Restricted Kinematic Alignment in Total Knee Arthroplasty: Scientific Exploration Involving Detailed Planning, Precise execution, and Knowledge of When to Abort

MacDessi, Samuel J.

doi:10.1016/j.artd.2021.05.024

Cited by 15 publications

(10 citation statements)

References 26 publications

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“…Implant position outside following thresholds were defined as unsafe and are based on previous literature and guidelines [ 9 , 16 ]. Limit for femoral flexion was 10° and femur coronal positioning great between 6° valgus and 3° varus.…”

Section: Methodsmentioning

confidence: 99%

Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology

Shatrov

Coulin

Batailler

et al. 2022

International Orthopaedics (SICOT)

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Purpose The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove. Methods One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial–lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°–40°) and deep flexion (70°–80°). Results Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion. Conclusion Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.

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Section: Methodsmentioning

confidence: 99%

Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology

Shatrov

Coulin

Batailler

et al. 2022

International Orthopaedics (SICOT)

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“…This technique can then be used to set distal femoral and proximal tibial resections to restore each patient’s unique limb alignment [31, 38, 39]. Although preoperative stress radiographs have demonstrated utility in defining the constitutional alignment and need for soft tissue releases intraoperatively [20, 27, 46], it is unknown whether the intraoperative sHKA method correlates with the aHKA.…”

Section: Introductionmentioning

confidence: 99%

Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty

Tarassoli

Wood

Chen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Kinematically aligned total knee arthroplasty (KA TKA) relies on precise determination of constitutional alignment to set resection targets. The arithmetic hip-knee-ankle angle (aHKA) is a radiographic method to estimate constitutional alignment following onset of arthritis. Intraoperatively, constitutional alignment may also be approximated using navigation-based angular measurements of deformity correction, termed the stressed HKA (sHKA). This study aimed to investigate the relationship between these methods of estimating constitutional alignment to better understand their utility in KA TKA. Methods A radiological and intraoperative computer-assisted navigation study was undertaken comparing measurements of the aHKA using radiographs and computed tomography (CT-aHKA) to the sHKA in 88 TKAs meeting the inclusion criteria. The primary outcome was the difference in the paired means between the three methods to determine constitutional alignment (aHKA, CT-aHKA, sHKA). Secondary outcomes included testing agreement across measurements using Bland-Altman plots and analysis of subgroup differences based on different patterns of compartmental arthritis. Results There were no statistically significant differences between any paired comparison or across groups (aHKA vs. sHKA: 0.1°, p = 0.817; aHKA vs. CT-aHKA: 0.3°, p = 0.643; CT-aHKA vs. sHKA: 0.2°, p = 0.722; ANOVA, p = 0.845). Bland-Altman plots were consistent with good agreement for all comparisons, with approximately 95% of values within limits of agreement. There was no difference in the three paired comparisons (aHKA, CT-aHKA, and sHKA) for knees with medial compartment arthritis. However, these findings were not replicated in knees with lateral compartment arthritis. Conclusions There was no significant difference between the arithmetic HKA (whether obtained using CT or radiographs) and the stressed HKA in this analysis. These findings further validate the preoperative arithmetic method and support use of the intraoperative stressed HKA as techniques to restore constitutional lower limb alignment in KA TKA. Level of evidence III.

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“…This is based on the observation that the postererior condylar axis is 3.5° to 0.3° IR to the TEA in a normal population [ 16 ]. This is also a limitation set out by the Food and Drug administration [ 17 ], and 85% of the normal population falls within this limitation [ 18 ]. Tibial rotation malrotation is also not well defined, with variations in definitions and thresholds.…”

Section: Methodsmentioning

confidence: 99%

Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

et al. 2022

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Restricted Kinematic Alignment in Total Knee Arthroplasty: Scientific Exploration Involving Detailed Planning, Precise execution, and Knowledge of When to Abort

Cited by 15 publications

References 26 publications

Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology

Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology

Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty

Can Patella Instability After Total Knee Arthroplasty be Treated With Medial Patellofemoral Ligament Reconstruction?

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