Editor's Spotlight/Take 5: The Chitranjan S. Ranawat Award: No Difference in 2-year Functional Outcomes Using Kinematic versus Mechanical Alignment in TKA: A Randomized Controlled Clinical Trial

Leopold, Seth S.

doi:10.1007/s11999-016-5143-2

Cited by 11 publications

(6 citation statements)

References 3 publications

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“…This finding is in congruence with the previous research by Blakeney, which demonstrated that patients who underwent KA had knee joint kinematics closer to those of healthy individuals than those treated with the MA technique [ 12 ]. Moreover, many studies support this observation based on the notion that the KA protocol facilitates knee motion generation that is close to normal [ 18 , 25 , 46 – 48 ]. The KA technique provides a satisfactory compromise solution that allows the reconstruction of the anatomy of most patients while avoiding the overcorrection and ligament relaxation necessary for MA.…”

Section: Discussionmentioning

confidence: 90%

Alignment strategy for different types of varus knee with generic instruments: Mechanical alignment or kinematic alignment?

Lin,

Cheng,

et al. 2023

J Orthop Surg Res

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Objective A thorough examination of the available approaches is crucial to comprehensively understand the variance among the alignment strategies employed in total knee arthroplasty (TKA). In this study, we assessed the functional outcomes during the perioperative and postoperative periods of TKA in patients using generic instruments with varus knee to compare the mechanical alignment (MA) and kinematic alignment (KA) procedures. Methods A total of 127 patients from the First Affiliated Hospital of Wannan Medical College who had undergone unilateral TKA between November 2019 and April 2021 were included. The patients with varus knee deformity were categorized into two groups [type I (n = 64) and type IV (n = 63)] based on the modified coronal plane alignment of the knee (mCPAK) classification. The type I and IV groups were further subdivided into MA (n = 30 and n = 32) and KA subgroups (n = 34 and n = 21), respectively. The clinical information collected included sex, surgical side, age, body mass index, and perioperative data [including operation time, intraoperative blood loss, length of hospital stay, and the American Society of Anesthesiologists (ASA) classification]. All patients were monitored for 12 months post-surgery to evaluate the recovery of knee joint function. During this period, the Knee Disability and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and the active range of motion (AROM) and visual analog scale (VAS) pain scores were compared at different time points, i.e., before the operation and 6 weeks, 6 months, and 12 months post-operation. Additionally, the patients’ subjective experiences were assessed at 6 and 12 months post-surgery using Forgotten Joint Score Knee (FJS-12 Knee), while complications were recorded throughout the monitoring period. Results No significant variances were observed in ASA classification, operation duration, blood loss volume during surgery, and hospital stay length between the patients who underwent KA TKA and those who received MA TKA (P > 0.05). During the initial 6 weeks post-operation, the KA group exhibited a significantly reduced average VAS pain score (P < 0.05), with no such differences at 6 months and 1 year after the surgery (P > 0.05). Furthermore, the KA group had significantly higher scores on the KOOS JR at 6 weeks, 6 months, and 1 year following the surgery (P < 0.05). Moreover, the AROM score of the KA group significantly improved only at 6 weeks after the surgery (P < 0.05); however, no prominent differences were found at 6 months and 1 year after the operation (P > 0.05). The KA cohort also exhibited a significant increase in FJS-12 Knee at 1 year following the operation (P < 0.05), whereas no such difference was detected at 6 months following the surgery (P > 0.05). Thus, compared to the MA method, the KA procedure provided pain relief and improved active motion range within 6 weeks after the surgery in patients undergoing TKA. Further, the KOOS JR exhibited significant increases at 6 weeks, 6 months, and 1 year while the FJS-12 Knee demonstrated a significant increase at 1 year after the KA TKA procedure. Conclusion Therefore, our study results suggest that the KA approach can be considered in patients using generic instruments with varus alignment of the knee, particularly those with mCPAK type I and IV varus knees, to help improve patient satisfaction.

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Section: Discussionmentioning

confidence: 90%

Alignment strategy for different types of varus knee with generic instruments: Mechanical alignment or kinematic alignment?

Lin,

Cheng,

et al. 2023

J Orthop Surg Res

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“…The KA-TKA attempts to modify implant position to recreate the anatomy of the prearthritic articular surface for the individual patient and restore the patient's natural alignment [ [7] , [17] ] [[, 17 ] [] [7] , [17] []. KA-TKA has generated interest for achieving better clinical outcomes than MA-TKA [ [8] , [18] ] [[, 18 ] [] [8] , [18] [] and meta-analyses comparing KA-TKA to MA-TKA reported that functional outcome as measured by the KSS favored KA-TKA in short-term follow-up [ [19] , [20] , [21] ]. However, since tibial plateau inclination might progress to ~10° in arthritic knees [ 5 ], it may be difficult to ascertain the natural tibial plateau inclination predicted from preoperative tibial plateau inclination.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical and biomechanical outcomes between the kinematic and mechanical alignment methods in total knee arthroplasty: Protocol for a multicenter randomized controlled trial

Takashima

Matsumoto

Takayama

et al. 2021

Contemporary Clinical Trials Communications

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Introduction The concept of anatomic restoration has garnered considerable interest in the form of kinematically aligned total knee arthroplasty (KA-TKA). KA-TKAs have been reported to reproduce natural alignment and kinematics. However, few randomized controlled trials (RCTs) have compared the biomechanical outcomes and the long-term clinical outcomes of KA-TKA with those of mechanically aligned TKA (MA-TKA). We aim to investigate the long-term clinical and biomechanical effects of KA-TKA and to determine whether KA-TKA or MA-TKA is more appropriate for primary TKA. Methods This trial will compare clinical and biomechanical outcomes of KA-TKA to those of MA-TKA. Two hundred patients will be enrolled in the RCT and randomized into KA-TKA or MA-TKA groups. Both the groups will be evaluated 1 week before the operation, on the day of the operation, 6 months after the operation, and 1, 5, and 10 years after the operation. The primary outcome is the difference between preoperative and 1-year postoperative functional activity scores of the 2011 Knee Society Score (2011 KSS) in both groups as well as the differences between the scores of both groups. The secondary outcomes will include differences in symptom, satisfaction, and expectation scores of the 2011 KSS, intraoperative kinematics evaluation, postoperative clinical outcomes and complications, pre- and postoperative gait analyses and radiograph evaluations between both KA-TKA and MA-TKA.

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“…With the development of the concept of individual TKA, more TKA alignment strategies have been proposed, such as anatomic alignment (AA), kinematic alignment (KA), restricted KA (rKA) and adjusted MA (aMA) [26]. Numerous studies have evaluated the clinical outcomes of TKA with different alignment strategies, but no consistent result has been achieved [3,18]. However, all of the above alignment strategies were for overall lower limb alignment.…”

Section: Introductionmentioning

confidence: 99%

Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models

Liu,

Lei,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to investigate the distribution of coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes in a Chinese osteoarthritis (OA) population and to compare different lower limb alignment targets according to the distribution characteristics to find suitable total knee arthroplasty (TKA) bone cut strategies for the Chinese OA patients.MethodsThe computed tomography (CT) images were retrospectively collected and the three‐dimensional (3D) models were reconstructed from 434 Chinese OA patients, including 93 males and 341 females, with a mean age of 66.4 ± 9.3 years. Femoral mechanical angle (FMA), tibial mechanical angle (TMA) and mechanical hip–knee–ankle angle (mHKA) were measured on the 3D models. Arithmetic hip–knee–ankle angle (aHKA) was calculated using FMA plus TMA, and joint line obliquity was calculated as 180 + TMA–FMA. The CPAK according to MacDessi and the functional knee phenotypes according to Hirschmann were performed. In addition, the suitable TKA bone cut strategies were explored according to the phenotypes and based on the characteristics of different alignment targets, such as mechanical alignment, anatomic alignment (AA), kinematic alignment, restricted KA (rKA) and adjusted MA (aMA). Statistical differences were determined using the independent‐samples t‐test or the two independent‐samples Wilcoxon test, with p < 0.05 considered statistically significant.ResultsThe Chinese OA population showed a varus alignment tendency (mHKA = 172.1° ± 7.2°), to which the TMA was a major contributor (TMA = 84.7° ± 4.4° vs. FMA = 91.3° ± 3.2°). The mHKA was on average 3.9° more varus than the aHKA. A total of 140 functional knee phenotypes were found and 45.6% were concentrated in VARFMA3°–NEUFMA0° to VARTMA3°–NEUTMA0°. More than 70% of patients had different FMA and TMA phenotypes. There were 92.9% of CPAK distributed in types I to IV, with type I accounting for 53.9%. The FMA phenotypes were less changed if the aMA and rKA were chosen, and the TMA phenotypes were less changed if the AA and rKA were chosen.ConclusionCompared with the CPAK, the functional knee phenotypes were more suitable for the Chinese OA population with a wide distribution and a varus tendency, and it seemed more appropriate to choose aMA and rKA as TKA alignment targets for resection.Level of EvidenceLevel Ⅲ.

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Editor's Spotlight/Take 5: The Chitranjan S. Ranawat Award: No Difference in 2-year Functional Outcomes Using Kinematic versus Mechanical Alignment in TKA: A Randomized Controlled Clinical Trial

Cited by 11 publications

References 3 publications

Alignment strategy for different types of varus knee with generic instruments: Mechanical alignment or kinematic alignment?

Alignment strategy for different types of varus knee with generic instruments: Mechanical alignment or kinematic alignment?

Comparison of clinical and biomechanical outcomes between the kinematic and mechanical alignment methods in total knee arthroplasty: Protocol for a multicenter randomized controlled trial

Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models

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