Kinematic alignment in total knee arthroplasty

Nisar, Sohail; Rivière, Charles; Emerton, Mark; Pandit, Hemant

doi:10.1302/2058-5241.5.200010

Cited by 50 publications

(34 citation statements)

References 72 publications

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“…Correction of coronal deformities requires soft tissue releases and the desire to avoid these has led to a growing interest in kinematic alignment in the recent years. Kinematic alignment aims to restore the individual pre-arthritic alignment [ 102 ]. However, complex and severe alignment deformities exist with intra- and extra-articular origins [ 21 ], and pre-arthritic alignment may differ from arthritic alignment.…”

Section: Resultsmentioning

confidence: 99%

Contemporary knee arthroplasty: one fits all or time for diversity?

Beckmann,

Meier,

Benignus

et al. 2021

Arch Orthop Trauma Surg

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Introduction Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. Materials and methods A Pubmed and Google Scholar search were performed with the following terms: “patient-specific knee” and “arthroplasty” and “custom implant” and “total knee replacement” and “partial knee replacement” and “patellofemoral knee replacement” and “bicompartmental knee replacement”. The full text of 90 articles was used to write this narrative review. Results Unicondylar, patellofemoral and bicompartmental knee arthroplasty are successful treatment options, which can be considered over TKA for their bone and ligament sparing character and the superior functional outcome that can be obtained with resurfacing procedures. For TKA, where compromises dominate our choices, especially in patients with individual variations of their personal anatomy outside of the standard, a customized implant could be a preferable solution. Conclusion TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.

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Section: Resultsmentioning

confidence: 99%

Contemporary knee arthroplasty: one fits all or time for diversity?

Beckmann,

Meier,

Benignus

et al. 2021

Arch Orthop Trauma Surg

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“…The Kinematic Alignment (KA) technique for total knee arthroplasty (TKA) is an alternative surgical technique aiming to resurface knee articular surfaces. 1 , 2 Ultimately, the goal of KA is to alter the knee physiological biomechanics as little as possible by restoring native (pre-arthritic) knee joint line alignment and ligaments laxities ( Fig. 1 , ).…”

Section: Introductionmentioning

confidence: 99%

“…1 , ). 1 , 2 Setting up the orientation and height of the KA bone cuts is done by referencing the articular surfaces, by compensating for cartilage and/or bone loss, and by considering the thickness of the implants. By doing so, components are aligned on knee kinematic axes.…”

Section: Introductionmentioning

confidence: 99%

Specific case consideration for implanting TKA with the Kinematic Alignment technique

et al. 2021

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The Kinematic Alignment (KA) technique for total knee arthroplasty (TKA) is an alternative surgical technique aiming to resurface knee articular surfaces. The restricted KA (rKA) technique for TKA applies boundaries to the KA technique in order to avoid reproducing extreme constitutional limb/knee anatomies. The vast majority of TKA cases are straightforward and can be performed with KA in a standard (unrestricted) fashion. There are some specific situations where performing KA TKA may be more challenging (complex KA TKA cases) and surgical technique adaptations should be included. To secure good clinical outcomes, complex KA TKA cases must be preoperatively recognized, and planned accordingly. The proposed classification system describes six specific issues that must be considered when aiming for a KA TKA implantation. Specific recommendations for each situation type should improve the reliability of the prosthetic implantation to the benefit of the patient. The proposed classification system could contribute to the adoption of a common language within our orthopaedic community that would ease inter-surgeon communication and could benefit the teaching of the KA technique. This proposed classification system is not exhaustive and will certainly be improved over time. Cite this article: EFORT Open Rev 2021;6:881-891. DOI: 10.1302/2058-5241.6.210042

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“…However, this individualized alignment is often not clearly defined, and a multitude of different philosophies, approaches, and terms can be found in the literature [ 1 ]. The clearest defined concept with the best clinical evidence available is the kinematic alignment (KA) approach [ 2 ]. The defined primary aim of KA is to reconstruct the individual joint surface of the femoral condyles with the prosthesis and thus to co-align the motion axes of the device to that of the patient’s knee [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Huber¹,

Christen²,

Calliess

et al. 2021

JPM

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Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

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Kinematic alignment in total knee arthroplasty

Cited by 50 publications

References 72 publications

Contemporary knee arthroplasty: one fits all or time for diversity?

Contemporary knee arthroplasty: one fits all or time for diversity?

Specific case consideration for implanting TKA with the Kinematic Alignment technique

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

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