Does Calipered Kinematically Aligned TKA Restore Native Left to Right Symmetry of the Lower Limb and Improve Function?

Nedopil, Alexander J.; Singh, Amrik; Howell, Stephen M.; Hull, Maury L.

doi:10.1016/j.arth.2017.09.039

Cited by 84 publications

(109 citation statements)

References 38 publications

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“…32 However, Nedopil et al showed that KA TKA restored native left to right symmetry of the hip-knee-ankle angle, distal lateral femoral angle, and proximal medial tibial angle in nearly all patients with negligible risk of varus alignment of the tibial component with respect to the native tibial joint line. 33 In addition, Shelton et al showed that KA TKA has a high proportion of varus or valgus outliers using mechanically aligned criteria; the intraoperative forces in the medial and lateral compartments of patients with outlier alignment were comparable with those with in-range alignment, with no evidence of overload of the medial or lateral compartment of the knee. 34 However, there has been no study that evaluated the biomechanical effects of MA TKA and KA TKA with respect to the contact stresses on the PE insert and patellar button and the forces exerted on the collateral ligaments.…”

Section: Discussionmentioning

confidence: 99%

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

et al. 2019

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Kinematic alignment (KA), which co-aligns the rotational axes of the components with three kinematic axes of the knee by aligning the components to the prearthritic joint lines, has been a recently introduced surgical technique. However, whether KA and cruciate retaining (CR) implants provide better biomechanical function during activities than mechanical alignment (MA) in posterior stabilized (PS) implants is unclear. We evaluated the biomechanical functions during the stance phase gait and deep knee bend, with a computer simulation and measured forces in the medial and lateral collateral ligaments and medial and lateral contact stresses in the polyethylene insert and patellar button. The forces on the medial collateral ligament in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions, whereas those on the lateral collateral ligament did not show any difference between the two surgical alignment techniques in the stance phase gait condition. The maximum contact stresses on the medial PE inserts in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions. However, the maximum contact stresses on the lateral PE inserts and the patellar button did not differ between MA and KA. The biomechanical function was superior in KA TKA than in MA TKA, and KA was more effective in CR TKA. This comparison could be used as a reference by surgeons to reduce the failure rates by using KA TKA instead of MA TKA.

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Section: Discussionmentioning

confidence: 99%

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

et al. 2019

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“…It is important to note that because cartilage wear was not present in these specimens, loss of cartilage thickness present in osteoarthritic patients did not have to be accounted for during these in vitro KA TKAs as it does in vivo . When the thicknesses of the femoral resections were within 0.5 mm of the thicknesses of the corresponding regions of the femoral component, the joint lines of the femoral component closely matched those of the native knee …”

Section: Methodsmentioning

confidence: 97%

“…After kinematic alignment of the femoral component was confirmed, kinematic alignment of the tibial component (Zimmer Persona CR) in V‐V, P‐D, and F‐E was confirmed when the knee was stable at 0° of flexion (i.e., had negligible V‐V laxity at 0° of flexion indicated by negligible gapping medially and laterally during a manual laxity assessment as judged visually by the surgeon, which matches the that of the native knee) and had the same A‐P offset of the distal medial condyle of the femur from the anterior cortex of the tibia at 90° of flexion as that in the ACL‐d knee before the distal femoral resections were made . These checks have been shown clinically to result in a V‐V orientation of the tibial component within 0.0° ± 1.8° of that of the contralateral healthy knee and a posterior slope within −0.2° ± 2.5° of the pre‐operative posterior slope . Correct thickness of the tibial insert was confirmed when the full extension position (i.e., flexion‐extension orientation of the tibia relative to the femur when the femur and tibia are simply supported) matched that of the ACL‐d knee before any resections were made.…”

Section: Methodsmentioning

confidence: 99%

“…One outcome goal of kinematically aligned total knee arthroplasty (KA TKA) is to restore objective metrics of biomechanical function such that they are not different from those of the native (i.e., pre‐arthritic) knee . To achieve this outcome goal, the surgical goal of KA TKA is to align the femoral and tibial components to restore the native joint lines (i.e., lines tangent to the distal femoral condyles and the tibial plateau in the coronal plane, to the posterior femoral condyles in the axial plane, and to the medial tibial plateau in the sagittal plane), which in turn should restore the native alignments of the limb and knee without soft tissue release . By doing so, KA TKA might limit differences in biomechanical function from native .…”

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confidence: 99%

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Analysis of differences in laxities and neutral positions from native after kinematically aligned TKA using cruciate retaining implants

Roth

Howell

Hull

2019

Journal Orthopaedic Research

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One biomechanical goal of kinematically aligned total knee arthroplasty (KA TKA) is to achieve knee laxities and neutral positions that are not different from those of the native knee without soft tissue release. However, replacing the articular surfaces and menisci with implants of discrete sizes and average shapes and resecting the anterior cruciate ligament (ACL) might prevent KA TKA from achieving this goal in the tibiofemoral joint. Accordingly, the objective was to determine whether either or both surgically induced changes cause differences in laxities and/or neutral positions from native using a cruciate retaining implant. Eight laxities and four neutral positions were measured from 0˚to 120˚flexion in 30˚increments in 13 human cadaveric knees in three knee conditions: native, ACL-deficient, and KA TKA. After KA TKA, 5 of the 40 laxity measures (8 laxities Â 5 flexion angles) and 6 of the 20 neutral position measures (4 neutral positions Â 5 flexion angles) were statistically different from those of the native knee. The greatest differences in laxities from native after KA TKA occurred at 30˚flexion in anterior translation (1.6 AE 2.1 mm increase, p < 0.0001); this difference was 1.7 AE 2.1 mm less than that in the ACL-d knee (p < 0.0001). The greatest difference in neutral positions from native after KA TKA occurred in anterior-posterior translation at 0˚flexion (3.8 AE 1.9 mm anterior, p < 0.0001); this difference was 2.6 AE 1.9 mm greater than that in the ACL-d knee (p ¼ 0.0002). Clinical Significance: These results indicate that the biomechanical goal of KA TKA is largely realized despite the two surgically induced changes. ß

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“…Moreover, whether a high level of knee exion can be achieved with less cutting of the posterior femur bone than with the previous conventional model (NexGen-LPS-Flex® system (Zimmer Biomet, Warsaw, Indiana) remains to be elucidated [21]. To the best of our knowledge, only a few studies have reported short-term outcomes and no study has used this implant system in Asian knees [22,23]. Therefore, the primary aim of our study was to evaluate the clinical outcomes of the Persona® knee system including whether it could achieve a higher level of knee exion.…”

Section: Introductionmentioning

confidence: 99%

Early Clinical and Radiological outcomes of the New Anatomic Knee System : Minimum 3-year Follow-up.

Ryu

Jeon

Shin³

et al. 2020

Preprint

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Background: For total knee arthroplasty (TKA), implant design and proper coverage are important for achieving patient satisfaction. An asymmetrical anatomic implant (Persona® knee system, Zimmer Biomet, Warsaw, Indiana) enables accurate coverage and minimal bone cutting. This study aimed to analyze the clinical and radiological outcomes of TKA using an asymmetrical anatomic implant over a minimum 3-year follow-up.Methods: The medical records of 94 patients who underwent 132 TKAs using the Persona® knee system, between April 2015 and January 2016 were reviewed. Pre- and post-operative clinical outcomes (assessed using the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores, and range of motion (ROM) were reviewed. The mechanical hip-knee-ankle (HKA) axis, component overhang and underhang and presence of a radiolucent line (RLL) were evaluated. Liner thickness were also reviewed.Results: At 3-year follow-up, the mean ROM improved from 108.4° to 130.3°. The mean IKDC subjective, WOMAC and global KOOS score significantly improved from 29.2 to 70.3, from 64.2 to 11.5, and from 66.6 to 21.7, respectively (p<0.0001). The mean mechanical HKA axis indicated the correction of the malalignment (from 9.2° varus to 0.3° varus, p<0.001). The incidence rates of >3-mm bone-to-implant size mismatch were 6.8% and 8.3% for the femoral and tibial components, respectively. RLL was found in seven cases, but they were small (>2 mm) and did not progress. In 36.3% of the knees, the additional liner thickness (11 or 13mm) was used. No case of implant loosening or early failure related to the implant design occurred. Conclusion: TKA using the Persona® knee system improved all the clinical knee scores and ROM without signs of early failure. This knee system also provides more implant size options than the conventional TKA systems and facilitates ligament balancing.

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Does Calipered Kinematically Aligned TKA Restore Native Left to Right Symmetry of the Lower Limb and Improve Function?

Cited by 84 publications

References 38 publications

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Analysis of differences in laxities and neutral positions from native after kinematically aligned TKA using cruciate retaining implants

Early Clinical and Radiological outcomes of the New Anatomic Knee System : Minimum 3-year Follow-up.

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Does Calipered Kinematically Aligned TKA Restore Native Left to Right Symmetry of the Lower Limb and Improve Function?

Cited by 84 publications

References 38 publications

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Analysis of differences in laxities and neutral positions from native after kinematically aligned TKA using cruciate retaining implants

Early Clinical and Radiological outcomes of&nbsp;the New Anatomic Knee System : Minimum 3-year Follow-up.

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Product

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Early Clinical and Radiological outcomes of the New Anatomic Knee System : Minimum 3-year Follow-up.