Good clinical results using a modified kinematic alignment technique with a cruciate sacrificing medially stabilised total knee arthroplasty

Abstract

Background This study aims to evaluate the clinical and radiological outcomes of a modiied technique of Kinematically Aligned Total Knee Arthroplasty (KA TKA) using a cruciate sacriicing (CS) medially stabilised prosthesis at a minimum 24-months follow-up. Methods 59 patients with a varus HKA angle who underwent a TKA from May, 2016 to April, 2017 were retrospectively enrolled. Radiological and clinical evaluations were assessed after 40 days, 6 months and at a minimum follow-up of 24 months. Long leg standing X-rays were performed pre-operatively and the Hip-Knee-Ankle (HKA) angle, the mechanical Lateral Distal Femoral Angle (mLDFA), the mechanical Medial Proximal Tibial Angle (mMPTA) and the Knee Joint Line Obliquity Angle (KJLOA) were analysed. At a minimum follow-up of 24 months, the patients were evaluated subjectively based on the Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) and the Oxford Knee Score (OKS). The post-operative range of motion (ROM) was measured. To reduce lexion instability, an original technique was used, with more posterior positioning of the femoral component, called the "virtuous mistake". Results were compared to the data reported in the literature in patients treated with standard kinematic alignment (KA) technique. ResultsNo difference was found between the mean pre-operative and post-operative angles regarding mLDFA (p value = 0.410) and mMTPA (p value = 0.242). A diference of 0.8° in HKA angle between males and females was found, with more varus results in males. At a minimum follow-up of 24 months, the WOMAC was 87 (SD 4.3), the OKS was 41 (SD 2.4), and the lexion was 124°, which was similar to the data reported in literature with standard KA. There were not any cases of aseptic failures. Conclusions The modiied KA TKA surgical technique proposed in this study can achieve good clinical results at minimum 24 months of follow-up, reproducing accurately native mLDFA and mMPTA. Level of evidence Level III, therapeutic study.

No difference in 13-year survival after medial pivot or central pivot mobile bearing total knee arthroplasty. A propensity matched comparative analysis

“…The clinical results published in the literature about the respective results of MPA and CPA TKAs are controversial. Some cohort studies report satisfactory results after implantation of a MPA TKA [5, 15, 20, 28]. In vivo knee kinematics may be improved if a medial pivot is present [1].…”

Implication of Changes in the Imaging Measurements after Mechanically Aligned Total Knee Arthroplasty

“…Ankle joint line orientation (AJLO) was the angle between the ankle joint line and the horizontal line. The midpoints of the ankle distance (MAD) was measured as the spacing between midpoints of ankle joints of both lower limbs 9 , 18 (Fig. 2 ).…”

Medial Stabilised Total Knee Arthroplasty: Definition and Performance

“…Given that KA aims to restore natural lower limb axes and MS-TKA aims to restore natural tibiofemoral kinematics, recent work has emerged which aims to combine the two. Early small studies suggest similar or even better results compared with traditional techniques (French, Munir, and Brighton 2020;Risitano et al 2020;Malavolta et al 2022).…”