The Kinematic Alignment Technique for Total Knee Arthroplasty

Rivière, Charles; Harman, Ciara; Boughton, Oliver; Cobb, Justin

doi:10.1007/978-3-030-24243-5_16

Cited by 13 publications

(18 citation statements)

References 60 publications

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“…Intraoperative gap can be helpful for bone defect compensation. 22 The calipered technique is categorized as unrestricted KA-TKA, as neither whole-leg nor component alignment is considered to decide the cutting surface. There is increasing evidence of mid-to long-term survival, and improved clinical outcome and satisfaction, compared with MA-TKA.…”

Section: Figmentioning

confidence: 99%

“…Similarly, patients with excessive alignment or obvious intraor extra-articular deformities might be out of the range of the unrestricted KA. 22 The restricted KA might therefore be a safe and a promising procedure and there have been reports of satisfactory short-to-midterm clinical results. 17,75 Soft-tissue release is sometimes necessary, however, and it can induce a deterioration of the soft-tissue envelope and a dissimilar restoration of the kinematics.…”

Section: Soft-tissue Respecting Techniquementioning

confidence: 99%

“…79 An improved component that works well with the KA-TKA technique might be helpful. 22 What is 'alignment' in KA? 'Kinematic alignment' originally referred to the approach that aimed to follow three kinematic axes.…”

Section: Soft-tissue Respecting Techniquementioning

confidence: 99%

“…The goal is eventually different between patients, so it is considered to be a personalized, individualized, or patient-specific approach. 15,22,23 This approach has received a great deal of attention in recent years, and many surgeons have reported good short-term and medium-term clinical results. [24][25][26][27][28] With the spread of KA-TKA, several derivatives with different modifications have been proposed, which has led to some confusion.…”

Section: Introductionmentioning

confidence: 99%

“…In KA-TKA, components are set respecting three kinematic axes: the cylindrical axis (CA), or condylar axis, is the axis between the centres of the estimated circle of medial and lateral condyles. 22 The femur rotates around the CA. The patellar axis is parallel to the CA and located anterior and Fig.…”

Section: Introductionmentioning

confidence: 99%

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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: Figmentioning

confidence: 99%

Section: Soft-tissue Respecting Techniquementioning

confidence: 99%

Section: Soft-tissue Respecting Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current concept of kinematic alignment total knee arthroplasty and its derivatives

et al. 2022

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A safe transition to a more personalized alignment in total knee arthroplasty: the importance of a “safe zone” concept

Eisenhart-Rothe

Lustig

Graichen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques

Tuecking

Savov

Zander

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose A key part of kinematic alignment (KA) and functional alignment (FA) is to restore the natural femoral joint line, in particular the medial joint line. KA is known to reproduce the femoral joint line accurately; however, direct comparisons with other surgical techniques such as FA are currently lacking. The purpose of this study was to evaluate diferences of alignment parameters in KA and FA techniques with a special focus given to the femoral joint line. Methods We performed a retrospective radiological analysis of pre-and postoperative long leg radiographs of 221 consecutive patients with varus or neutral leg alignment, who underwent primary total knee arthroplasty (TKA) procedures from 2018 to 2020. Patients were assigned to one of four groups: (1) FA: image-based robotic-assisted TKA, (2) FA: imageless robotic-assisted TKA, (3): restricted KA: 3D cutting block-assisted (patient-speciic instruments, PSI) TKA, (4): unrestricted KA: calipered technique. Patients' radiographs were (re)-analyzed for overall limb alignment, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), as well as medial and lateral femoral joint line alteration. Statistical signiicance was determined using unpaired t testing (FA vs. KA group) and one-way ANOVA (subgroup analyses). Results Comparisons of KA vs. FA, as well as individual subgroups of KA and FA did not show any diferences in the accuracy of medial joint line reconstruction (< 2 mm, p = 0.384, p = 0.744, respectively) and LDFA alteration (< 2°, p = 0.997, 0.921, respectively). Correction of MPTA (3.4° vs. 2.2°) and lateral femoral joint line (2.1 mm vs. 1.5 mm) was higher for FA and FA subgroups compared to KA and KA subgroups (both p < 0.001). Conclusion Kinematic and functional alignments showed a comparable accuracy in reconstruction of the medial femoral joint line and femoral joint line orientation. Increased correction of MPTA and lateral femoral joint line was recorded with FA techniques. Level of evidence III.

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The Kinematic Alignment Technique for Total Knee Arthroplasty

Cited by 13 publications

References 60 publications

Current concept of kinematic alignment total knee arthroplasty and its derivatives

Current concept of kinematic alignment total knee arthroplasty and its derivatives

A safe transition to a more personalized alignment in total knee arthroplasty: the importance of a “safe zone” concept

Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques

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