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Cited by 174Total Knee Arthroplasty OutcomesKnee injuries and reconstruction techniquesProsthetics and Rehabilitation Robotics

Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment

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Winnock de Grave, Philip, Luyckx, Thomas, Claeys, Kurt, Tampere, Thomas, Kellens, Jonas, Müller, Jacobus, Gunst, Paul·2022·Knee Surgery, Sports Traumatology, Arthroscopy
DOI 10.1007/s00167-020-06165-4PMC PMC8866329
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Abstract

Purpose: Various alignment philosophies for total knee arthroplasty (TKA) have been described, all striving to achieve excellent long‐term implant survival and good functional outcomes. In recent years, in search of higher functionality and patient satisfaction, a shift towards more tailored and patient‐specific alignment is seen. The purpose of this study was to describe a restricted ‘inverse kinematic alignment’ (iKA) technique, and to compare clinical outcomes of patients that underwent robotic‐assisted TKA performed by restricted iKA vs. adjusted mechanical alignment (aMA). Methods: The authors reviewed the records of a consecutive series of patients that received robotic‐assisted TKA with restricted iKA (n = 40) and with aMA (n = 40). Oxford Knee Score (OKS) and satisfaction on a visual analogue scale (VAS) were collected at a follow‐up of 12 months. Clinical outcomes were assessed according to patient acceptable symptom state (PASS) thresholds, and uni‐ and multivariable linear regression analyses were performed to determine associations of OKS and satisfaction with six variables (age, sex, body mass index (BMI), preoperative hip–knee–ankle (HKA) angle, preoperative OKS, alignment technique). Results: The restricted iKA and aMA techniques yielded comparable outcome scores (p = 0.069), with OKS, respectively, 44.6 ± 3.5 and 42.2 ± 6.3. VAS Satisfaction was better (p = 0.012) with restricted iKA (9.2 ± 0.8) compared to aMA (8.5 ± 1.3). The number of patients that achieved OKS and satisfaction PASS thresholds was significantly higher (p = 0.049 and p = 0.003, respectively) using restricted iKA (98% and 80%) compared to aMA (85% and 48%). Knees with preoperative varus deformity, achieved significantly (p = 0.025) better OKS using restricted iKA (45.4 ± 2.0) compared to aMA (41.4 ± 6.8). Multivariable analyses confirmed better OKS (β = 3.1; p = 0.007) and satisfaction (β = 0.73; p = 0.005) with restricted iKA. Conclusions: The results of this study suggest that restricted iKA and aMA grant comparable clinical outcomes at 12‐month follow‐up, though a greater proportion of knees operated by restricted iKA achieved the PASS thresholds for OKS and satisfaction. Notably. in knees with preoperative varus deformity, restricted iKA yielded significantly better OKS and satisfaction than aMA. Level of evidence: Level III, comparative study.

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  • There are several available methods for identifying native coronal plane morphology, including generic cartilage wear assumptions, use of long leg radiographs, or methods based on advanced imaging.

    “There are several available methods for identifying native coronal plane morphology, including generic cartilage wear assumptions, use of long leg radiographs, or methods based on advanced imaging [12–15].”

    From Imageless robotic total knee arthroplasty determines similar coronal plane alignment of the knee (CPAK) parameters to long leg radiographs (2024) · cites this paper as [13]

    The Surgical technique section (page unavailable) describes preoperative CT used to create a subject-specific knee model, supporting the advanced-imaging example. The iKA section describes restoring pre-arthritic alignment while accounting for bony wear. Neither section establishes generic cartilage-wear assumptions or long-leg radiographs as methods for identifying native morphology; the full-leg radiograph shown is postoperative. (LLM, conf=0.85)

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Research works printed but not linked: 26

  1. [1]Allen MM Pagnano MW Neutral mechanical alignment: is it necessary? Bone Joint J 2016 98 1 81 83 10.1302/0301-620X.98B1.36403 26733648 · DOI
  2. [2]Almaawi AM Hutt JRB Masse V Lavigne M Vendittoli PA The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty J Arthroplasty 2017 32 7 2133 2140 10.1016/j.arth.2017.02.028 28302462 · DOI
  3. [3]Beck EC Nwachukwu BU Mehta N Jan K Okoroha KR Rasio J Nho SJ Defining meaningful functional improvement on the visual analog scale for satisfaction at 2 years after hip arthroscopy for femoroacetabular impingement syndrome Arthroscopy 2020 36 3 734 742.e732 10.1016/j.arthro.2019.09.028 31735577 · DOI
  4. [4]Calliess T Ettinger M Savov P Karkosch R Windhagen H Individualized alignment in total knee arthroplasty using image-based robotic assistance: Video article Orthopade 2018 47 10 871 879 10.1007/s00132-018-3637-1 30218354 PMC6182501 · DOI
  5. [6]Dossett HG Estrada NA Swartz GJ LeFevre GW Kwasman BG A randomised controlled trial of kinematically and mechanically aligned total knee replacements Bone Joint J 2014 96 7 907 913 10.1302/0301-620X.96B7.32812 24986944 · DOI
  6. [7]Gillespie D Mandziak D Howie C Influence of posterior lateral femoral condyle geometry on patellar dislocation Arch Orthop Trauma Surg 2015 135 11 1503 1509 10.1007/s00402-015-2310-y 26298562 · DOI
  7. [8]Hirschmann MT Hess S Behrend H Amsler F Leclercq V Moser LB Phenotyping of hip-knee-ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability Knee Surg Sports Traumatol Arthrosc 2019 27 5 1378 1384 10.1007/s00167-019-05507-1 30968238 · DOI
  8. [9]Hirschmann MT Moser LB Amsler F Behrend H Leclercq V Hess S Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment Knee Surg Sports Traumatol Arthrosc 2019 27 5 1385 1393 10.1007/s00167-019-05508-0 30980119 · DOI
  9. [10]Hirschmann MT Moser LB Amsler F Behrend H Leclerq V Hess S Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients Knee Surg Sports Traumatol Arthrosc 2019 27 5 1394 1402 10.1007/s00167-019-05509-z 30976825 · DOI
  10. [11]Howell SM Hull ML Kinematic alignment in total knee arthroplasty 2012 Philadelphia, PA Elsevier
  11. [12]Hungerford DS Kenna RV Krackow KA The porous-coated anatomic total knee Orthop Clin North Am 1982 13 1 103 122 10.1016/S0030-5898(20)30270-4 7063184 · DOI
  12. [13]Insall JN Binazzi R Soudry M Mestriner LA Total knee arthroplasty Clin Orthop Relat Res NO 1985 192 13 22 3967412
  13. [14]Liu HX Shang P Ying XZ Zhang Y Shorter survival rate in varus-aligned knees after total knee arthroplasty Knee Surg Sports Traumatol Arthrosc 2016 24 8 2663 2671 10.1007/s00167-015-3781-7 26377095 · DOI
  14. [15]Matsuda S Miura H Nagamine R Mawatari T Tokunaga M Nabeyama R Iwamoto Y Anatomical analysis of the femoral condyle in normal and osteoarthritic knees J Orthop Res 2004 22 1 104 109 10.1016/S0736-0266(03)00134-7 14656667 · DOI
  15. [16]Nakajima A Sonobe M Akatsu Y Aoki Y Takahashi H Suguro T Nakagawa K Association between limb alignment and patient-reported outcomes after total knee arthroplasty using an implant that reproduces anatomical geometry J Orthop Surg Res 2018 13 1 320 10.1186/s13018-018-1030-8 30558616 PMC6296124 · DOI
  16. [17]Nedopil AJ Howell SM Hull ML What mechanisms are associated with tibial component failure after kinematically-aligned total knee arthroplasty? Int Orthop 2017 41 8 1561 1569 10.1007/s00264-017-3490-6 28493211 · DOI
  17. [18]Rivière C Iranpour F Auvinet E Howell S Vendittoli P-A Cobb J Parratte S Alignment options for total knee arthroplasty: a systematic review Orthop Traumatol Surg Res 2017 103 7 1047 1056 10.1016/j.otsr.2017.07.010 28864235 · DOI
  18. [19]Rivière C Lazic S Boughton O Wiart Y Vïllet L Cobb J Current concepts for aligning knee implants: patient-specific or systematic? EFORT Open Rev 2018 3 1 1 6 10.1302/2058-5241.3.170021 29657839 PMC5890125 · DOI
  19. [20]Roger J Lustig S Cerciello S Bruno CF Neyret P Servien E Short lateral posterior condyle is associated with trochlea dysplasia and patellar dislocation Knee Surg Sports Traumatol Arthrosc 2019 27 3 731 739 10.1007/s00167-018-5023-2 29995166 · DOI
  20. [21]Scholes C Ebrahimi M Ektas N Ireland J Efficacy of a second-generation rotating bearing tibial platform in total knee arthroplasty: a prospective observational cohort study with registry analysis J Knee Surg 2019 10.1055/s-0039-1678679 30836393 · DOI
  21. [22]Thienpont E Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty Knee Surg Sports Traumatol Arthrosc 2013 21 10 2370 2374 10.1007/s00167-012-2215-z 23007414 · DOI
  22. [23]Thienpont E Schwab PE Paternostre F Koch P Rotational alignment of the distal femur: anthropometric measurements with CT-based patient-specific instruments planning show high variability of the posterior condylar angle Knee Surg Sports Traumatol Arthrosc 2014 22 12 2995 3002 10.1007/s00167-014-3086-2 24888223 · DOI
  23. [24]Thienpont E Schwab PE Cornu O Bellemans J Victor J Bone morphotypes of the varus and valgus knee Arch Orthop Trauma Surg 2017 137 3 393 400 10.1007/s00402-017-2626-x 28110363 · DOI
  24. [25]Vanlommel L Vanlommel J Claes S Bellemans J Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees Knee Surg Sports Traumatol Arthrosc 2013 21 10 2325 2330 10.1007/s00167-013-2481-4 23552665 · DOI
  25. [26]Yazdi H Nazarian A Wu JS Amiri A Hafezi P Babikian M Mohamadi A Pakdaman R Ghorbanhoseini M Different references for valgus cut angle in total knee arthroplasty Arch Bone Jt Surg 2018 6 4 289 293 30175176 PMC6110428
  26. [27]Young SW Walker ML Bayan A Briant-Evans T Pavlou P Farrington B The Chitranjan S. Ranawat Award: no difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial Clin Orthop Relat Res 2017 475 1 9 20 10.1007/s11999-016-4844-x 27113595 PMC5174030 · DOI

Cited by

Sorted by citations

Authors
Winnock de Grave, P., Luyckx, T., Claeys, K., Tampere, T., Kellens, J., Müller, J., & Gunst, P.
Affiliations
  • <!--<label>1</label>--> Dept. Orthopaedic Surgery AZ Delta Roeselare Brugsesteenweg 90 8800 Roeselare Belgium
  • Universitair Ziekenhuis Leuven (BE)
  • KU Leuven (BE)
  • Ghent University Hospital (BE)
  • <!--<label>5</label>--> ReSurg SA Rue Saint‐Jean 22 1260 Nyon Switzerland
  • AZ Delta (BE)
ORCID
Venue
Knee Surgery, Sports Traumatology, Arthroscopy
Publisher
Wiley
Published
2020-07-31
Volume
30
Issue
2
Pages
488-499
ISSN
  • 0942-2056 (ISSN-L)
  • 1433-7347
DOI
10.1007/s00167-020-06165-4
PMC
PMC8866329
OpenAlex
W3046702169
Cited by
174
References
1
Citations by year
2026: 27 · 2025: 45 · 2024: 40 · 2023: 31 · 2022: 22 · 2021: 6 · 2020: 2
FWCI
13.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Knee Surgery Sports Traumatology Arthroscopy (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Lirias (KU Leuven) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
Keywords
total knee arthroplasty, robotic surgery, patient satisfaction, Oxford Knee Score, varus deformity, knee alignment, functional outcome, hip-knee-ankle angle, body mass index, implant survival, patient-reported outcomes
MeSH terms
Biomechanical Phenomena, Humans, Knee Joint, Knee Prosthesis, Personal Satisfaction, Treatment Outcome, Arthroplasty, Replacement, Knee, Osteoarthritis, Knee

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