Superiority of kinematic alignment over mechanical alignment in total knee arthroplasty during medium‐ to long‐term follow‐up: A meta‐analysis and trial sequential analysis

Wang, Guiguan; Chen, Long; Luo, Fenqi; Luo, Jun; Xu, Jie

doi:10.1002/ksa.12093

Cited by 4 publications

(1 citation statement)

References 53 publications

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“…Practicing and aspiring arthroplasty surgeons pursuing a robust, reproducible technique that avoids the higher costs, resource commitments, complexities and potentially less favourable revision rates of technology‐assisted TKA techniques may wish to consider the described procedure [ 22 , 43 , 51 ]. In addition, kinematic alignment strategies likely achieve higher patient satisfaction rates [ 10 , 38 , 47 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Conventionally instrumented inverse kinematic alignment for total knee arthroplasty: How is it done?

Russell,

Keyes,

Hirschmann

et al. 2024

J. exp. orthop.

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PurposeFor primary total knee arthroplasty (TKA), there is an increasing trend towards patient‐specific alignment strategies such as kinematic alignment (KA) and inverse kinematic alignment (iKA), which by restoring native joint mechanics may yield higher patient satisfaction rates. Second, the most recent Australian joint registry report describes favourable revision rates for conventionally instrumented TKA compared to technology‐assisted techniques such as those using navigation, robotics or custom‐cutting blocks. The aim of this technique article is to describe in detail a surgical technique for TKA that: (1) utilises the principles of iKA and (2) uses conventionally instrumented guided resections thereby avoiding the use of navigation, robotics or custom blocks.MethodsA TKA technique is described, whereby inverse kinematic principles are utilised and patient‐specific alignment is achieved. Additionally, the patellofemoral compartment of the knee is restored to the native patellofemoral joint line. The sequenced technical note provided may be utilised for cemented or cementless components; cruciate retaining or sacrificing designs and for fixed or rotating platforms.ResultsAn uncomplicated, robust and reproducible technique for TKA is described.DiscussionKnee arthroplasty surgeons may wish to harness the emerging benefits of both a conventionally instrumented technique and a patient‐specific alignment strategy.Level of EvidenceLevel V.

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Section: Discussionmentioning

confidence: 99%

Conventionally instrumented inverse kinematic alignment for total knee arthroplasty: How is it done?

Russell,

Keyes,

Hirschmann

et al. 2024

J. exp. orthop.

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Inverse kinematic total knee arthroplasty using conventional instrumentation restores constitutional coronal alignment

Keyes,

Russell,

Bertalan

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeRestricted inverse kinematic alignment (iKA) is a contemporary alignment strategy for total knee arthroplasty (TKA), commonly performed with robotic assistance. While superior clinical results are reported for kinematic‐type alignment strategies, registry data indicate no survivorship benefit for navigation or robotic assistance. This study aimed to determine the efficacy of an instrumented, restricted iKA technique for achieving patient‐specific alignment.MethodsSeventy‐nine patients undergoing 84 TKAs (five bilateral procedures) using an iKA technique were included for preoperative and postoperative lower limb alignment analysis. The mean age was 66.5 (range: 43–82) with 33 male and 51 female patients. Artificial intelligence was employed for radiographic measurements. Alignment profiles were classified using the Coronal Plane Alignment of the Knee (CPAK) system. Preoperative and postoperative alignment profiles were compared with subanalyses for preoperative valgus, neutral and varus profiles.ResultsThe mean joint‐line convergence angle (JLCA) reduced from 2.5° to −0.1° postoperatively. The mean lateral distal femoral angle (LDFA) remained unchanged postoperatively, while the mean medial proximal tibial angle (MPTA) increased by 2.5° (p = 0.001). By preservation of the LDFA and restoration of the MPTA, the mean hip knee ankle angle (HKA) moved through 3.5° varus to 1.2° valgus.The CPAK system was used to visually depict changes in alignment profiles for preoperative valgus, neutral and varus knees; with 63% of patients observing an interval change in classification.ConclusionEncouraged by the latest evidence supporting both conventional instrumentation and kinematic‐type TKA strategies, this study describes how a restricted, conventionally instrumented iKA technique may be utilised to restore constitutional lower limb alignment.Level of EvidenceLevel III.

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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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Superiority of kinematic alignment over mechanical alignment in total knee arthroplasty during medium‐ to long‐term follow‐up: A meta‐analysis and trial sequential analysis

Cited by 4 publications

References 53 publications

Conventionally instrumented inverse kinematic alignment for total knee arthroplasty: How is it done?

Conventionally instrumented inverse kinematic alignment for total knee arthroplasty: How is it done?

Inverse kinematic total knee arthroplasty using conventional instrumentation restores constitutional coronal alignment

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

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