The dissatisfied total knee arthroplasty patient. New technologies-the white knight in shining armor coming to their rescue?

Thienpont, Emmanuel; Klasan, Antonio

doi:10.1007/s00402-021-04218-y

Cited by 7 publications

(4 citation statements)

References 27 publications

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“…Regarding the tibia, the important tenet of reconstruction is to produce volumetric replacement while replicating the native varus joint line and the native tibial slope to allow the collateral ligaments to stabilize the knee throughout the arc of motion in the absence of a central pivot 75 . Current off-the-shelf implants do not match the coronal oblique tibial joint line.…”

Section: Current Issuesmentioning

confidence: 99%

The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty

2022

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Total knee arthroplasty (TKA) is an effective treatment option for many patients, but a small group of patients are dissatisfied following TKA.» Alignment, in combination with balance, stability, and knee kinematics, is an important modifiable surgical factor that can affect patient outcomes. » Driven by the subset of dissatisfied patients after TKA, new techniques have evolved in the search for a more anatomic reconstruction of individual knee morphology and a more accurate approximation of the individual lower-extremity alignment.» There is a need to optimize 3 aspects of TKA to improve patient outcomes-mechanical tooling processes, implants that resurface the epiphysis, and techniques that respect the variable anatomy of patients.

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Section: Current Issuesmentioning

confidence: 99%

The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty

2022

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“…The hypothesis was refuted. Robotic systems allow a better understanding of the anatomy and allow the application of personalised alignment strategies in the hope of achieving better results [37]. Currently, however, the evidence of improved outcomes using robotics is scarce [19,22,33].…”

Section: Discussionmentioning

confidence: 99%

The effect of different alignment strategies on trochlear orientation after total knee arthroplasty

Klasan,

Anelli‐Monti,

Putnis

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeWhen planning and delivering total knee arthroplasty (TKA), there are multiple coronal alignment strategies such as functional alignment (FA), kinematic alignment (KA), mechanical and adjusted mechanical alignment (MA, aMA). Recent three‐dimensional and robotic‐assisted surgery (RAS) studies have demonstrated that KA potentially better restores the trochlear anatomy than MA. The purpose of this study was to compare the restoration of the native trochlear orientation in patients undergoing RAS TKA using four different alignment strategies. It was hypothesised that FA would result in the lowest number of outliers.MethodsThis is a prospective study of 200 patients undergoing RAS‐TKA with a single implant. All patients were analysed for MA and KA prebalancing, and 157 patients received aMA and 43 patients FA with intraoperative balancing. Preoperative transverse computed tomography scans were used to determine the posterior condylar axis (PCA), lateral trochlear inclination (LTI) angle, sulcus angle (SA) and anterior trochlear line (ATL) angle. Implant measurements were obtained using a photographic analysis. Intraoperative software data combined with implant data and preoperative measurements were used to calculate the differences. Outliers were defined as ≥3° of alteration. Trochlea dysplasia was defined as LTI < 12°.ResultsNative transepicondylar PCA had a median of 2°, LTI 18°, SA 137°, ATL 4°. LTI outliers were observed in 47%–60% of cases, with KA < FA < aMA < MA. For ATL, the range of outliers was 40.5%–85%, KA < FA < aMA < MA. SA produced 81% of outliers. Of all median angle values, only LTI when using KA was not significantly altered compared to the native knee.ConclusionThere is a significant alteration of trochlear orientation after TKA, regardless of the alignment strategy used. KA produced the lowest, but a substantial, number of outliers. The uniform design of implants causes the surgeon to compromise on balance in flexion versus trochlear position. The clinical relevance of this compromise requires further clinical investigations.Level of EvidenceLevel II, prospective cohort study.

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“…The persistence of dissatisfaction rates among patients undergoing total knee arthroplasty (TKA) despite numerous advancements in orthopedics has prompted a reevaluation of the conventional mechanical alignment paradigm [1][2][3][4]. Recent inquiries into refining outcomes have challenged the long-standing gold standard of mechanical alignment in knee surgeries [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Only 26% of Native Knees Show an Identical Coronal Functional Knee Phenotype in the Contralateral Knee

Sava,

Leica,

Amsler

et al. 2024

JPM

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Background: A comprehensive exploration evaluating left-to-right knee symmetry across all anatomical planes utilizing three-dimensional (3D) scans stands absent from the existing body of research. Therefore, the primary objectives of this investigation involved examining potential differences and resemblances in alignment and structure between left and right non-osteoarthritic (native) knees in various planes (coronal, sagittal, and axial) using three-dimensional single-photon emission computed tomography/computed tomography (SPECT/CT) images. Methods: A total of 282 native knees from 141 patients were retrospectively gathered from the hospital’s records. Patients, aged between 16 and 45, who underwent Tc99m-methyl diphosphonate SPECT/CT scans for both knees, adhering to the Imperial Knee Protocol, were included. A statistical analysis was conducted, including 23 knee morphometric parameters, comparing left and right knees, and classifying them based on functional knee phenotypes across the coronal, sagittal, and axial planes. Results: Regarding the functional coronal knee phenotype, 26% of patients (n = 37) exhibited identical phenotypes in both knees (p < 0.001). Significant correlated similarities between the left and right knees were observed in the coronal plane (Pearson’s r = 0.76, 0.68, 0.76, 0.76, p < 0.001) and in several morphometric measures in the sagittal plane (Pearson’s r = 0.92, 0.72, 0.64, p < 0.001). Moderately correlated similarities were noted in the axial plane (Pearson’s r = 0.43, 0.44, 0.43, p < 0.001). Conclusions: Only 26% of native knees exhibit an identical coronal phenotype in their contralateral knee, whereas 67% have the adjacent coronal phenotype. Strongly correlated resemblances were established across various left and right knee morphometric parameters in the coronal, sagittal, and axial planes. These findings could enhance decisions in procedures like total knee arthroplasties or osteotomies, where alignment is key to outcomes, and reveal a potential for future artificial intelligence-driven models to improve our understanding and improve personalized treatment strategies for knee osteoarthritis.

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The dissatisfied total knee arthroplasty patient. New technologies-the white knight in shining armor coming to their rescue?

Cited by 7 publications

References 27 publications

The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty

The Role of Stability and Alignment in Improving Patient Outcomes After Total Knee Arthroplasty

The effect of different alignment strategies on trochlear orientation after total knee arthroplasty

Only 26% of Native Knees Show an Identical Coronal Functional Knee Phenotype in the Contralateral Knee

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