Anatomical versus mechanical joint reconstruction: time to pick your surgical philosophy!

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

doi:10.1007/s00167-022-07013-3

Cited by 4 publications

(6 citation statements)

References 21 publications

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“…A secondary finding was that medial deviation occurred after MA TKA, though the frequency was significantly less than unKA TKA. 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][23][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: 90%

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.

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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.

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Section: Discussionsupporting

confidence: 90%

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.

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“…Whilst implants’ longevity has been shown to be good, the prosthetic joint perception often remains disappointing with ~ 50% residual knee symptoms and ~ 15% of patients being dissatisfied [2]. Due to the suspicion that poor prosthetic joint perception could be related to the systematic alteration of the native knee physiology (anatomy, laxity and biomechanics) that is unique to each individual [1, 4], the MA technique was recently challenged and new alignment techniques for TKA have been developed [5, 7].…”

Section: Figmentioning

confidence: 99%

“…The Kinematic alignment (KA) technique for TKA is one of these aforementioned methods, which aims to minimise alteration of the native knee’s anatomy (or contours), laxity, and kinematics, thus preserving the unique physiology of the individual knee [7, 8]. Since its introduction in 2007, surgeons performing KA TKAs have focussed on restoring the femorotibial joint architecture, whilst continuing to reconstruct the patellofemoral compartment in a systematic rather non anatomical way [3].…”

Section: Figmentioning

confidence: 99%

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

Rivière

Villet

Roby

2023

Knee Surg Sports Traumatol Arthrosc

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“…In contrast, KA seeks to replicate the native knee anatomy and geometry, accommodating the inherent varus angulation of the proximal tibial plateau [31]. Consensus regarding the superior alignment approach for arthroplasty function and outcomes remains elusive [32]. While MA promotes knee flexion and uniform component wear, it imposes an unnatural limb position that alters knee biomechanics [31].…”

Section: Overview Of the Divide Between The Mechanical And Anatomical...mentioning

confidence: 99%

Navigating the Divide: A Comprehensive Review of the Mechanical and Anatomical Axis Approaches in Total Knee Replacement

Suneja,

Deshpande,

Pisulkar

et al. 2024

Cureus

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This comprehensive review explores the mechanical and anatomical axis approaches in total knee replacement (TKR) surgery, addressing the ongoing debate within the orthopedic community. Emphasizing the significance of TKR in alleviating knee-related disorders, this review underscores the pivotal role of accurate alignment in achieving optimal surgical outcomes. The purpose is to navigate the divide between the well-established mechanical axis approach, focusing on a straight-line alignment, and the anatomical axis approach, aligning with natural knee landmarks. The analysis delves into the advantages, disadvantages, and clinical implications of each approach, offering a nuanced perspective on their efficacy. The conclusion emphasizes a patient-centric approach, recommending the adoption of hybrid strategies and the incorporation of emerging technologies for enhanced precision. The future of TKR aligns with personalized medicine, leveraging advancements in computer-assisted navigation, robotics, and patientspecific implants. Ongoing professional development and interdisciplinary collaboration are crucial for surgeons, and as the field evolves, innovations in artificial intelligence, imaging, and 3D printing are expected to shape the trajectory of TKR alignment approaches.

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Anatomical versus mechanical joint reconstruction: time to pick your surgical philosophy!

Cited by 4 publications

References 21 publications

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

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

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

Navigating the Divide: A Comprehensive Review of the Mechanical and Anatomical Axis Approaches in Total Knee Replacement

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