Anatomical restoration of the anterior femoral compartment when performing KATKA: the end of the flush anterior femoral cut dogma!

Rivière, Charles; Villet, Loïc; Roby, Gabriel Bouchard

doi:10.1007/s00167-023-07405-z

Cited by 3 publications

(1 citation statement)

References 9 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous reports of 3‐D analysis of the difference between the femoral component positioned with unKA and the native trochlea have generally confirmed the present study's findings that a femoral component with a PTA of 6° valgus positioned with unKA does not restore the native trochlea in all patients [14, 15, 22–24]. One explanation, according to a CT analysis of 4116 knees, is that the angle formed by the native trochlear angle (i.e., sulcus) and distal femoral joint line varies widely from 24° varus to 30° valgus, which suggests that existing arthroplasty components and techniques may not replicate the anatomy of morphologic outliers and could lead to dissatisfaction [9, 21, 24, 26].…”

Section: Discussionsupporting

confidence: 87%

Better forgotten joint scores when the angle of the prosthetic trochlea is lateral to the quadriceps vector in kinematically aligned total knee arthroplasty

Howell,

Sappey‐Marinier,

Niesen

et al. 2023

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeThe primary aim was to analyze unrestricted kinematic alignment (unKA) total knee arthroplasty (TKA) and determine the frequency of medial deviation of the prosthetic trochlear angle (PTA) of the femoral component relative to the quadriceps vector (QV) that terminates at the anterior inferior iliac spine (AIIS), and whether patients with medial deviation had a worse Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) relative to those with lateral deviation. The secondary aim was to determine the frequency of medial deviation for mechanical alignment (MA) TKA simulations. Methods From a database of a single surgeon, the study extracted de-identified data on 147 patients with a CT scanogram showing the pelvis and AIIS, a limb with an unKA TKA, and a native (i.e., healthy) opposite limb. On the scanogram, an examiner, blinded to the PROMs, measured the PTA-QV angle on the unKA TKA and on the opposite limb simulated MA TKA by drawing the PTA at 6° valgus relative to the femoral mechanical axis and measuring the PTA-QV angle. Results Medial deviation of the PTA occurred in 86% of patients with unKA TKA, and the 126 with medial deviation had a 17/1 point worse median FJS/OKS than the 21 with lateral deviation at a mean follow-up of 47 ± 8 months, respectively (p < 0.0001, p = 0.0053). In addition, 21%, 17%, and 8% of MA TKA had medial deviation after radiographic simulation using reported surgical errors for manual, patient-specific, and robotic instrumentation, respectively. Conclusion In most patients with unKA TKA and a smaller proportion with MA TKA, a PTA of 6° valgus was medial to the QV, which, by excluding the patient's Q-angle, might alter patellofemoral kinematics like an incorrectly oriented trochleoplasty. The 17-point worse FJS in the patients with an unKA TKA and medial deviation of the PTA suggests the surgical target should be to orient the PTA lateral to the QV. Level of evidence IV.

show abstract