Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Yoon, Joonsung; Shin, Yang Sik

doi:10.1016/j.arthro.2017.08.129

Cited by 14 publications

(22 citation statements)

References 25 publications

(28 reference statements)

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“…KA TKA has been shown to be a viable alternative to MA TKA, with equivalent if not slightly better outcomes published in the literature overall. Specifically, KA TKA has been shown to result in better functional outcomes and shorter operative times compared to MA TKA [15,31]. The results of our study add to this body of work, showing that KA TKA is able to correct sagittal deformities with less bony resection and soft tissue releases to achieve the same amount of correction to full extension compared to MA TKA.…”

Section: Discussionsupporting

confidence: 52%

“…A lower requirement for bony resection would suggest a minimised need for distal femoral re-cuts required to achieve full extension, which, although not statistically significant, was indeed the case in this study. This combined with the avoidance of soft tissue releases to balance the knee may have resulted in the decreased intraoperative time, which was not studied in this paper but has previously been demonstrated in the literature [15].…”

Section: Pre-operative Laxity (Degrees Sd In Brackets)mentioning

confidence: 79%

“…Early studies comparing MA and KA TKA have demonstrated either equivalent or better clinical outcomes for KA TKA [7][8][9][10][11][12]. This may be because KA TKA produces more neutral weight bearing positions and decreased knee adduction moment, a surrogate for medial tibiofemoral joint loading and thus implant durability when compared to MA TKA [13,14], or it may result from less disruption of the native soft tissue envelope [15][16][17]. The KA technique attempts to modify implant position in order to recreate the anatomy of the prearthritic articular surface for the individual patient.…”

Section: Introduction/purposementioning

confidence: 99%

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Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Twiggs²,

Leie

et al. 2019

The Knee

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Background: Kinematically aligned (KA) total knee arthroplasty (TKA) has emerged as an alternative approach to the intraoperative alignment targets of mechanically aligned (MA) TKA. While the clinical outcomes of the two philosophies have been investigated, further investigation is required to quantify exactly how the two philosophies differ in their approach to correcting the deformities encountered in osteoarthritic knees such as fixed flexion deformities (FFD) and coronal malalignment. The aim of this paper was to compare MA and KA philosophies in TKA in terms of the intra-operative correction of FFD and coronal malalignment and quantify the way in which each philosophy achieves a well-balanced knee that can reach full extension. Methods: A retrospective review of prospective data collected from 210 consecutive TKAs performed by a single surgeon between March 2015 and May 2017 was undertaken. MA and KA cases were compared in terms of pre-operative patient deformity and characteristics, intraoperative steps taken to correct FFD (including bony resections, soft tissue releases and components used) and postoperative alignment achieved. Results: One hundred twenty MA and 90 KA TKAs were analysed. There was no significant difference in terms of patient age, gender and preoperative coronal and sagittal deformity between the two cohorts. KA TKAs were able to achieve the same degree of sagittal correction as MA TKAs with less total bony resection (16.7 mm vs. 18.9 mm, p b 0.0001), less soft tissue releases (10% vs. 49.2%, p b 0.0001). This was achieved with a difference in component alignment. The femur was in more valgus (−2.5 vs. −0.03°, p b 0.0001), the tibia in more varus (2.3 vs. 0.3°, p b 0.0001), and the overall alignment slightly more varus in the KA group (1.1 vs. 0.4°, p = 0.007), without significant difference in the proportion of patients within three degrees of a neutral axis. Conclusion: This study shows that using a kinematic alignment philosophy in total knee arthroplasty results in the achievement of extension range-of-motion and soft tissue balance goals with less bone resection and less soft tissue release. This allows for bone stock preservation and minimization of trauma due to soft tissue release. Further study is required to correlate these results with patient reported outcomes and determine their clinical significance. Level of evidence: IIIretrospective cohort study.

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Section: Discussionsupporting

confidence: 52%

Section: Pre-operative Laxity (Degrees Sd In Brackets)mentioning

confidence: 79%

Section: Introduction/purposementioning

confidence: 99%

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Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Twiggs²,

Leie

et al. 2019

The Knee

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“…[3][4][5][6] Metaanalyses comparing kinematically and mechanically aligned TKA judged that the functional outcome, as measured with the Knee Society score (KSS), favored kinematically aligned TKA in a short-term follow-up period. [7][8][9] Implantation of classic mechanical alignment is aligning the femoral and tibial component perpendicular to the mechanical axis. In kinematic alignment, however, the principles are coaligning the transverse axis of the best-fitting femoral component with the primary transverse axis in the femur and placing the tibial component, so that the longitudinal axis of the tibia is perpendicular to the transverse axis in the femur.…”

mentioning

confidence: 99%

Intraoperative Soft Tissue Balance/Kinematics and Clinical Evaluation of Modified Kinematically versus Mechanically Aligned Total Knee Arthroplasty

et al. 2019

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AbstractRecently, kinematically aligned total knee arthroplasty has been found to achieve better clinical outcomes than mechanically aligned TKA. Despite the good clinical outcomes that are reported at short- to mid-term follow-up, intraoperative variables that are associated with a better outcome have not been measured. Therefore, this study was conducted to compare intraoperative kinematics/soft tissue balance and the clinical outcomes of patients who underwent modified kinematically (restricted tibial cut) or mechanically aligned total knee arthroplasty. Sixty cruciate-retaining total knee arthroplasties (30 modified kinematically [3-degree varus and 7-degree posterior slope in tibial cut] and 30 mechanically aligned) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative kinematics assessed by the navigation system and soft tissue balance assessed by an offset-type tensor were compared between the groups. One year postoperatively, the range of motion and 2011 Knee Society scores were compared between the groups. Kinematic assessment exhibited that tibial internal rotation during flexion was significantly maintained in the kinematic compared with the mechanical group (p < 0.05). Varus/valgus ligament balance at 90 and 120 degrees of flexion significantly maintained lateral laxity in the kinematic compared with the mechanical group (p < 0.05). Improvement of flexion angles, functional activity scores, and patient satisfaction were significantly better in the kinematic than in the mechanical group (p < 0.05). Modified kinematically aligned cruciate-retaining total knee arthroplasty maintained more tibial internal rotation and lateral laxity during flexion than mechanically aligned total knee arthroplasty; thus, the former may result in better clinical outcomes.

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“…Масла в огонь подлили сторонники кинематической ориентировки компонентов эндопротеза коленного сустава. устанавливая большеберцовый компонент с варусом в 3°, сохраняя внутреннюю ротацию дистального бедра, то есть разрушая классические представления об ориентации компонентов, они демонстрируют результаты, сопоставимые или превосходящие исходы при использовании стандартного подхода [17].…”

Section: Introductionunclassified

Residual Deformity After Bilateral Knee Arthroplasty: Impact on Short Term Outcomes

Зиновьев

Паськов

Sergeev

et al. 2018

Traumatology and Orthopedics of Russia

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Purpose— to evaluate the impact of frontal positioning of prosthesis components after bilateral Tka on short term functional outcomes. Material and Methods. The authors performed a retrospective analysis of teleroentgenograms of 466 patients after bilateral Tka with initial varus deformity. Functional and roentgenological outcomes were evaluated at average in 16,4±2,9 months postoperatively. Mean preoperative varus deformity was 10° (from 5 to 25°), initial angle between the anatomical and mechanical femoral axis (FVa) was 6,7±2° (from 3 to 12°). The neutral axis of both lower limbs (Hka = 180±0,5°) was obtained in 99 (21,2%) out of 466 patients. Residual deformity in one of the limbs above 3° with the neutral alignment of the contralateral limb was observed in 44 (9,4%) patients, bilateral residual deformity – in 32 (6,9%) patients. Other 291 patients demonstrated the deviation from mechanical axis in the range from 1 to 3° (±0,5°). all patients were divided into three groups: first group consisted of 10 patients with neutral axis of one limb and varus deformity of the other limb above 3°; second group — 10 patients with bilateral residual varus deformity above 3°; third group — 12 patients with neutral axis of both limbs (Hka = 180°). The angle of residual deformity averaged 3,7° (from 3,2 to 5,1°).Results.No statistically significant differences between the groups were observed for dynamometric parameters and SF-36 scores, as well as for functional kSS scores (p>0,05). However, the authors reported in patients of the first group a stance phase on the side of residual varus deformity longer at 15% (p<0,05) and transfer phase shorter at 17% (p<0,05) as compared to contralateral limb (with neutral alignment, Hka = 180°), which is indicative of load asymmetry and can have a negative impact at a later stage.Conclusion. Symmetrical residual varus deformity of lower limbs in the rage of 3,2–5,1° has no negative impact of short term clinical and functional outcomes of Tka. Muscular function and gait properties in patients with neutral axis of the lower limbs and in patients with symmetrical residual varus deformity after Tka were similar 16,4±2,9 months postoperatively.

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Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Cited by 14 publications

References 25 publications

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty

Intraoperative Soft Tissue Balance/Kinematics and Clinical Evaluation of Modified Kinematically versus Mechanically Aligned Total Knee Arthroplasty

Residual Deformity After Bilateral Knee Arthroplasty: Impact on Short Term Outcomes

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