PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study

Calließ, Tilman; Bauer, K.; Stukenborg-Colsman, Christina; Windhagen, Henning; Budde, Stefan; Ettinger, Max

doi:10.1007/s00167-016-4136-8

Cited by 185 publications

(171 citation statements)

References 25 publications

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“…This eventually resulted in 6 studies that were included in the meta-analysis. [14][15][16][17][18][19] 3.2. Study characteristics, patient populations, and quality assessment of the included studies The 6 studies we examined included 371 patients who underwent primary TKA through the KA technique and 372 patients who underwent primary TKA through the MA technique.…”

Section: Identification Of Studiesmentioning

confidence: 99%

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Yoon

Shin

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Identification Of Studiesmentioning

confidence: 99%

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Yoon

Shin

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…In KA TKA, the aim is to restore the native joint line anatomy and orientation, preserving the patients' native soft tissue envelope by balancing the knee with bony resection rather than soft tissue releases. Early studies comparing MA and KA TKA have demonstrated either equivalent or better clinical outcomes for KA TKA [7][8][9][10][11][12]. This may be because KA TKA produces more neutral weight bearing positions and decreased knee adduction moment, a surrogate for medial tibiofemoral joint loading and thus implant durability when compared to MA TKA [13,14], or it may result from less disruption of the native soft tissue envelope [15][16][17].…”

Section: Introduction/purposementioning

confidence: 99%

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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“…KA is guided by magnetic resonance imaging (MRI) and computed tomography (CT) scans to coalign the flexion-extension axis of the femoral component to the natural kinematic axes of the patient's individual knee. 21 In addition, manual instrument techniques were also reported to be effective. 22 KA studied by some researchers was reported to make good performance on reducing the prevalence of unexplained pain, stiffness, instability, and improving the speed of the knee function recovery.…”

mentioning

confidence: 99%

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis

Wang

et al. 2017

J Knee Surg

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This meta-analysis was conducted to study whether kinematically aligned total knee arthroplasty (TKA) improves short-term functional outcomes compared with mechanical alignment without changing the hip-knee-ankle angle. Prospective cohort studies were searched from electronic literature databases, including PubMed, Web of Science, Embase (Ovid interface), and Cochrane Library (Ovid interface). Total 1,159 records were identified. Six trials involving 561 patients were eligible for data extraction and meta-analysis. The included studies recorded outcomes in the follow-up range from 6 to 34 months. Primary outcomes were to assess the functional outcomes in follow-up, and KA group achieved better performance on WOMAC score (mean difference [MD] = -18.82, 95% CI: -16.06 to -5.58), knee function score (MD = 7.23, 95% CI: 0.52-13.94), Oxford knee score (MD = 4.76, 95% CI: 0.40-9.12), and knee range of flexion (MD = 4.48, 95% CI: 2.09-6.86), whereas other parameters including Knee Society score, knee range of extension, VAS pain score, and the occurrence of the complications were without significant difference ( > 0.05). Second outcomes evaluated the perioperative clinic indexes. Our meta-analysis showed that KA group had a shorter time of operation (MD = -15.44, 95% CI: -27.47 to -3.71) and a longer walk distance before discharge (MD = 53.24, 95% CI: 21.32-85.15) when compared with the MA group, whereas the change in hemoglobin, incision length, knee range of flexion before discharge, and length of stays were without significant difference ( > 0.05). Third outcomes were used to analyze the alignment data. Our study showed that KA had larger angles of femoral component and mechanical axis of the femur (MD = -1.95,95% CI: -2.77 to -1.13), tibial component and mechanical axis of tibia (MD = 2.06, 95% CI: 1.43-2.70), anatomic knee angle (MD = -0.72, 95% CI: -1.33 to -0.11), and operative limb alignment (MD = -1.97, 95% CI: -2.50 to -1.45,) compared with the MA group, but the hip-knee-ankle angles between the two groups were similar. KA provided better functional outcomes and better flexion following short-term follow-up of TKA. However, longer-term follow-up and larger sample studies are needed to put into research in the future.

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PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study

Abstract: II.

Cited by 185 publications

References 25 publications

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

Comparison of Kinematic and Mechanical Alignment Techniques in Primary Total Knee Arthroplasty: A Meta-Analysis

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

Does Kinematic Alignment Improve Short-Term Functional Outcomes after Total Knee Arthroplasty Compared with Mechanical Alignment? A Systematic Review and Meta-analysis

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