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

2017 ◽  
Vol 31 (01) ◽  
pp. 078-086 ◽  
Author(s):  
Yanhong Li ◽  
Yuliang Wang ◽  
Mingxuan Yang ◽  
Shuanke Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Mechanical Axis ◽  
Meta Analysis ◽  
Mechanical Alignment ◽  
Short Term ◽  
Significant Difference ◽  
Total Knee

AbstractThis 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 (p > 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 (p > 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.

scholarly journals The Effect of Intra- vs. Extramedullary Tibial Guides on the Alignment of Lower Extremity and Functional Outcomes following Total Knee Arthroplasty: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Mohammadreza Razzaghof ◽  
SM Javad Mortazavi ◽  
Alireza Moharrami ◽  
Pouya Tabatabaei Irani ◽  
Abbas Noori
Keyword(s):  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Definitive Treatment ◽  
Normal Ranges ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Abstract Background: Total knee arthroplasty (TKA) has been known as a definitive treatment of advanced knee osteoarthritis. Both intra- (IM) and extramedullary (EM) tibial guides have been used to restore the desired extremity alignment. However, controversy exists regarding the superiority of either technique. We aimed to compare their functional outcomes and accuracy in providing neutral alignment after TKA. Methods: In a randomized, double-blinded clinical trial, we studied 98 patients undergoing primary TKA in two groups of IM and EM. We measured the medial proximal tibial angle (MPTA), varus angle (VA), and joint-line convergence angle with normal ranges of 90°±3°, 0-2°, and 0±3°, respectively, on a three-joint alignment view after three months. We also assessed functional outcomes at the last follow-up. Finally, we compared these outcomes between groups. Results: Eighty-four patients (IM=42, EM=42) were included in the final analysis (16 males, 68 females; mean age: 63.9±8.6 years; mean follow-up: 27±2.9 months). The mean postoperative alignment angles showed no significant difference, although MPTA outliers were significantly more frequent in the EM group (26.2% vs. 9.5% in IM, P=0.04). None of the functional outcomes showed a significant difference between groups. However, the mean ROM increase was significantly higher in VAs within ±3° of normal than those outside it (30.8 vs. 27.4, respectively; P=0.039). Conclusions: We conclude that both techniques were not different in terms of the mean alignment angles and functional outcomes. However, fewer MPTA outliers can be seen with IM. A postoperative mechanical axis within ±3° of neutral can result in a more ROM increase after one year. Trial registration: IRCT, IRCT20160809029286N5. Registered 21 April 2020, https://www.irct.ir/trial/46976

scholarly journals Difference between Mechanical Alignment in Navigation and Scanogram during Total Knee Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Rohan Bhimani ◽  
Fardeen Bhimani ◽  
Preeti Singh
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Navigation ◽  
Primary Total Knee Arthroplasty ◽  
P Value ◽  
Mechanical Alignment ◽  
Significant Difference ◽  
Total Knee ◽  
The Mean

Introduction. Malpositioning of the implant results in polyethylene wear and loosing of implant after total knee arthroplasty. Scanogram is often used for measurement of limb alignment. Computer navigation provides real time measurements and thus, the aim is to see any association pre- and postoperatively between coronal alignments measured on scanogram to computer navigation during total knee arthroplasty. Material and Methods. We prospectively gathered data of 200 patients with advanced degenerative symptomatic arthritis, who were consecutively selected for primary total knee arthroplasty with computer navigation. Every patient’s pre- and postoperative scanogram were compared to the intraoperative computer navigation findings. Results. The results show that the preoperative mean mechanical axis on navigation was 10.65° (SD ± 6.95) and on scanogram it was 10.38° (SD ± 6.89). On the other hand, the mean postoperative mechanical axis on navigation was 0.69° (SD ± 0.87) and on scanogram it was 2.73° (SD ± 2.10). Preoperatively, there was no significant difference (p value = 0.46) between the two. However, the postoperative outcomes suggest that there was a noteworthy difference, with no correlation between the mean Hip-Knee Ankle Axis (HKA) and intraoperative mechanical axis (p value <0.0001). Conclusion. Postoperative mechanical alignment values after total knee arthroplasty are lower on navigation than measured on standing full length hip to ankle scanogram.

Imageless Computer Navigation in Total Knee Arthroplasty Provides Superior Short Term Functional Outcomes: A Meta-Analysis

2014 ◽  
Vol 29 (5) ◽  
pp. 938-944 ◽  
Author(s):  
Brett A. Rebal ◽  
Oladapo M. Babatunde ◽  
Jonathan H. Lee ◽  
Jeffrey A. Geller ◽  
David A. Patrick ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Computer Navigation ◽  
Short Term ◽  
Total Knee

Kinematically Aligned Total Knee Arthroplasty Did Not Show Superior Patient-Reported Outcome Measures: An Updated Meta-analysis of Randomized Controlled Trials with at Least 2-Year Follow-up

2020 ◽  
Author(s):  
Shuhei Hiyama ◽  
Tsuneari Takahashi ◽  
Katsushi Takeshita
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Difference ◽  
Patient Reported ◽  
Total Knee

AbstractKinematically aligned total knee arthroplasty (KATKA) was developed to improve the anatomical alignment of knee prostheses, assisting in restoring the native alignment of the knee and promoting physiological kinematics. Early clinical results were encouraging, showing better functional outcomes than with mechanically aligned total knee arthroplasty (MATKA). However, there have been concerns about implant survival, and follow-up at 10 years or more has not been reported. In addition, randomized controlled trials (RCTs) comparing KATKA with MATKA have reported inconsistent results. The current meta-analysis of RCTs with a minimum of 2 years of follow-up investigated the clinical and radiological differences between KATKA and MATKA. A systematic review of the English language literature resulted in the inclusion of four RCTs. The meta-analysis found no significant difference in any of the following parameters: postoperative range of motion for flexion (mean difference for KATKA − MATKA [MD], 1.7 degrees; 95% confidence interval [CI], −1.4 to 4.8 degrees; p = 0.29) and extension (MD, 0.10 degrees; 95% CI, −0.99 to 1.2 degrees; p = 0.86); Oxford Knee Score (MD, 0.10 points; 95% CI, −1.5 to 1.7 points; p = 0.90); Knee Society Score (MD, 1.6 points; 95% CI, −2.8 to 6.0 points; p = 0.49); and Knee Function Score (MD, 1.4 points; 95% CI, −4.9 to 7.8 points; p = 0.66). In addition, there was no significant difference between KATKA and MATKA in the rate of complications requiring reoperation or revision surgery (odds ratio, 1.01; 95% CI, 0.25–4.09; p = 0.99) or in the length of hospital stay (MD, 1.0 days; 95% CI, −0.2 to 2.2 days; p = 0.092). KATKA did not increase the number of patients with poor clinical results due to implant position, particularly for varus placement of the tibial component. In this meta-analysis based on four RCTs with a minimum of 2 years of follow-up, KATKA were only relevant to cruciate retaining TKA and could not be extrapolated to posterior stabilized TKA. Patient-reported outcome measures with KATKA were not superior to those with MATKA.

Mobile Bearing versus Fixed Bearing for Total Knee Arthroplasty: Meta-analysis of Randomized Controlled Trials at Minimum 10-Year Follow-up

2020 ◽  
Author(s):  
Pu Chen ◽  
Liuwei Huang ◽  
Dong Zhang ◽  
Xiaozhe Zhang ◽  
Yufeng Ma ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Mobile Bearing ◽  
Fixed Bearing ◽  
Randomized Controlled ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Total Knee

AbstractThis meta-analysis aimed to compare the clinical and radiographic outcomes between mobile-bearing total knee arthroplasty (MB-TKA) and fixed-bearing total knee arthroplasty (FB-TKA) at a minimum 10-year follow-up. PubMed, EMBASE, and Cochrane databases were searched. All included articles were evaluated by two trained reviewers according to the guidelines of the Cochrane Collaboration Handbook for potential risk, and the Consolidated Standards on Reporting Trials (CONSORT) checklist and scoring system was also used to assess the methodological quality of each study. The extracted data included function scores, range of motion (ROM) of the knee, incidence of adverse events or revision, survivorship analysis, and radiographic outcomes. Seven randomized controlled trials (RCTs) were included in this meta-analysis, and all RCTs had a follow-up period longer than 10 years. This meta-analysis shows no significant difference between the two groups with respect to the Keen Society Score (KSS; p = 0.38), KSS function score (p = 0.30), the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC; p = 0.59), ROM (p = 0.71), radiolucent line (p = 0.45), femoral and tibial component positions in the coronal plane (p = 0.55 and 0.35, respectively), revision incidence (p = 0.77), and survivorship rates (p = 0.39). Meanwhile, it showed a slight difference between the two groups in the tibial component position in the sagittal plane (p = 0.003). According to this meta-analysis, the current best available evidence suggests no significant difference between the MB-TKA and FB-TKA groups with respect to the clinical outcomes, radiographic outcomes, revision, and survivorship at a minimum 10-year follow-up. This is a Level II, meta-analysis study.

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

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 18 ◽  
Author(s):  
Elliot Sappey-Marinier ◽  
Adrien Pauvert ◽  
Cécile Batailler ◽  
John Swan ◽  
Laurence Cheze ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Cohort Studies ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Kinematic Alignment ◽  
Mechanical Alignment ◽  
Significant Difference ◽  
Total Knee

Purpose: The aim of this study was to perform a systematic review of the literature to determine whether there are any clinical or radiological differences in mechanically aligned Total Knee Arthroplasty (TKA) compared with kinematically aligned TKA. Methods: This study included retrospective cohort studies, prospective randomized controlled trials (PRCTs) and prospective cohort studies comparing clinical and radiological outcomes, and complications in TKA with kinematic alignment (KA) and mechanical alignment (MA). All studies had a minimum follow-up of 2 years. Results: Five PRCTs published between 2014 and 2020 were included. These studies showed a low risk of bias and were of very high quality. We did not find a superiority of KA compared to MA technique for clinical and radiological outcomes, except in one study which showed a significant difference favoring KA between the two groups for all clinical scores. Conclusion: We found that KA in TKA achieved clinical and radiological results similar to those of MA. The complication rate was not increased for KA TKAs. Studies with longer follow-up and larger cohorts are required to prove any benefit of KA technique over MA technique.

Effects of the Use of Tourniquet in Total Knee Arthroplasty on the Clinical and Functional Outcomes with 5 Years of Follow-up: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Sherwan A. Hamawandi ◽  
Hazhar I. Amin ◽  
Ameer K. Al-Humairi
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Controlled Trial ◽  
Thigh Pain ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Total Knee

AbstractThe use of tourniquet in total knee arthroplasty (TKA) had a lot of controversies with no clear agreement about the advantages and disadvantages of tourniquet. This study aims to show the effects of tourniquet use in TKA on the functional and clinical outcomes with follow-up of 5 years. This is a randomized, double-blind, and single-center study of 101 patients who were treated by TKA and divided randomly into two groups. Tourniquet was used in group A and was not used in group B. Both groups were assessed by Knee Society score (KSS), knee injury and osteoarthritis outcome score (KOOS), visual analogue scale (VAS) score for thigh pain, and postoperative complications. Both groups were followed up for 5 years. The group of no tourniquet showed significant better functional outcomes measured by KSS at postoperative periods of 2 weeks (p = 0.001), 6 weeks (p = 0.006), and 3 months (p = 0.034), and KOOS at postoperative periods of 2 weeks (p = 0.001), 6 weeks (p =0.001), and 3 months (p = 0.016). However, there was no significant difference in long-term follow-up of 5 years. There were significantly better results with use of tourniquet regarding surgeon's visualization during surgery, less operative time, and less calculated blood loss, while significantly better results with no use of tourniquet were reported regarding less hospital stay, less postoperative analgesic consumption, and less postoperative thigh pain measured by VAS score at postoperative periods of day 1 (p = 0.001), day 5 (p = 0.001), 2 weeks (p = 0.001), and 6 weeks (p = 0.001). Regarding postoperative blood transfusion and clinical deep venous thrombosis, there was no significant difference between use of tourniquet or not. The evidence presented in this level-1 randomized controlled trial suggests that no use of tourniquet in TKA can improve functional outcomes in early postoperative period with no significant difference on functional outcome at 5 years of follow-up.

scholarly journals Comparison of Outcomes in Obese Patients After Total Knee Arthroplasty With Neutral or Mild Varus: a Retrospective Study With 8-year Follow-up

2021 ◽  
Author(s):  
Ya-hao Lai ◽  
Jian Cao ◽  
Wei Feng ◽  
Ze-xi Li ◽  
Hong Xu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Womac Score ◽  
Obese Patients ◽  
Prosthesis Survival ◽  
Significant Difference ◽  
Total Knee ◽  
Knee Society Function Score

Abstract Background Residual varus after total knee arthroplasty (TKA) can affect functional outcomes and prosthetic survival, which may worsen in the presence of obesity. However, no studies were found to compare the outcomes of obese patients involving postoperative residual mild varus or neutral. The aim of this study was to compare outcomes for knees of obese patients with neutral or mild varus after TKA. Methods We retrospectively reviewed 188 consecutive obese patients (body mass index ≥ 30 kg/m2) at our hospital who underwent TKA due to varus knee osteoarthritis from January 2010 to December 2015. The mechanical hip-knee-ankle axis angle was measured in all patients pre- and postoperatively. Prosthesis survival and knee function were retrospectively assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Society Knee Score (KS-KS), Knee Society Function Score (KS-FS), Forgotten Joint Score (FJS), and range of motion (ROM). Results Of the 156 knees in 132 obese patients who completed follow-up for a mean of 8.32 ± 1.47 years, 97 knees were corrected from varus to neutral and 54 knees were kept in mild residual varus. Knees with mild varus showed significantly better WOMAC and FJS scores. The two types of knees did not differ significantly in KS-KS, KS-FS or ROM. Although one patient with a neutral knee had to undergo revision surgery, there was no significant difference between two groups.Conclusions For obese patients with osteoarthritis, preservation of residual varus alignment after TKA can improve functional outcomes without compromising prosthesis survival.

Sign in / Sign up

Export Citation Format

Share Document