Kinematically aligned total knee arthroplasty reproduces more native rollback and laxity than mechanically aligned total knee arthroplasty: A matched pair cadaveric study

Koh, In Jun; Lin, Charles C.; Patel, Nilay A.; Chalmers, Christen E.; Maniglio, Mauro; Han, Sung Bin; McGarry, Michelle H.; Lee, Thay Q.

doi:10.1016/j.otsr.2019.03.011

Cited by 31 publications

(34 citation statements)

References 44 publications

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“…The results of this study imply that MA-TKA alone may not be the sole cause of kinematic abnormalities observed when using this surgical technique, even though previous studies speculated that MA may be directly related to patient dissatisfaction ( Nam et al, 2014 ; Delport et al, 2015 ; Ishikawa et al, 2015 ; Hutt et al,2016a,b ; Theodore et al, 2017 ; Vendittoli and Blakeney, 2017 ; Blakeney et al, 2019 ; Koh et al, 2019a ; Maderbacher et al, 2019 ). The better clinical outcomes following KA-TKA may be related to other factors, such as less soft tissue release ( An et al, 2019 ).…”

Section: Discussionmentioning

confidence: 53%

“…An alternative technique, kinematic alignment (KA), was introduced by Howell et al (2008) to restore the anatomical shape of the tibio-femoral articulation ( Konan et al, 2015 ). Kinematically aligned total knee arthroplasty (KA-TKA) has been shown to better restore knee kinematics than MA-TKA under in vivo radiological assessment ( Howell et al, 2013 ), gait analysis ( Blakeney et al, 2019 ), cadaveric studies ( Keshmiri et al, 2019 ; Koh et al, 2019a ,b; Maderbacher et al, 2019 ) and computer simulations ( Ishikawa et al, 2015 ; Theodore et al, 2017 ). However, it is implausible that “near normal” knee kinematics can be achieved by only restoring the anatomical morphology of the tibiofemoral joint ( Ishikawa et al, 2015 ), especially without the constraints of the anterior cruciate ligament (ACL) and menisci following KA-TKA ( Blunn et al, 1991 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities

Wang

Liang

Luan

et al. 2021

Front. Bioeng. Biotechnol.

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Kinematically aligned total knee replacements have been shown to better restore physiological kinematics than mechanical alignment and also offer good postoperative satisfaction. The purpose of this study is to evaluate the extent to which an inclined joint line in a kinematically aligned knee can alter the postoperative kinematics. A multi-body dynamic simulation was used to identify kinematic changes in the joint. To accurately compare mechanical alignment, kinematic alignment and a natural knee, a “standard” patient with neutral alignment of the lower extremities was selected for modeling from a joint database. The arthroplasty models in this study were implanted with a single conventional cruciate-retaining prosthesis. Each model was subjected to a flexion movement and the anteroposterior translation of the femoral condyles was collected for kinematic analysis. The results showed that the mechanical alignment model underwent typical paradoxical anterior translation of the femoral condyles. Incorporating an inclined joint line in the model did not prevent the paradoxical anterior translation, but a 3° varus joint line in the kinematic alignment model could reduce the peak value of this motion by about 1 mm. Moreover, the inclined joint line did not restore the motion curve back to within the range of the kinematic curve of the natural knee. The results of this study suggest that an inclined joint line, as in the kinematic alignment model, can slightly suppress paradoxical anterior translation of the femoral condyles, but cannot restore kinematic motions similar to the physiological knee. This finding implies that prostheses intended to be used for kinematic alignment should be designed to optimize knee kinematics with the intention of restoring a physiological motion curve.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities

Wang

Liang

Luan

et al. 2021

Front. Bioeng. Biotechnol.

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“…An interesting study has shown the influence of the prosthesis on the rollback [ 19 ]. Restoring the rollback as it was before the operation leads to better postoperative results and ensures that the prosthesis does not impair the overall mobility of the knee [ 18 ]. These studies by the same author prove that, on a computerized model, regardless of the surgical technique, the rollback is reduced after TKA.…”

Section: Introductionmentioning

confidence: 99%

A patient-specific 3D model of the knee to compare the femoral rollback before and after total knee arthroplasty (TKA)

et al. 2021

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Purpose Total knee arthroplasty (TKA) is nowadays performed as a standard procedure on a large number of patients suffering from arthrosis. Replacing the knee joint causes changes in the geometry and kinematics of the knee, which are unique to each individual. This research focuses on the method to detect these changes after TKA and on the impact on the knee movement. This approach could reduce complications in patients with post-operative pain and reduce the number of revisions. Methods A 3D model of a patient’s knee was made by measuring the movement with a medically certified infrared stereo camera. This measurement was combined with the 3D model of the patient’s bones, previously segmented from the CT scan. This model is printed in 3D, one part being the mechanism that follows the movement of the patient, and the other part being the 3D copy of the femur and tibia bones. The knee replacement operation is performed directly on the model and the resulting rollback is being measured before and after TKA. Results We observe a difference in the rollback before and after TKA on the 3D printed model. The variation in size and shape of the femoral implant compared to the natural femur condyles is one of the reasons for the changes in the rollback effect. The rollback is half as large after the prosthesis insertion, which confirms the fact that the femoral prosthesis geometry influences the knee kinematics. Conclusions In this study, a first 3D model combining the patient-specific kinematic and the geometry of his bones has been constructed. This model allows the surgeon to validate the plan of the operation, but also to understand the problems and consequences generated by the prosthesis insertion. The rollback is one of the most important motion of the knee joint and this behavior could be quantified, providing comparative analysis of the knee joint before and after the operation. As a future study, the model could be used to analyse more parameters of the TKA such as the impact of different implantation methods.

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“…It has been generally believed in academic circles that the position of the knee joint rotation axis relative to the femur shifts with the change of the exion angle of the knee joint, and the motion trajectory is J-shaped [2,8,12,18]. In addition, the concept of femoral rollback has been widely recognized for a long time and is commonly described in current literature reports [7,11,14,25,27].…”

Section: Introductionmentioning

confidence: 99%

Knee Joint Rotation Axis Is More Laterally Rotated and Valgus Than We Previously Thought

Zheng

Song

Luo

et al. 2021

Preprint

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Background: Currently, the patient satisfaction rate after receiving TKA is around 80% to 90% and there is still room for further improvement. With the aim to provide reference for improving TKA surgery, stereophotogrammetry was used in this study to evaluate knee joint kinematics.Methods: Multiple MRI images of knee joints flexed at 0, 10, 20... to 100 degrees were scanned in bilateral knees of 45 asymptomatic adult volunteers. After three-dimensional alignment of the femur, the displacement and rotation angles of the tibia flexed at different angles were measured. Contributing factors were tested using One-way ANOVA and chi-square test in SPSS 24.Results: 1)No contributing factors was found to influence rotation axis; 2) Within the range of motion at 0-100° of flexion, the rotation axis exhibited no significant displacement relative to the femur. 3) On the horizontal plane, the lateral rotation angle of knee joint axis was 4.91°±1.84°(3°~7°) relative to transepicondylar axis (TEA) and 7.84°±2.09° relative to posterior condylar axis (PCA); on the coronal plane, the valgus angle of knee joint axis was 3.38°±0.82°(2.5°~5°) relative to tibial plateau, and 6.53°±0.91°(5°~8°) relative to the perpendicular line of the lower limb force line. Conclusion: No contributing factors were found, but the rotation axis of the knee joint is more laterally rotated and valgus than previously thought. These findings may explain the research result of some current literatures, and may provide theoretical rationale for further improvement of knee prosthesis design.

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Kinematically aligned total knee arthroplasty reproduces more native rollback and laxity than mechanically aligned total knee arthroplasty: A matched pair cadaveric study

Cited by 31 publications

References 44 publications

Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities

Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities

A patient-specific 3D model of the knee to compare the femoral rollback before and after total knee arthroplasty (TKA)

Knee Joint Rotation Axis Is More Laterally Rotated and Valgus Than We Previously Thought

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