Mechanical alignment technique for TKA: Are there intrinsic technical limitations?

Rivière, Charles; Iranpour, Farhad; Auvinet, Edouard; Aframian, Arash; Asare, K.; Harris, Simon; Cobb, Justin P.; Parratte, Sébastien

doi:10.1016/j.otsr.2017.06.017

Cited by 54 publications

(29 citation statements)

References 54 publications

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“…Although its underlying reason is not clear, alignment technique of TKA is beginning to be considered to be related to the patient's postoperative outcomes and dissatisfaction (13,14). With the application of more accurate alignment assistant instruments, the conventional MA technique has begun to be challenged in recent years (7,15,16), because MA cannot fully respect the patient's natural alignment of lower extremities and joint line orientation, and a signi cant variation in overall coronal limb alignment and in femoral and tibial joint lines had been proved to exist in osteoarthritic knees (17).…”

Section: Discussionmentioning

confidence: 99%

How joint line orientation affects the amount of bone resection in mechanically aligned TKA: a retrospective clinical-radiographic correlation study

Wang

Liang

et al. 2020

Preprint

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Abstract Background The discrepancy of bone resections between the medial and the lateral compartment is very common in total knee replacement (TKA) when mechanical alignment (MA) is used. The purpose of this study was to explore whether or how the joint line orientation affects the gross amount of bone resection in mechanically aligned TKA. Methods A total of 112 patients (137 knees) diagnosed with osteoarthritis (OA) were included. Simulated bone cuttings were conducted on the coronal view using full-length weight bearing radiographs according to the technical requirement of MA, and the feasibility of simulated osteotomy was verified by intraoperative calipered measurement. Correlation and regression analyses were conducted between the amounts of bone resection and various parameters, including hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), joint line congruency angle (JLCA), and medial proximal tibial angle (MPTA). Moreover, any intraoperative bone resection adjustments if existed, were retrospectively collected using medical records query system. Results All knees in current case series can be artificially divided into 4 subgroups: 84 varus knees (61.3%) with valgus femur in subgroup 1, 32 varus knees (23.4%) with varus femur in subgroup 2. 14 valgus knees (10.2%) with varus tibia in subgroup 3, 7 valgus knees (5.1%) with valgus tibia in subgroup 4. The amount of simulated bone resection had high consistency with the intraoperative measurement. MPTA and mLDFA had a positive correlation with the bone resection amount in subgroup 1. The regression equation was Bone resection (mm) = 0.556*mLDFA (deg.) + 0.098*MPTA (deg.) -39.74, R2 = 0.808. Similarly, the intraoperative bone cutting adjustments also showed a certain relationship with mLDFA in subgroup 1. Conclusions Deformities of knee OA can be divided into 4 subgroups based on the alignment of extremities and the joint line orientations. When a TKA is performed in varus knee with valgus femur using conventional instrument and mechanical alignment technique, the amount of bone resection on coronal plane is linearly related to the patient’s mLDFA.

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Section: Discussionmentioning

confidence: 99%

How joint line orientation affects the amount of bone resection in mechanically aligned TKA: a retrospective clinical-radiographic correlation study

Wang

Liang

et al. 2020

Preprint

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“… 36 This may be due to poor soft tissue and ligament balancing as a result of using MA to try and correct an ‘unbalanceable’ knee. 37 – 39 …”

Section: What Are the Potential Disadvantages Of Ka?mentioning

confidence: 99%

Kinematic alignment in total knee arthroplasty

et al. 2020

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Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival. Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010

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“…Some authors have shown that 40% of knees cannot be adequately balanced by collateral ligament release when performing measured resection MA-TKA. 23 This is of prime importance as poor TKA outcome may often be the consequence of the non-physiological MA technique.…”

Section: Risk Factorsmentioning

confidence: 99%

The stiff total knee arthroplasty: causes, treatment modalities and results

Rodríguez-Merchán¹

2019

EFORT Open Reviews

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It is clear that the stiff total knee arthroplasty (TKA) is a multifactorial entity associated with preoperative, intraoperative and postoperative factors. Management of the stiff TKA is best achieved by preventing its occurrence using strategies to control preoperative factors, avoid intraoperative technical errors and perform aggressive, painless postoperative physical medicine and rehabilitation; adequate pain control is paramount in non-invasive management. Careful attention to surgical exposure, restoring gap balance, minimizing surgical trauma to the patellar ligament/extensor mechanism, appropriate implant selection, pain control and adequate physical medicine and rehabilitation (physiotherapy, Astym therapy) all serve to reduce its incidence. For established stiff TKA, there are multiple treatment options available including mobilization under anaesthesia (MUA), arthroscopic arthrolysis, revision TKA, and combined procedures. Cite this article: EFORT Open Rev 2019;4:602-610. DOI: 10.1302/2058-5241.4.180105

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Mechanical alignment technique for TKA: Are there intrinsic technical limitations?

Abstract: level 4.

Cited by 54 publications

References 54 publications

How joint line orientation affects the amount of bone resection in mechanically aligned TKA: a retrospective clinical-radiographic correlation study

How joint line orientation affects the amount of bone resection in mechanically aligned TKA: a retrospective clinical-radiographic correlation study

Kinematic alignment in total knee arthroplasty

The stiff total knee arthroplasty: causes, treatment modalities and results

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