Kinematic Alignment – Management von Deformitäten und Flexionskontrakturen

Malavolta, Michele; Kley, Kristian

doi:10.1007/s00132-020-03970-0

Cited by 3 publications

(6 citation statements)

References 17 publications

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“… 29 , 30 , 38 This approach is also known as ‘true KA’ 39 or ‘pure KA’. 40 The technique is straightforward and is facilitated using conventional mechanical instruments, 29 , 30 but there are several concerns. Firstly, the tibial cut is made based on tibial landmarks.…”

Section: Introductionmentioning

confidence: 99%

Current concept of kinematic alignment total knee arthroplasty and its derivatives

et al. 2022

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The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA , the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered ‘alignment outliers’ in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients’ own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients’ own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal.

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Section: Introductionmentioning

confidence: 99%

Current concept of kinematic alignment total knee arthroplasty and its derivatives

et al. 2022

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“…In that regard, posterior capsulotomy and distal femoral cuts are generally used to correct the flexion contracture in patients undergoing TKA. It was observed that posterior capsulotomy alone is not sufficient in many patients and it also may leave instability at 90 degrees of knee flexion 8,9. Due to this reason, in the treatment of flexion contracture in patients undergoing TKA, a distal femoral cut is of more interest.…”

Section: Discussionmentioning

confidence: 99%

“…It was observed that posterior capsulotomy alone is not sufficient in many patients and it also may leave instability at 90 degrees of knee flexion. 8,9 Due to this reason, in the treatment of flexion contracture in patients undergoing TKA, a distal femoral cut is of more interest. However, the allowed size of the distal femoral cut is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…7 Posterior capsulotomy has been found to be associated with an increased risk of genu recurvatum. 8,9 For this reason, many surgeons avoid performing posterior capsulotomy to correct flexion contracture in TKA.…”

Section: Introductionmentioning

confidence: 99%

“…Two options have been proposed to eliminate this flexion contracture, including the posterior capsulotomy and an additional resection of the distal femur 7. Posterior capsulotomy has been found to be associated with an increased risk of genu recurvatum 8,9. For this reason, many surgeons avoid performing posterior capsulotomy to correct flexion contracture in TKA.…”

Section: Introductionmentioning

confidence: 99%

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Up to 4 millimeters excessive distal femoral resection in total knee arthroplasty has no significant effect on patellar height and functional score in patient with severe flexion contracture: a retrospective study

Jabalameli

Yahyazadeh

Bagherifard

et al. 2022

Current Orthopaedic Practice

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Background:Excessive distal femoral resection in patients with severe preoperative flexion contracture has been previously attributed to the joint line elevation after performing total knee arthroplasty (TKA). In this study, the authors investigated the effects of excessive distal femoral cut on the patellar height as well as the outcome of TKA. Methods:This retrospective study included patients with severe flexion contracture ( > 30 degrees) who underwent TKA. They were divided into two groups according to the size of distal femoral cut: group A ( ≤ 9 mm, n = 27) and group B ( > 9 mm, n = 22). The functional and radiographic outcomes as well as radiographic indices of patellar height, including adductor ratio, Insall-Salvati index, Blackburne-Peel index, Caton-Deschamps index, and fibular height, were compared between these two study groups. Results:The baseline characteristics of the participants were comparable. The mean femoral cut was 8.3 ± 0.8 in group A and 12.6 ± 0.9 in group B. The mean changes of the adductor ratio, Insall-Salvati index, Caton-Deschamps index, Blackburne-Peel index, and fibular height were not significantly different between the two study groups. As well, the functional and radiographic outcomes of TKA were comparable. No revision surgery was required during the mean follow-up of 51.7 ± 32.4 mo. No genu recurvatum was recorded, and no patient complained of knee instability. Conclusions:An excessive distal femoral cut does not seem to change patellar height in TKA patients, so it could be used safely for patients with a severe preoperative flexion deformity.

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Intraoperative sensor technology quantifies inter-prosthesis pressure for predicting lower limb alignment after Oxford unicompartmental knee arthroplasty

Sun

Liu

et al. 2023

Front. Bioeng. Biotechnol.

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Purpose: The aim of this study is to quantify inter-prosthetic pressures at different knee angles in Oxford unicompartmental knee arthroplasty (OUKA) and its correlation with postoperative lower limb alignment.Methods: This study included 101 patients (122 knees) who underwent OUKA from March 2022 to July 2022. The previously designed matrix flexible force sensor was used to measure the inter-prosthesis pressure of different knee joint angles during the UKA operation, and the force variation trend and gap balance difference were obtained. The correlation between inter-prosthesis pressure and postoperative lower limb alignment index including hip-knee-ankle angle (HKAA) and posterior tibial slope (PTS) was analyzed. The effect of PTS change (ΔPTS) on the inter-prosthesis pressure and the range of motion (ROM) of the knee joint was analyzed. Radiographic and short-term clinical outcomes of included patients were assessed.Results: The inter-prosthesis pressure of the different knee joint angles during the operation was not consistent. The mean inter-prosthesis pressure and gap balance difference were 73.68.28 ± 41.65N and 36.48 ± 20.58N. The inter-prosthesis pressure at 0° and 20° was positively correlated with postoperative HKAA (p < 0.001). ΔPTS was positively correlated with the pressure at the end of knee extension and negatively correlated with the pressure at the end of knee flexion (p < 0.001). The HKAA, ROM, degree of fixed knee flexion deformity, and knee society score of the included patients were significantly improved compared with those before the operation (p < 0.001).Conclusion: The inter-prosthesis pressure measured at the knee extension position can predict postoperative HKAA to some degree. Changes in PTS will affect the inter-prosthesis pressure at the end of flexion and end of knee extension, but this change is not related to the range of motion of the knee joint.

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Kinematic Alignment – Management von Deformitäten und Flexionskontrakturen

Cited by 3 publications

References 17 publications

Current concept of kinematic alignment total knee arthroplasty and its derivatives

Current concept of kinematic alignment total knee arthroplasty and its derivatives

Up to 4 millimeters excessive distal femoral resection in total knee arthroplasty has no significant effect on patellar height and functional score in patient with severe flexion contracture: a retrospective study

Intraoperative sensor technology quantifies inter-prosthesis pressure for predicting lower limb alignment after Oxford unicompartmental knee arthroplasty

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