In Kinematically Aligned Total Knee Arthroplasty, Failure to Recreate Native Tibial Alignment Is Associated With Early Revision

Scanlon, Christopher M.; Sun, David; Alvarez, Amanda Milena; Webb, Matthew L.; Perez, Brian A.; Yu, Austin S.; Hume, Eric

doi:10.1016/j.arth.2020.06.029

Cited by 5 publications

(1 citation statement)

References 18 publications

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“…In contrast, small increases in the tibial component varus, compared with native alignment, were associated with early aseptic revision in patients undergoing KATKA. Increasing the tibial varus by ≥ 2.2° is associated with an increased likelihood of revision [ 14 ]. Therefore, KATKA is a controversial procedure in some patients [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials

Miura¹,

Takahashi²,

Watanabe

et al. 2023

BMC Musculoskelet Disord

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Background Mechanically aligned total knee arthroplasty (MATKA) is a well-established procedure. Kinematically aligned TKA (KATKA) has been proposed to restore and preserve pre-arthritic knee anatomy. However, normal knee anatomy varies widely, and there have been concerns regarding restoring unusual anatomy. Accordingly, restricted KATKA (rKATKA) was introduced to reproduce constitutional knee anatomy within a safe range. This network meta-analysis (NMA) aimed to evaluate the clinical and radiological outcomes of the surgeries. Methods We performed a database search on August 20, 2022, which included randomized controlled trials (RCTs) comparing any two of the three surgical TKA techniques for knee osteoarthritis. We conducted a random-effects NMA within the frequentist framework and evaluated confidence in each outcome using the Confidence in Network Meta-Analysis tool. Results Ten RCTs with 1,008 knees and a median follow-up period of 1.5 years were included. The three methods might result in little to no difference in range of motion (ROM) between methods. In patient-reported outcome measures (PROMs), the KATKA might result in a slight improvement compared with the MATKA (standardized mean difference, 0.47; 95% confidence interval [CI], 0.16–0.78; very low confidence). There was little to no difference in revision risk between MATKA and KATKA. KATKA and rKATKA showed a slight valgus femoral component (mean difference [MD], -1.35; 95% CI, -1.95–[-0.75]; very low confidence; and MD, -1.72; 95% CI, -2.63–[-0.81]; very low confidence, respectively) and a slight varus tibial component (MD, 2.23; 95% CI, 1.22–3.24; very low confidence; and MD, 1.25; 95% CI, 0.01–2.49; very low confidence, respectively) compared with MATKA. Tibial component inclination and hip–knee–ankle angle might result in little to no difference between the three procedures. Conclusions KATKA and rKATKA showed similar ROM and PROMs and a slight variation in the coronal component alignment compared with MATKA. KATKA and rKATKA are acceptable methods in short- to mid-term follow-up periods. However, long-term clinical results in patients with severe varus deformity are still lacking. Surgeons should choose surgical procedures carefully. Further trials are warranted to evaluate the efficacy, safety, and subsequent revision risk.

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Section: Introductionmentioning

confidence: 99%

Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials

Miura¹,

Takahashi²,

Watanabe

et al. 2023

BMC Musculoskelet Disord

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Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review

Ollivier,

Luyckx,

Stragier

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePatellofemoral pain, maltracking and instability remain common and challenging complications after total knee arthroplasty. Controversy exists regarding the effect of kinematic alignment on the patellofemoral joint, as it generally leads to more femoral component valgus and internal rotation compared to mechanical alignment. The aim of this systematic review is to thoroughly examine the influence of kinematic alignment on the third space.MethodsA systematic search of the Pubmed, Cochrane and Web of Science databases was performed to screen for relevant articles published before 7 April 2024. This led to the final inclusion of 42 articles: 2 cadaveric, 9 radiographic, 12 computer simulation and 19 clinical studies. The risk of bias was evaluated with the risk of bias in non‐randomised studies ‐ of interventions tool as the lowest level of evidence of the included clinical studies was IV. The effects of kinematic alignment on patellar kinematics and kinetics, trochlear anatomy reconstruction and patellofemoral complication rate were investigated.ResultsKinematic alignment closely restores native patellar kinematics and kinetics, better reproduces native trochlear anatomy than mechanical alignment and leads to a 0%–11.4% incidence of patellofemoral complications. A more valgus joint line of the distal femur can cause lateral trochlear undercoverage and a trochlear angle orientation medial to the quadriceps vector when applying kinematic alignment, both of which can be solved by using an adjusted design with a 20.5° valgus trochlea.ConclusionKinematic alignment appears to be a safe strategy for the patellofemoral joint in most knees, provided that certain precautions are taken to minimize the risk of complications.Level of EvidenceLevel IV clinical studies, in vitro research.

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Variation in knee balance as a function of hip-knee-ankle angle and joint line obliquity in robotic assisted total knee arthroplasty

Kim

Wakelin²,

Plaskos³

et al. 2022

International Orthopaedics (SICOT)

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In Kinematically Aligned Total Knee Arthroplasty, Failure to Recreate Native Tibial Alignment Is Associated With Early Revision

Cited by 5 publications

References 18 publications

Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials

Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials

Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review

Variation in knee balance as a function of hip-knee-ankle angle and joint line obliquity in robotic assisted total knee arthroplasty

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