Kinematic versus mechanical alignment for primary total knee arthroplasty with minimum 2 years follow-up: a systematic review

Sappey‐Marinier, Elliot; Pauvert, Adrien; Batailler, Cécile; Swan, John; Chèze, Laurence; Servien, Elvire; Lustig, Sébastien

doi:10.1051/sicotj/2020014

Cited by 36 publications

(24 citation statements)

References 62 publications

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“…Sappey-Marinier et al performed a systematic review of the clinical and radiological outcomes after TKA with KA versus with MA at 2 years of follow-up [25]. They reported that four of five prospective randomized controlled trial studies did not find any difference between the two groups (MA or KA) for all scores [26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

Personalized alignment in total knee arthroplasty: current concepts

Lustig

Sappey‐Marinier

Fary

et al. 2021

SICOT-J

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Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of “kinematic alignment” is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the “inverse kinematic alignment” is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is “restricted kinematic alignment” which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of “functional alignment” which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient’s specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts.

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Section: Resultsmentioning

confidence: 99%

Personalized alignment in total knee arthroplasty: current concepts

Lustig

Sappey‐Marinier

Fary

et al. 2021

SICOT-J

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“… 7 Some studies have shown improved clinical outcomes in TKA with KA compared to mechanical alignment at short-term follow-up, while other systematic reviews and meta-analyses have shown no difference in clinical or functional outcomes between the two alignment techniques for TKA. 10 , 17 , 19 , 36 - 41 …”

Section: Introductionmentioning

confidence: 99%

Current concepts in total knee arthroplasty

et al. 2021

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Limb alignment in total knee arthroplasty (TKA) influences periarticular soft-tissue tension, biomechanics through knee flexion, and implant survival. Despite this, there is no uniform consensus on the optimal alignment technique for TKA. Neutral mechanical alignment facilitates knee flexion and symmetrical component wear but forces the limb into an unnatural position that alters native knee kinematics through the arc of knee flexion. Kinematic alignment aims to restore native limb alignment, but the safe ranges with this technique remain uncertain and the effects of this alignment technique on component survivorship remain unknown. Anatomical alignment aims to restore predisease limb alignment and knee geometry, but existing studies using this technique are based on cadaveric specimens or clinical trials with limited follow-up times. Functional alignment aims to restore the native plane and obliquity of the joint by manipulating implant positioning while limiting soft tissue releases, but the results of high-quality studies with long-term outcomes are still awaited. The drawbacks of existing studies on alignment include the use of surgical techniques with limited accuracy and reproducibility of achieving the planned alignment, poor correlation of intraoperative data to long-term functional outcomes and implant survivorship, and a paucity of studies on the safe ranges of limb alignment. Further studies on alignment in TKA should use surgical adjuncts (e.g. robotic technology) to help execute the planned alignment with improved accuracy, include intraoperative assessments of knee biomechanics and periarticular soft-tissue tension, and correlate alignment to long-term functional outcomes and survivorship.

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“…The proponents of KA argue that so doing should avoid mid-flexion instability (MFI) and stiffness. To date, KA has shown similar or better clinical outcomes compared to MA at mid-term follow-up for primary TKA [12,13]. Hence, the authors hypothesize that MA TKAs that fail due to stiffness and/or MFI are unlikely to improve if revised back into MA but should improve significantly if revised back to their native alignment using KA principles.…”

Section: Introductionmentioning

confidence: 99%

Kinematic Alignment of Failed Mechanically Aligned Total Knee Arthroplasty Restored Constitutional Limb Alignment and Improved Clinical Outcomes: A Case Report of 7 Patients

Sappey-Mariner

Bini

2022

JPM

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Background: Stiffness and mid-flexion instability (MFI) is a recognized complication of mechanically aligned (MA) total knee arthroplasty (TKA). Kinematic alignment (KA) has been proposed as a means by which to restore normal joint motion following TKA and potentially avoid stiffness and MFI. Several studies have documented improved function with KA when compared to MA. The aim of this study was to determine if revising MA TKAs failed for either MFI or stiffness into KA resolves MFI, achieves better range of motion, and improves clinical outcomes. Methods: A retrospective, single surgeon review was performed. All consecutive TKAs revised from MA into KA for MFI (def: >5 mm opening between 10° and 45° of flexion) or stiffness (def: flexion ≤90°) between January 2017 and May 2021 were included. The constitutional limb alignment of the operated knee was “reverse engineered” by measuring the coronal alignment of the contralateral healthy knee or pre-operative x-rays. Femoral Rotation was set at 3 degrees internal to the trans epicondylar axis. All coronal and sagittal angles were digitally measured on pre- and post-operative long leg and maximum flexion radiographs (minimum 12 month follow-up). The Knee Society Score (KSS) and range of motion assessments were collected preoperatively and at final follow-up. Comparisons between groups were done with a paired T test. Significance was set at p < 0.05. Results: Seven patients were included. Two were male, the mean age was 70.1 years (±9.3), mean follow-up was 32 months (±26). Three patients were revised for MFI and 4 for stiffness. Constitutional limb alignment was restored within 2 degrees for all patients. The mean total KSS gain was 65.9 (±18.1). The total KSS was significantly improved in all patients (p < 0.001). The mean maximum flexion gain was 30 deg (±23°) (p = 0.01). MFI was absent in all patients. Conclusion: In a limited series of patients, revision of stiff or unstable TKA from MA to KA resulted in improved range of motion by 30° on averages, resolved instability without the use of constrained liners, improved clinical outcomes with a mean gain of 75 points on the KSS, and restored constitutional limb alignment within 2 degrees in all patients. As these short term results are promising, further study is warranted.

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Kinematic versus mechanical alignment for primary total knee arthroplasty with minimum 2 years follow-up: a systematic review

Cited by 36 publications

References 62 publications

Personalized alignment in total knee arthroplasty: current concepts

Personalized alignment in total knee arthroplasty: current concepts

Current concepts in total knee arthroplasty

Kinematic Alignment of Failed Mechanically Aligned Total Knee Arthroplasty Restored Constitutional Limb Alignment and Improved Clinical Outcomes: A Case Report of 7 Patients

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