demonstrated ability to improve surgical accuracy compared to conventional total knee arthroplasty (CTKA). While the precise impact of RTKA on postoperative patient‐reported outcome measures (PROMs) remains inconclusive, the increased accuracy in alignment and joint kinematics suggests potential improvements in patient satisfaction and functional outcomes. Two primary RTKA systems exist: image‐based, which uses preoperative CT scans for detailed 3D modeling, and image‐less, which relies on intra‐operative digitization of anatomical landmarks. Both systems aim to achieve accurate implant placement and soft‐tissue balancing, yet they differ in methodology and reliance on preoperative data.Despite RTKA's theoretical advantages, there is ongoing debate about whether accuracy alone is sufficient to achieve optimal postoperative outcomes, particularly concerning joint kinematics and alignment strategies. Literature reveals no significant difference in coronal plane alignment between image‐based and image‐less systems, though image‐less systems may be more prone to varus errors due to the reliance on intra‐articular landmarks. Additionally, image‐free systems may face challenges in replicating native knee anatomy, especially in the sagittal plane, leading to potential limitations in achieving ideal tibial slope reconstruction.The future of RTKA may lie in refining implant positioning strategies that minimize postoperative alterations to pre‐arthritic knee kinematics, particularly with standardized off‐the‐shelf implants. As robotic technology evolves, there is potential to enhance surgical outcomes by combining accuracy with personalized alignment approaches that better address individual patient anatomy. Further research is needed to assess the long‐term clinical benefits of RTKA and its capacity to improve patient‐specific functional outcomes.Level of evidencelevel 5

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Same same but different—Image‐based versus imageless robotic‐assisted total knee arthroplasty!

Hirschmann,

Avram,

Graichen

et al. 2024

J. exp. orthop.

View full text Add to dashboard Cite

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Anteroposterior axis of the tibia for kinematic aligned total knee arthroplasty

Toyooka,

Arai,

Masuda

et al. 2024

J. exp. orthop.

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PurposeIt is not known where the anatomical axis of rotation on the tibial side will be in kinematic alignment (KA), a rapidly expanding area of total knee arthroplasty (TKA) alignment technique today. The purpose of this study was to define the tibial axis for KA‐TKA.MethodsFifty patients who underwent computed tomography (CT) examination of the lower extremities at a single institution were included. The posterior condylar axis (PCA) and surgical epicondylar axis (SEA) were identified in the CT axial view and projected onto the tibial slice. The respective perpendicular lines that pass through was attachment of the posterior cruciate ligament (PCL) were identified as the anatomic axis of rotation of the tibia relative to the PCA and SEA, and the position of each axis of rotation. Furthermore, the relationship of these perpendicular lines with the Akagi line was evaluated.ResultsThe axis of tibial rotation to the SEA was similar to that of the Akagi line; the axis of tibial rotation to the PCA was located approximately 2.9° medial to the Akagi line, and when the origin of the tibial axis was set at the PCL attachment site, the intersection point of the tibial axis was approximately 2.5 mm medial to the medial border of the tibial tuberosity. The distribution of tibial axis had a wide range.ConclusionAlthough there is a large individual variation, the average tibial axis for KA‐TKA is 2.9° more internally rotated than the Akagi line.Level of EvidenceLevel IV.

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Patient‐reported outcome measures following individualised TKA are not affected by the degree of preoperative coronal varus or valgus laxity

Sappey‐Marinier,

Bouguerra,

Chapuis

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo determine whether there is a correlation between preoperative coronal varus or valgus laxity and patient‐reported outcome measures (PROMs) 2 years after individualised total knee arthroplasty (TKA).MethodsRecords of 150 consecutive patients who received individualised TKA were retrospectively analysed, and 126 with complete pre‐ and postoperative data were included. Preoperative coronal varus and valgus stress radiographs (15 N load) were taken using a telos stress device with the knee in 5°–10° of flexion. Varus stress angles were positive if the joint opened on the lateral side, and valgus stress angles were positive if the joint opened on the medial side. The sum of varus and valgus stress angles indicated total joint laxity. During surgery, cases that required tibial recuts to balance the joint were recorded. Patients completed three PROMs and rated their satisfaction. Correlations between laxity and PROMs were evaluated using Pearson's correlation.ResultsStress radiographs revealed varus stress angles of 6.3° ± 3.5° (range, −4.5° to 14.1°), valgus stress angles of 0.1° ± 3.7° (range, −8.0° to 10.9°), and the sum of the varus and valgus stress angle of 6.4° ± 3.3° (range, 0.1° to 17.1°). There were no correlations between laxity and PROMs: r < 0.160 for varus stress angle, r < 0.180 for valgus stress angle and r < 0.160 for the sum of stress angles. There were no statistically significant or clinically relevant differences in PROMs between knees without and those with tibial recuts.ConclusionPreoperative coronal varus or valgus laxity was not correlated with PROMs following individualised TKA at a minimum 2‐year follow‐up. Individualised TKA with personalised alignment enables adequate accommodation of a broad spectrum of preoperative coronal varus–valgus laxities.Level of EvidenceIV

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Decoupling the trochlea from the condyles in total knee arthroplasty: The end of a curse?

Cited by 4 publications

References 43 publications

Same same but different—Image‐based versus imageless robotic‐assisted total knee arthroplasty!

Same same but different—Image‐based versus imageless robotic‐assisted total knee arthroplasty!

Anteroposterior axis of the tibia for kinematic aligned total knee arthroplasty

Patient‐reported outcome measures following individualised TKA are not affected by the degree of preoperative coronal varus or valgus laxity

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