A Single Surgeon Series Comparing the Outcomes of a Cruciate Retaining and Medially Stabilized Total Knee Arthroplasty Using Kinematic Alignment Principles

Purpose The purpose of this study was to perform a systematic review and meta-analysis to compare clinical and patient-reported outcome measures of medially stabilised (MS) TKA when compared to other TKA designs. Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses algorithm was used. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and EMCARE databases were searched to June 2020. Studies with a minimum of 12 months of follow-up comparing an MS TKA design to any other TKA design were included. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. Results The 22 studies meeting the inclusion criteria included 3011 patients and 4102 TKAs. Overall Oxford Knee Scores were significantly better (p = 0.0007) for MS TKA, but there was no difference in the Forgotten Joint Scores (FJS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS)-Knee, KSS-Function, and range of motion between MS and non-MS TKA designs. Significant differences were noted for sub-group analyses; MS TKA showed significantly worse KSS-Knee (p = 0.02) and WOMAC (p = 0.03) scores when compared to Rotating Platform (RP) TKA while significantly better FJS (p = 0.002) and KSS-knee scores (p = 0.0001) when compared to cruciate-retaining (CR) TKA. Conclusion This review and meta-analysis show that MS TKA designs result in both patient and clinical outcomes that are comparable to non-MS implants. These results suggest implant design alone may not provide further improvement in patient outcome following TKA, surgeons must consider other factors, such as alignment to achieve superior outcomes. Level of evidence III.

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“…Subgroup analysis showed a significant improvement of FJS in MS TKA over CR TKA, however, this was based on a single study [16].…”

Section: Fjsmentioning

confidence: 83%

“…2). Three of the included studies reported a significant difference in favour of the MS implants over the comparator [16,17,41].…”

Section: Fjsmentioning

confidence: 98%

Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta-analysis of the current literature

Nisar

Ahmad

Pandit

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“…There has also been a recent prospective comparison study involving 103 patients who had either a cruciate-retaining TKR (CR-TKR) or a medially stabilized TKR (MS-TKR), in both groups the KA technique was used. 51 The study demonstrated a substantially better FJS with the MS-TKR at one year, but also showed that the KA principle was safe and effective using both CR and MS-TKR. 51 …”

Section: What Are the Clinical Outcomes Of Ka From The Literature?mentioning

confidence: 71%

“… 51 The study demonstrated a substantially better FJS with the MS-TKR at one year, but also showed that the KA principle was safe and effective using both CR and MS-TKR. 51 …”

Section: What Are the Clinical Outcomes Of Ka From The Literature?mentioning

confidence: 71%

Kinematic alignment in total knee arthroplasty

et al. 2020

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Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival. Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010

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“…7). [49][50][51][52] In medial compartment, the insert should have a near 1:1 ball-and-socket conformity to promote A-P stability like the native knee. In lateral compartment, the insert should be flat without a posterior rim to enable internal-external (I-E) rotation of the tibia on the femur like the native knee.…”

Section: Medial Stabilized Design Implanted With Kinematic Alignment Restores Higher Function and Offers Better Anterior Stability Than Amentioning

confidence: 99%

Kinematically Aligned Total Knee Arthroplasty with Patient-Specific Instrument

2020

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Kinematically aligned total knee arthroplasty (TKA) is a new alignment technique. Kinematic alignment corrects arthritic deformity to the patient's constitutional alignment in order to position the femoral and tibial components, as well as to restore the knee's natural tibial-femoral articular surface, alignment, and natural laxity. Kinematic knee motion moves around a single flexion-extension axis of the distal femur, passing through the center of cylindrically shaped posterior femoral condyles. Since it can be difficult to locate cylindrical axis with conventional instrument, patient-specific instrument (PSI) is used to align the kinematic axes. PSI was recently introduced as a new technology with the goal of improving the accuracy of operative technique, avoiding practical issues related to the complexity of navigation and robotic system, such as the costs and higher number of personnel required. There are several limitations to implement the kinematically aligned TKA with the implant for mechanical alignment. Therefore, it is important to design an implant with the optimal shape for restoring natural knee kinematics that might improve patient-reported satisfaction and function.

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A Single Surgeon Series Comparing the Outcomes of a Cruciate Retaining and Medially Stabilized Total Knee Arthroplasty Using Kinematic Alignment Principles

Cited by 39 publications

References 47 publications

Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta-analysis of the current literature

Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta-analysis of the current literature

Kinematic alignment in total knee arthroplasty

Kinematically Aligned Total Knee Arthroplasty with Patient-Specific Instrument

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