Early Outcomes of Kinematic Alignment in Primary Total Knee Arthroplasty: A Meta-Analysis of the Literature

Courtney, P. Maxwell; Lee, Gwo Chin

doi:10.1016/j.arth.2017.02.041

Cited by 147 publications

(95 citation statements)

References 34 publications

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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%

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%

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

Twiggs²,

Leie

et al. 2019

The Knee

View full text Add to dashboard Cite

show abstract

“…[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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“…2,3 Studies have reported mean Oxford Knee Scores (OKS) ranging from 27 to 30 points after revision of a failed UKA to a TKA with MA, which is a lower range than those of a primary MA TKA and more comparable to a revision TKA. [2][3][4][5][6] Kinematically aligned (KA) has emerged as a viable alternative to MA TKA as four meta-analyses, three randomized trials, and a national multicenter study showed that patients treated with KA TKA reported significantly better pain relief, function, flexion, and a more normal feeling knee than patients treated with MA TKA, [7][8][9][10][11][12][13][14][15] whereas two randomized trials showed similar clinical outcomes. 16,17 The goal of KA is to co-align the axes and joint lines of the components with the three "kinematic" axes and joint lines of the prearthritic or native knee without placing limits on the preoperative deformity and postoperative correction and without ligament release.…”

mentioning

confidence: 99%

Revision of a Medial UKA to a Kinematic Aligned TKA: Comparison of Operative Complexity, Postoperative Alignment, and Outcome Scores to a Primary TKA

et al. 2019

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Revision of a medial unicompartmental knee arthroplasty (UKA) to a mechanically aligned total knee arthroplasty (MA TKA) is inferior to a primary TKA; however, revision with kinematic alignment (KA) has not been well studied. The present study determined whether patients revised with KA had a higher use of revision components, different postoperative alignment, and different clinical outcome scores from patients with a primary KA TKA. From 2006 to 2017, all patients suitable for a revision of a failed medial UKA to a TKA and a primary TKA were treated with KA. Reasons for the revision performed in ten females and six males at a mean age 67 ± 8 years included progression of osteoarthritis in the lateral hemi-joint (n = 6), aseptic loosening (n = 4), unremitting medial pain without loosening (n = 4), and insert wear (n = 2). Patients with a revision were matched 1:3 with a control cohort treated with a primary KA TKA. Revisions were performed with primary components without augments, stem extensions, or bone grafts. Seven postoperative alignment parameters of the limb and components were comparable to the control cohort (p > 0.05). At a mean follow-up of 5 years (1–10), implant survival was 100%, and the revision/primary group clinical outcome scores were 39/43 points for the Oxford Knee Score (OKS), 2.2/1.0 cm for the Visual Analog Pain Score, and 12/7 points for the Western Ontario and McMaster Universities Osteoarthritis Index score. When compared with primary KA TKA, surgeons that revise a failed medial UKA to a TKA with use of KA can expect similar operative complexity, comparable postoperative alignments, and a mean OKS of 39 points, which is higher than the mean 27 to 30 point range reported for revision of a failed UKA to a TKA with the use of MA.

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Early Outcomes of Kinematic Alignment in Primary Total Knee Arthroplasty: A Meta-Analysis of the Literature

Cited by 147 publications

References 34 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

Revision of a Medial UKA to a Kinematic Aligned TKA: Comparison of Operative Complexity, Postoperative Alignment, and Outcome Scores to a Primary TKA

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