Kinematic TKA using navigation: Surgical technique and initial results

Hutt, Jonathan; LeBlanc, Marc-André; Massé, Vincent; Lavigne, Martin; Vendittoli, Pascal‐André

doi:10.1016/j.otsr.2015.11.010

Cited by 136 publications

(112 citation statements)

References 27 publications

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“…Early studies comparing MA and KA TKA have demonstrated either equivalent or better clinical outcomes for KA TKA [7][8][9][10][11][12]. This may be because KA TKA produces more neutral weight bearing positions and decreased knee adduction moment, a surrogate for medial tibiofemoral joint loading and thus implant durability when compared to MA TKA [13,14], or it may result from less disruption of the native soft tissue envelope [15][16][17]. The KA technique attempts to modify implant position in order to recreate the anatomy of the prearthritic articular surface for the individual patient.…”

Section: Introduction/purposementioning

confidence: 99%

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Twiggs²,

Leie

et al. 2019

The Knee

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Background: Kinematically aligned (KA) total knee arthroplasty (TKA) has emerged as an alternative approach to the intraoperative alignment targets of mechanically aligned (MA) TKA. While the clinical outcomes of the two philosophies have been investigated, further investigation is required to quantify exactly how the two philosophies differ in their approach to correcting the deformities encountered in osteoarthritic knees such as fixed flexion deformities (FFD) and coronal malalignment. The aim of this paper was to compare MA and KA philosophies in TKA in terms of the intra-operative correction of FFD and coronal malalignment and quantify the way in which each philosophy achieves a well-balanced knee that can reach full extension. Methods: A retrospective review of prospective data collected from 210 consecutive TKAs performed by a single surgeon between March 2015 and May 2017 was undertaken. MA and KA cases were compared in terms of pre-operative patient deformity and characteristics, intraoperative steps taken to correct FFD (including bony resections, soft tissue releases and components used) and postoperative alignment achieved. Results: One hundred twenty MA and 90 KA TKAs were analysed. There was no significant difference in terms of patient age, gender and preoperative coronal and sagittal deformity between the two cohorts. KA TKAs were able to achieve the same degree of sagittal correction as MA TKAs with less total bony resection (16.7 mm vs. 18.9 mm, p b 0.0001), less soft tissue releases (10% vs. 49.2%, p b 0.0001). This was achieved with a difference in component alignment. The femur was in more valgus (−2.5 vs. −0.03°, p b 0.0001), the tibia in more varus (2.3 vs. 0.3°, p b 0.0001), and the overall alignment slightly more varus in the KA group (1.1 vs. 0.4°, p = 0.007), without significant difference in the proportion of patients within three degrees of a neutral axis. Conclusion: This study shows that using a kinematic alignment philosophy in total knee arthroplasty results in the achievement of extension range-of-motion and soft tissue balance goals with less bone resection and less soft tissue release. This allows for bone stock preservation and minimization of trauma due to soft tissue release. Further study is required to correlate these results with patient reported outcomes and determine their clinical significance. Level of evidence: IIIretrospective cohort study.

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Section: Introduction/purposementioning

confidence: 99%

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Twiggs²,

Leie

et al. 2019

The Knee

View full text Add to dashboard Cite

show abstract

“…Femoral external rotation was set at 3° to the femoral posterior condyles. With regarding to the KA-TKA, a restricted KA protocol described by Hutt et al [9] was conducted in our institution. The HKA angles were limited for the KA-TKA from 6° varus to 3° valgus.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…The main outcome was Knee Society Score (KSS) 2011 [10], including symptom (0-25), satisfaction (0-40), expectation (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) and functional activities (0-100) at the 1-year followup. Secondary outcomes included the range of motion (ROM) and HKA angle.…”

Section: Surgical Techniquesmentioning

confidence: 99%

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

Luan

Chen

et al. 2020

Preprint

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Background Making decision in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). Methods We reviewed 296 patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a portable navigation system from 2016 to 2018 in our prospectively maintained database. The minimum followup was 1 year. Clinical outcomes including range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS. Results ROM and KSS at the 1-year followup didn’t differ between MA-TKAs and KA-TKAs (all p>0.05). Alignment techniques did not associate with postoperative ROM (Adjusted β=0.4, 95% confidence interval [CI]: -0.3, 1.6; p=0.752) or 1-year KSS (Adjusted β=2.2, 95%CI: -0.7, 5.6; p=0.107). Patients with BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction<0.05), Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction<0.05). Conclusions Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

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“…Femoral external rotation was set at 3° to the femoral posterior condyles. With regard to the KA-TKA, a modi ed KA protocol described by Hutt et al [9] was conducted in our institution. The bone cut was modi ed from patient anatomy, which was conducted as planned using the portable navigation system.…”

Section: Surgical Techniquesmentioning

confidence: 99%

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

Luan

Chen

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background Making decisions in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). Methods We reviewed 296 consecutive patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a computer-assisted navigation from 2016 to 2018 in our prospectively maintained database. The minimum followup was one year. Clinical outcomes including the range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS.Results ROM and KSS at the 1-year followup didn't differ between MA-TKAs and KA-TKAs (all p>0.05). Alignment techniques did not associate with postoperative ROM (Adjusted β=0.4, 95% confidence interval [CI]: -0.3, 1.6; p=0.752) or 1-year KSS (Adjusted β=2.2, 95%CI: -0.7, 5.6; p=0.107). Patients with a BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction<0.05). Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction<0.05).Conclusions Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

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Kinematic TKA using navigation: Surgical technique and initial results

Abstract: IV (retrospective case series review).

Cited by 136 publications

References 27 publications

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

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