scholarly journals Total knee arthroplasty according to the original knee phenotypes with kinematic alignment surgical technique—early clinical and functional outcomes

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Cheng-En Hsu ◽  
Jen-Ting Huang ◽  
Kwok-Man Tong ◽  
Kui-Chou Huang
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Functional Improvement ◽  
Kinematic Alignment ◽  
Varus Alignment ◽  
Operative Planning ◽  
Total Knee ◽  
One Year

Abstract Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients’ demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed. Results The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P < 0.05). Conclusion The early outcomes of this phenotype-oriented KA-TKA using generic total knee instruments are promising. Setting individualized alignment target according to original knee phenotype is rational and practical. The residual varus alignment did not cause any aseptic loosening in the 3 years follow-up. Long-term survivorship and functional outcomes need to be evaluated in future studies.

scholarly journals Personalized alignment in total knee arthroplasty: current concepts

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 19
Author(s):  
Sébastien Lustig ◽  
Elliot Sappey-Marinier ◽  
Camdon Fary ◽  
Elvire Servien ◽  
Sébastien Parratte ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Inverse Kinematic ◽  
Joint Line ◽  
Kinematic Alignment ◽  
Joint Line Obliquity ◽  
Total Knee ◽  
Neutral Alignment

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.

scholarly journals Good early results obtained with a guided-motion implant for total knee arthroplasty: a consecutive case series

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Hagen Hommel
Keyword(s):  
Total Knee Arthroplasty ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Knee Score ◽  
Function Score ◽  
Early Results ◽  
Total Knee ◽  
One Year

A bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design was introduced to improve knee kinematics by more closely approximating those of a normal knee. Previous studies have shown a high incidence of complications with this implant type, which led to recent modifications of the design by the manufacturer. The current study was undertaken to assess whether the use of a guided-motion knee system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. The secondary aim was to assess if there were any differences between the original and modified implant designs. This retrospective study enrolled 204 consecutive patients (204 knees) undergoing TKA for osteoarthritis of the knee, with the first 154 receiving cemented Journey BCS I implants and the remaining 51 receiving cemented Journey BCS II implants when these became available. At follow-up, patients were tested for the presence of iliotibial friction syndrome (ITB-F) and midflexion instability. Knee score and function score were taken preoperatively, at one year, and at final follow-up. Outcome data between the two implant types were compared using the Mann-Whitney test. No patients were lost to follow-up. Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness (flexion < 90°). Incidence of ITB-F syndrome was considered low: three (2.0%) knees in the BCS I group and two (3.9%) in the BCS II group (p = 0.367). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (3.9%) in the BCS II group (p = 0.367). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no significant differences in range of motion, knee score, or function score. When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant. Long-term follow-up studies are needed to confirm our findings.

scholarly journals Pros and cons of navigated versus conventional total knee arthroplasty—a retrospective analysis of over 2400 patients

2021 ◽  
Author(s):  
Matthias Meyer ◽  
Tobias Renkawitz ◽  
Florian Völlner ◽  
Achim Benditz ◽  
Joachim Grifka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Retrospective Analysis ◽  
Outcome Measures ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Complication Rates ◽  
Total Knee ◽  
One Year ◽  
Navigated Tka ◽  
Surgery Duration

Abstract Introduction Because of the ongoing discussion of imageless navigation in total knee arthroplasty (TKA), its advantages and disadvantages were evaluated in a large patient cohort. Methods This retrospective analysis included 2464 patients who had undergone TKA at a high-volume university arthroplasty center between 2012 and 2017. Navigated and conventional TKA were compared regarding postoperative mechanical axis, surgery duration, complication rates, one-year postoperative patient-reported outcome measures (PROMs) (WOMAC and EQ-5D indices), and responder rates as defined by the criteria of the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus (OMERACT-OARSI). Results Both navigated (1.8 ± 1.6°) and conventional TKA (2.1 ± 1.6°, p = 0.002) enabled the exact reconstruction of mechanical axis. Surgery duration was six minutes longer for navigated TKA than for conventional TKA (p < 0.001). Complication rates were low in both groups with comparable frequencies: neurological deficits (p = 0.39), joint infection (p = 0.42 and thromboembolic events (p = 0.03). Periprosthetic fractures occurred more frequently during conventional TKA (p = 0.001). One-year PROMs showed excellent improvement in both groups. The WOMAC index was statistically higher for navigated TKA than for conventional TKA (74.7 ± 19.0 vs. 71.7 ± 20.7, p = 0.014), but the increase was not clinically relevant. Both groups had a similarly high EQ-5D index (0.23 ± 0.24 vs. 0.26 ± 0.25, p = 0.11) and responder rate (86.5% [256/296] vs. 85.9% [981/1142], p = 0.92). Conclusion Both methods enable accurate postoperative leg alignment with low complication rates and equally successful PROMs and responder rates one year postoperatively. Level of evidence III. Retrospective cohort study.

Varus alignment of the tibial component up to seven degrees is not associated with poor long-term outcomes in a neutrally aligned total knee arthroplasty

2021 ◽  
Author(s):  
Francisco Antonio Miralles-Muñoz ◽  
Marta Rubio-Morales ◽  
Laiz Bello-Tejada ◽  
Santiago González-Parreño ◽  
Alejandro Lizaur-Utrilla ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Varus Alignment ◽  
Long Term Outcomes ◽  
Total Knee
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