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Gattu N, Sutton M, Doherty DB, Lanfermeijer ND, Rodriguez-Quintana D, Ismaily SK, Pletka CA, Noble PC, Han S. Variations in Trochlear Morphology of Contemporary and Legacy Total Knee Arthroplasty Prostheses: A Review of 22 Designs. J Arthroplasty 2024; 39:1583-1588. [PMID: 38072096 DOI: 10.1016/j.arth.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024] Open
Abstract
BACKGROUND The morphology of the trochlear compartment of total knee arthroplasty (TKA) prostheses is a major determinant of postoperative patello-femoral kinematics, particularly with unresurfaced patellae. The objective of this study was to quantify and compare the trochlear morphology of a large series of contemporary and legacy TKA designs. METHODS The 3-dimensional surface models of 22 femoral components (13 contemporary and 9 legacy) were created using high-resolution laser scanning. The trochlear profile of each component was analyzed from proximal to distal in 15° increments around the trochlear axis. In each profile, the following variables were measured: sulcus angle, medio-lateral deviation of the sulcus, the height and width of the facets, and the trochlear groove orientation. RESULTS In the contemporary group, the sulcus angle decreased progressively along the trochlear arc to varying degrees, except for 2 symmetrical designs, whereas the sulcus angle of the legacy designs showed considerable variability. The height of the medial facet was very strongly correlated with that of the lateral facet in the contemporary group (R2 = 0.89), whereas the correlation was weak for the legacy designs (R2 = 0.36). Moreover, the trochlear sulcus deviated laterally from distal to proximal in 10 contemporary designs and 7 legacy designs, resulting in a trochlear groove orientation of 4.2 to 11.1° and 4.3 to 10.5°, respectively. In the remaining 5 designs (3 contemporary and 2 legacy), the sulcus was vertical. CONCLUSIONS There is more consistency in trochlear morphology of contemporary TKA designs compared to that of legacy designs, yet there are still large variations between different designs.
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Affiliation(s)
- Nikhil Gattu
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Marriah Sutton
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David B Doherty
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Camryn A Pletka
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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Lundgren LS, Willems N, Marchand RC, Batailler C, Lustig S. Surgical factors play a critical role in predicting functional outcomes using machine learning in robotic-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38819941 DOI: 10.1002/ksa.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE Predictive models help determine predictive factors necessary to improve functional outcomes after total knee arthroplasty (TKA). However, no study has assessed predictive models for functional outcomes after TKA based on the new concepts of personalised surgery and new technologies. This study aimed to develop and evaluate predictive modelling approaches to predict the achievement of minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) 1 year after TKA. METHODS Four hundred thirty robotic-assisted TKAs were analysed in this retrospective study. The mean age was 67.9 ± 7.9 years; the mean body mass index (BMI) was 32.0 ± 6.8 kg/m2. The following PROMs were collected preoperatively and 1-year postoperatively: knee injury and osteoarthritis outcome score for joint replacement, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) Function, WOMAC Pain. Demographic data, preoperative CT scan, implant size, implant position on the robotic system and characteristics of the joint replacement procedure were selected as predictive variables. Four machine learning algorithms were trained to predict the MCID status at 1-year post-TKA for each PROM survey. 'No MCID' was chosen as the target. Models were evaluated by class discrimination (F1-score) and area under the receiver operating characteristic curve (ROC-AUC). RESULTS The best-performing model was ridge logistic regression for WOMAC Function (area under the curve [AUC] = 0.80, F1 = 0.48, sensitivity = 0.79, specificity = 0.62). Variables most strongly contributing to not achieving MCID status were preoperative PROMs, high BMI and femoral resection depth (posterior and distal), supporting functional positioning principles. Conversely, variables contributing to a positive outcome (achieving MCID) were medial/lateral alignment of the tibial component, whether the procedure was an outpatient surgery and whether the patient received managed Medicare insurance. CONCLUSION The most predictive variables included preoperative PROMs, BMI and surgical planning. The surgical predictive variables were valgus femoral alignment and femoral rotation, reflecting the benefits of personalised surgery. Including surgical variables in predictive models for functional outcomes after TKA should guide clinical and surgical decision-making for every patient. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Robert C Marchand
- Orthopedic Surgery Department, South County Orthopaedics, Ortho Rhode Island, Wakefield, Rhode Island
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Univ Lyon, IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Univ Lyon, IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Villeurbanne, France
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Vendittoli PA, Beckers G, Massé V, de Grave PW, Ganapathi M, MacDessi SJ. Why we should use boundaries for personalised knee arthroplasty and the lack of evidence for unrestricted kinematic alignment. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38804654 DOI: 10.1002/ksa.12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Pascal-André Vendittoli
- Department of Orthopaedic Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Québec, Canada
- Clinique Orthopédique Duval, Laval, Québec, Canada
- Personalised Arthroplasty Society, Atlanta, Georgia, USA
| | - Gautier Beckers
- Personalised Arthroplasty Society, Atlanta, Georgia, USA
- Department of Orthopaedic Surgery, Klinikum Großhadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Vincent Massé
- Department of Orthopaedic Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Québec, Canada
- Clinique Orthopédique Duval, Laval, Québec, Canada
- Personalised Arthroplasty Society, Atlanta, Georgia, USA
| | - Philip Winnock de Grave
- Personalised Arthroplasty Society, Atlanta, Georgia, USA
- Department of Orthopaedic Surgery, AZ Delta Hospital, Roeselare, Belgium
- European Knee Society, Haacht, Belgium
| | - Muthu Ganapathi
- Personalised Arthroplasty Society, Atlanta, Georgia, USA
- Department of Trauma and Orthopaedics, Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Penrhosgarnedd, Bangor, UK
| | - Samuel J MacDessi
- School of Clinical Medicine, St George Hospital, University of NSW Medicine and Health, Kogarah, Sydney, Australia
- Sydney Knee Specialists, Kogarah, New South Wales, Australia
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Bonnin M, Saffarini M, Lustig S, Hirschmann MT. Decoupling the trochlea from the condyles in total knee arthroplasty: The end of a curse? Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769816 DOI: 10.1002/ksa.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Michel Bonnin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | - Sébastien Lustig
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Département de chirurgie orthopédique et de médecine du sport, FIFA Medical Center of excellence, Hôpital de la Croix-Rousse, Centre Hospitalier Universitaire de Lyon, Lyon, France-Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR, Lyon, France
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, Switzerland
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Klasan A, Anelli-Monti V, Putnis SE, Neri T, Kammerlander C. The effect of different alignment strategies on trochlear orientation after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38606595 DOI: 10.1002/ksa.12178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE When planning and delivering total knee arthroplasty (TKA), there are multiple coronal alignment strategies such as functional alignment (FA), kinematic alignment (KA), mechanical and adjusted mechanical alignment (MA, aMA). Recent three-dimensional and robotic-assisted surgery (RAS) studies have demonstrated that KA potentially better restores the trochlear anatomy than MA. The purpose of this study was to compare the restoration of the native trochlear orientation in patients undergoing RAS TKA using four different alignment strategies. It was hypothesised that FA would result in the lowest number of outliers. METHODS This is a prospective study of 200 patients undergoing RAS-TKA with a single implant. All patients were analysed for MA and KA prebalancing, and 157 patients received aMA and 43 patients FA with intraoperative balancing. Preoperative transverse computed tomography scans were used to determine the posterior condylar axis (PCA), lateral trochlear inclination (LTI) angle, sulcus angle (SA) and anterior trochlear line (ATL) angle. Implant measurements were obtained using a photographic analysis. Intraoperative software data combined with implant data and preoperative measurements were used to calculate the differences. Outliers were defined as ≥3° of alteration. Trochlea dysplasia was defined as LTI < 12°. RESULTS Native transepicondylar PCA had a median of 2°, LTI 18°, SA 137°, ATL 4°. LTI outliers were observed in 47%-60% of cases, with KA < FA < aMA < MA. For ATL, the range of outliers was 40.5%-85%, KA < FA < aMA < MA. SA produced 81% of outliers. Of all median angle values, only LTI when using KA was not significantly altered compared to the native knee. CONCLUSION There is a significant alteration of trochlear orientation after TKA, regardless of the alignment strategy used. KA produced the lowest, but a substantial, number of outliers. The uniform design of implants causes the surgeon to compromise on balance in flexion versus trochlear position. The clinical relevance of this compromise requires further clinical investigations. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Antonio Klasan
- Department of Orthropedics and Traumatology, AUVA UKH Steiermark, Graz, Austria
- Department of Orthropedics and Traumatology, Johannes Kepler University Linz, Linz, Austria
| | | | - Sven E Putnis
- Department of Orthropedics and Traumatology, University Hospital Bristol, Bristol, UK
| | - Thomas Neri
- Department of Orthropedics and Traumatology, University Hospital St. Etienne, St. Etienne, France
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Orsi AD, Shatrov J, Plaskos C, Kreuzer S. Personalized alignment techniques better restore the native trochlear groove compared to systematic alignment techniques in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:915-928. [PMID: 38426570 DOI: 10.1002/ksa.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The relationship between constitutional coronal alignment and implant positioning on trochlear groove restoration in total knee arthroplasty (TKA) is poorly understood. This study aimed to determine whether the choice of alignment philosophy significantly affects the restoration of the trochlea groove. METHODS Sixty-one imageless robotic TKAs performed by a single orthopaedic surgeon were retrospectively reviewed. In each case, the entire native trochlea was digitized to generate the native femoral anatomy, and implants were planned according to a functional alignment (FA) technique. Final implant position was recorded using the validated bone resection planes from the navigation system. Simulated femoral component positions were generated according to previously described alignment techniques: mechanical alignment (MA), gap balancing (GB), kinematic alignment (KA), restricted kinematic alignment (rKA) and restricted inverse kinematic alignment (riKA). Trochlear angle (TA), trochlear under/overstuffing and mediolateral sulcus offset were compared between the six simulated alignment techniques, as well as the final implanted technique. Further analyses investigated the effect of preoperative coronal alignment on trochlear position. Comparisons were assessed with an analysis of variance and Welch's t-tests or Wilcoxon's rank-sum tests with Bonferroni corrections. RESULTS The implanted and simulated techniques all resulted in greater TA valgus compared to the native groove (p < 0.001). The implanted technique, KA and rKA were closer to the native TA than GB, MA and riKA (p > 0.001). All alignment philosophies understuffed the native trochlea groove. KA and rKA understuffed less than all other techniques (p < 0.001), and GB understuffed more than all other techniques (p < 0.001). In extension, all techniques shifted the trochlear sulcus laterally, while in flexion, they medialized it. These effects were most prominent in GB and MA. CONCLUSION Personalized alignment techniques such as KA and rKA, which consider variations in individual anatomy, best restore the native patellar groove compared to systematic alignment techniques when using a standardized femoral component. LEVEL OF EVIDENCE Level III, retrospective review.
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Affiliation(s)
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
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Huang F, Harris S, Zhou T, Roby GB, Preston B, Rivière C. Which method for femoral component sizing when performing kinematic alignment TKA? An in silico study. Orthop Traumatol Surg Res 2024; 110:103769. [PMID: 37979678 DOI: 10.1016/j.otsr.2023.103769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/01/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The kinematically alignment (KA) technique for TKA aims to reproduce the pre-arthritic knee anatomy, including both the femoro-tibial and femoro-patellar joints. An in silico study was conducted to compare 3 different femoral component sizing techniques to identify the anatomical landmark which allows closest restoration of the native trochlear anatomy. Our study's question was: what was the best method for sizing the femoral component when performing KA-TKA? It was hypothesized that sizing the femoral component by aiming to restore the groove height would be the best method to restore the native trochlear anatomy. METHODS GMK sphere® (Medacta) femoral component 3D models were virtually kinematically aligned on 30 tri-dimensional (3D) bony osteoarthritis knee models. The femoral component was mediolaterally positioned to match distal native and prosthetic grooves. Three methods were used to size the femoral component: a conventional method with the anterior femoral cut flush to the femoral cortex (C-KATKA) and two alternative personalized methods aiming to recreate either the medial facet's height (ATM-KATKA) or the groove's height (ATG-KATKA). In-house analysis software was used to compare native and prosthetic trochlear articular surfaces and mediolateral implant overhangs. RESULTS Compared with the C-KATKA, ATG-KATKA and ATM-KATKA techniques increased the component size by a mean of 0.90 (SD 0.31, min 0.5 to max 1.5) (p<0.001) and 1.02 (SD 0.31, min 0.5 to max 1.5) (p<0.001), respectively. C-KATKA technique substantially proximally understuffed the trochleae with maximum values of 7.11mm (SD 1.39, min 3.93mm to max 10.57mm) in the medial facet, 4.72mm (SD 1.27, min 1.46mm to max 6.86mm) in the lateral facet and 4.51mm (SD 1.40, min 1.92mm to max 7.30mm) in the groove, respectively. Alternative techniques understuffed medial facet with maximum values of 5.07mm (SD 1.29, min 2.83mm to max 8.34mm) and 4.70mm (SD 1.52, min 0.83mm to max 8.04mm) for ATG-KATKA and ATM-KATKA techniques, respectively. There was no significant understuffing of the groove or lateral facet for alternative techniques (ATM and ATG). The ATM-KATKA and ATG-KATKA techniques generated mediolateral implant overhang, mainly postero-lateral, with a rate of 90.0% and 86.7%, respectively. In this study, no mediolateral implant overhang was found for C-KATKA. DISCUSSION/CONCLUSION The C-KATKA technique substantially understuffs the native trochlear articular surfaces in medial, lateral and groove parts. Alternative techniques (ATM-KATKA and ATG-KATKA) for sizing the femoral component better restore the native trochlear anatomy but also generate a high rate of postero-lateral implant overhangs. Would this postero-lateral implant overhang be clinically deleterious remains unknown? The aspect ratio of contemporary femoral TKA implants can probably be optimized to allow a better anatomical restoration of the anterior femoral compartment. LEVEL OF EVIDENCE II, in silico study.
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Affiliation(s)
- Fasen Huang
- MSK laboratory, Department of Surgery and Cancer, Imperial College London, London W12 0BZ, United Kingdom; Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, China
| | - Simon Harris
- MSK laboratory, Department of Surgery and Cancer, Imperial College London, London W12 0BZ, United Kingdom
| | - Tianyu Zhou
- MSK laboratory, Department of Surgery and Cancer, Imperial College London, London W12 0BZ, United Kingdom
| | - Gabriel B Roby
- Bordeaux Arthroplasty Research Institute, 6, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Benjamin Preston
- Imperial College London School of Medicine, South Kensington Campus, London SW7 2DD, United Kingdom
| | - Charles Rivière
- MSK laboratory, Department of Surgery and Cancer, Imperial College London, London W12 0BZ, United Kingdom; Bordeaux Arthroplasty Research Institute, 6, rue Georges-Negrevergne, 33700 Mérignac, France; Clinique du Sport Bordeaux-Mérignac, 4, rue Georges-Negrevergne, 33700 Mérignac, France.
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Hull ML, Simileysky A, Howell SM. Differences in Trochlear Morphology of a New Femoral Component Designed for Kinematic Alignment from a Mechanical Alignment Design. Bioengineering (Basel) 2024; 11:62. [PMID: 38247939 PMCID: PMC10812931 DOI: 10.3390/bioengineering11010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Because kinematic alignment (KA) aligns femoral components in greater valgus and with less external rotation than mechanical alignment (MA), the trochlear groove of an MA design used in KA is medialized, which can lead to complications. Hence, a KA design has emerged. In this study, our primary objective was to quantify differences in trochlear morphology between the KA design and the MA design from which the KA design evolved. The KA and MA designs were aligned in KA on ten 3D femur-cartilage models. Dependent variables describing the morphology of the trochlea along the anterior flange, which extends proximal to the native trochlea, and along the arc length of the native trochlea, were determined, as was flange coverage. Along the anterior flange, the KA groove was significantly lateral proximally by 10 mm and was significantly wider proximally by 5 mm compared to the MA design (p < 0.0001). Along the arc length of the native trochlea, the KA groove was significantly lateral to the MA design by 4.3 mm proximally (p ≤ 0.0001) and was significantly wider proximally by 19 mm than the MA design. The KA design reduced lateral under-coverage of the flange from 4 mm to 2 mm (p < 0.0001). The KA design potentially mitigates risk of patellofemoral complications by lateralizing and widening the groove to avoid medializing the patella for wide variations in the lateral distal femoral angle, and by widening the flange laterally to reduce under-coverage. This information enables clinicians to make informed decisions regarding use of the KA design.
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Affiliation(s)
- Maury L. Hull
- Department of Biomedical Engineering, Department of Mechanical Engineering, Department of Orthopaedic Surgery, University of California Davis, Davis, CA 95616, USA
| | - Alexander Simileysky
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
| | - Stephen M. Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
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Howell SM, Sappey-Marinier E, Niesen AE, Nedopil AJ, Hull ML. Better forgotten joint scores when the angle of the prosthetic trochlea is lateral to the quadriceps vector in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5438-5445. [PMID: 37792084 DOI: 10.1007/s00167-023-07598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The primary aim was to analyze unrestricted kinematic alignment (unKA) total knee arthroplasty (TKA) and determine the frequency of medial deviation of the prosthetic trochlear angle (PTA) of the femoral component relative to the quadriceps vector (QV) that terminates at the anterior inferior iliac spine (AIIS), and whether patients with medial deviation had a worse Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) relative to those with lateral deviation. The secondary aim was to determine the frequency of medial deviation for mechanical alignment (MA) TKA simulations. METHODS From a database of a single surgeon, the study extracted de-identified data on 147 patients with a CT scanogram showing the pelvis and AIIS, a limb with an unKA TKA, and a native (i.e., healthy) opposite limb. On the scanogram, an examiner, blinded to the PROMs, measured the PTA-QV angle on the unKA TKA and on the opposite limb simulated MA TKA by drawing the PTA at 6° valgus relative to the femoral mechanical axis and measuring the PTA-QV angle. RESULTS Medial deviation of the PTA occurred in 86% of patients with unKA TKA, and the 126 with medial deviation had a 17/1 point worse median FJS/OKS than the 21 with lateral deviation at a mean follow-up of 47 ± 8 months, respectively (p < 0.0001, p = 0.0053). In addition, 21%, 17%, and 8% of MA TKA had medial deviation after radiographic simulation using reported surgical errors for manual, patient-specific, and robotic instrumentation, respectively. CONCLUSION In most patients with unKA TKA and a smaller proportion with MA TKA, a PTA of 6° valgus was medial to the QV, which, by excluding the patient's Q-angle, might alter patellofemoral kinematics like an incorrectly oriented trochleoplasty. The 17-point worse FJS in the patients with an unKA TKA and medial deviation of the PTA suggests the surgical target should be to orient the PTA lateral to the QV. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
| | - Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, 94143, USA.
- Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 69008, Lyon, France.
| | - Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
| | - Alexander J Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074, Würzburg, Germany
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
- Department of Orthopedic Surgery, University of California, Davis Medical Center, Sacramento, CA, 95817, USA
- Department of Mechanical Engineering, University of California, Davis, CA, 95616, USA
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Takashima Y, Nakano N, Ishida K, Kamenaga T, Tsubosaka M, Kuroda Y, Hayashi S, Kuroda R, Matsumoto T. Effects of Femoral Component Design on the Deepest Point Position of the Trochlear Grove in Kinematically Aligned Total Knee Arthroplasty: A Comparison of Four Prothesis Designs. J Knee Surg 2023; 36:1316-1322. [PMID: 36150661 DOI: 10.1055/s-0042-1756502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the study is to explore and compare the differences in trochlear shape and knee anatomy between four types of prostheses and preoperative native knee matched with preoperative computed tomography (CT). Thirty patients were scheduled for primary kinematically aligned total knee arthroplasty (TKA) for varus knee osteoarthritis at our hospital and the region between their pelvis to ankle joint was simulated using a CT-based three-dimensional planning software. The axial plane containing the transepicondylar axis was set as Slice A, and the 10-mm distal plane from Slice A was set as Slice B. The distances to the deepest trochlear groove between the native knee and each prosthesis and the medial and lateral facet heights were compared among the four groups. The deepest femoral trochlear groove of the prostheses was located 1.6 to 3.0 mm more medial than that of the native knee, and in the Persona group, it was significantly more medial than in the e-motion or Triathlon groups on both Slices A and B. The native knee and the medial and lateral facet heights of the four prostheses on both Slices A and B were significantly lower than those of preoperative native knees when femoral prostheses were set in the kinematically aligned (KA)-TKA position. The deepest point of the trochlear groove of the Persona group was the most medial among the four prostheses studied, and the deepest points differed depending on the prosthesis design in KA-TKA. Thus, surgeons should carefully select the type of prostheses used in KA-TKA.
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Affiliation(s)
- Yoshinori Takashima
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Kafelov M, Farhat J, Servien E, Lustig S, Batailler C. New measurement technique for restoration of the trochlear offset after image-based robotic-assisted total knee arthroplasty: a reliability study. SICOT J 2023; 9:29. [PMID: 37772857 PMCID: PMC10540675 DOI: 10.1051/sicotj/2023027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION The new concepts in total knee arthroplasty (TKA) tend to improve the alignment and ligament balancing after TKA. Nevertheless, the assessment of the anterior compartment is difficult. The purpose of this study was to describe a new measurement technique of trochlear offset restoration on CT-scan after primary robotic-assisted TKA and assess its reliability and repeatability. METHOD This monocentric study assessed the trochlear offset restoration on a CT scan after 20 robotic-assisted TKA. To evaluate the trochlear offset restoration, we measured the depth difference between the native and the prosthetic trochlea. Four sequential positions were assessed on the trochlea: at full extension, at 30°, 70°, and 90° flexion. For each of these positions, we compared the highest point of the lateral native condyle and the lateral prosthetic condyle, the highest point of the medial native condyle and the medial prosthetic condyle, the deepest point of the native trochlear groove and the prosthetic trochlea. Two independent reviewers performed the measurements to assess their reliability. To determine intraobserver variability, the first observer performed the measurements twice. RESULTS The mean age was 67.3 years old ± 8.3. Mean values of the trochlear offset restoration for the medial condyle, trochlear groove and lateral condyle were respectively: 1.0 mm ± 1.6, 1.1 mm ± 1.5, -2.7 mm ± 2.3 in full extension; -3.5 mm ± 1.7, -1.5 mm ± 1.7, -3.9 mm ± 3.9 at 30° flexion; -5.1 mm ± 1.8, 2.1 mm ± 2.7, -3.8 mm ± 1.8 at 70° flexion; 2.0 mm ± 1.4 and 3.1 mm ± 1.5 for the medial and lateral condyles at 90° flexion. The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements with mean kappa values of 0.92 and 0.74. CONCLUSION We present a novel measurement technique on CT scan for evaluating the restoration of the trochlear offset after TKA, demonstrating excellent inter and intra-observer reliability.
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Affiliation(s)
- Moussa Kafelov
- Orthopaedics surgery and Sports Medicine Department, FIFA medical center of excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
- University Multiprofile Hospital for Active Treatment and Emergency Medicine “N. I. Pirogov” Sofia Bulgaria
| | - Jawhara Farhat
- Orthopaedics surgery and Sports Medicine Department, FIFA medical center of excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
| | - Elvire Servien
- Orthopaedics surgery and Sports Medicine Department, FIFA medical center of excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1 Lyon France
| | - Sébastien Lustig
- Orthopaedics surgery and Sports Medicine Department, FIFA medical center of excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
- University Multiprofile Hospital for Active Treatment and Emergency Medicine “N. I. Pirogov” Sofia Bulgaria
| | - Cécile Batailler
- Orthopaedics surgery and Sports Medicine Department, FIFA medical center of excellence, Croix-Rousse Hospital, Lyon University Hospital 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
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12
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Sim CHS, Sultana R, Tay KXK, Howe CY, Howe TS, Koh JSB. SF-36 physical function and general health domains are independent predictors of acute hospital length of stay after hip fracture surgery. Musculoskelet Surg 2023; 107:287-294. [PMID: 35798925 DOI: 10.1007/s12306-022-00753-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The demographics and co-morbidities of individuals may impact healthcare consumption, but it is less understood how premorbid physical and mental function may influence these effects. The aim of this study is to determine patient's pre-fracture quality of life and mobility affect acute hospital burden in the management of hip fracture, using length of stay (LOS) as a proxy for healthcare resource. MATERIALS AND METHODS This is a retrospective study which investigated hip fracture patients who underwent surgery over the period of 2017-2020. Variables collected include LOS, age, gender, race, marital status, payer type, ASA score, time to surgery (TTS), type of surgery, fracture type, POD1 mobilization, discharge disposition, pre-fracture SF-36, EQ-5D and Parker mobility score (PMS) based on patient's recollection on admission. These variables were correlated with LOS using binary logistic regression on SAS. RESULTS There were 1045 patients, and mean age was 79.5 + 8.57 (range 60-105) years with an average LOS 13.64 + 10.0 days (range 2-114). On univariate analysis, PMS, EQ-5D and all domains of SF-36 except bodily pain (BP), emotional role and mental health were associated significantly with LOS. Amongst the QOL and PMS scores, only the domains of SF-36 Physical Function (PF) (OR = 0.993, p = 0.0068) and General Health perception (GH) (OR 0.992, p = 0.0230) remained significant on the multivariate model. CONCLUSION Our study showed that poor premorbid scores of SF36 PF and GH are independent factors associated with longer LOS in hip fracture patients after surgery, regardless of fracture type, age and ASA status. Hence, premorbid SF36 PF and GH can be used to identify patients that are at risk of prolonged hospital stay and employ targeted strategies to facilitate rehabilitation and discharge planning.
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Affiliation(s)
- Craigven H S Sim
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore, Singapore.
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Kenny X K Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore, Singapore
| | - C Y Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore, Singapore
| | - T S Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore, Singapore
| | - Joyce S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, Academia Level 4, Singapore, Singapore
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Parente A, Medetti M, Raineri D, Parente F, Ventura A, Legnani C. Patellofemoral knee pain following total knee arthroplasty. Comparison between adjusted mechanical and inverse restricted kinematic alignment. J Orthop 2023; 43:121-124. [PMID: 37583756 PMCID: PMC10424064 DOI: 10.1016/j.jor.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/17/2023] Open
Abstract
Objective The aim of this study was to assess the functional, radiological, and clinical outcomes of patellofemoral joint in patients who had total knee arthroplasty (TKA) without patellar resurfacing for end-stage osteoarthritis using inverse restricted kinematic alignment (irKA) compared to a control group using adjusted mechanical alignment (aMA), both executed with the same implant at the same Institution. The hypothesis was that patients undergoing TKA without patellar resurfacing for end-stage osteoarthritis using irKA would have superior outcomes related to the patellofemoral joint in comparison to a control group using aMA. Methods A retrospective examination of registries' prospectively obtained from patients who underwent primary TKA at our Institution between 2016 and 2020 was performed. 40 consecutive patients who underwent TKA implant using irKA were compared to a control group of 80 who had undergone adjusted mechanically-aligned TKA. Groups were matched for age and body mass index. Clinical assessment included Visual Analog Scale (VAS), Knee Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and Kujala Knee Score. Standard weight-bearing anteroposterior and lateral view x-rays were used for radiographic evaluation. Patellar height was assessed using Caton-Deschamps (C-D) and Insall index on lateral view films. Results In comparison to pre-operative status, both groups had postoperative improvements in VAS, KOOS, KSS, and Kujala ratings (p<0.001). Regarding Kujala score, there were no statistically significant differences between the groups (p = 0.68). Insall index and C-D index results were not statistically different across groups (p = 0.02 and 0.74 respectively). Conclusion Improvements in post-operative clinical and functional outcomes following TKA were associated with either irKA or aMA. There were no discernible changes between the two groups in terms of postoperative patellofemoral discomfort or variations in patellar height.
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Affiliation(s)
- Andrea Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Marta Medetti
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | | | - Franco Parente
- IRCCS Istituto Ortopedico Galeazzi, Hip and Knee Arthroplasty Surgery Center, Milan, Italy
| | - Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy
| | - Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy
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Hiranaka T, Fujishiro T, Koide M, Okamoto K. Kinematically Aligned Oxford Unicompartmental Knee Arthroplasty Using the Microplasty Instrumentation System. Clin Orthop Surg 2023; 15:690-694. [PMID: 37529198 PMCID: PMC10375823 DOI: 10.4055/cios22205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 08/03/2023] Open
Abstract
This technical note demonstrates kinematically aligned Oxford unicompartmental knee arthroplasty using the Microplasty instrumentation system with custom-made devices. The medial joint line is evaluated preoperatively; if it is aligned and parallel with the lateral joint line, they are considered to comprise the coronal knee joint line (CJL). In this case, the coronal inclination of a spoon gauge inserted into the medial joint space indicates the CJL. Otherwise, an accessory spoon is inserted and connected to the medial spoon to refer to the posterior condylar line, which is considered the CJL. The tibial cutting block is then connected without changing the inclination of the spoon and the coronal tilt of the tibial extramedullary rod is adjusted, which is implemented with a custom-made ankle yoke. The remainder of the steps is then identical to the conventional Microplasty procedure. This technique can imitate the cutting line to the CJL, which might be considered ideal from mechanical and kinematic perspectives.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
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Liu Z, Zhou A, Fauveau V, Lee J, Marcadis P, Fayad ZA, Chan JJ, Gladstone J, Mei X, Huang M. Deep Learning for Automated Measurement of Patellofemoral Anatomic Landmarks. Bioengineering (Basel) 2023; 10:815. [PMID: 37508842 PMCID: PMC10376187 DOI: 10.3390/bioengineering10070815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Patellofemoral anatomy has not been well characterized. Applying deep learning to automatically measure knee anatomy can provide a better understanding of anatomy, which can be a key factor in improving outcomes. METHODS 483 total patients with knee CT imaging (April 2017-May 2022) from 6 centers were selected from a cohort scheduled for knee arthroplasty and a cohort with healthy knee anatomy. A total of 7 patellofemoral landmarks were annotated on 14,652 images and approved by a senior musculoskeletal radiologist. A two-stage deep learning model was trained to predict landmark coordinates using a modified ResNet50 architecture initialized with self-supervised learning pretrained weights on RadImageNet. Landmark predictions were evaluated with mean absolute error, and derived patellofemoral measurements were analyzed with Bland-Altman plots. Statistical significance of measurements was assessed by paired t-tests. RESULTS Mean absolute error between predicted and ground truth landmark coordinates was 0.20/0.26 cm in the healthy/arthroplasty cohort. Four knee parameters were calculated, including transepicondylar axis length, transepicondylar-posterior femur axis angle, trochlear medial asymmetry, and sulcus angle. There were no statistically significant parameter differences (p > 0.05) between predicted and ground truth measurements in both cohorts, except for the healthy cohort sulcus angle. CONCLUSION Our model accurately identifies key trochlear landmarks with ~0.20-0.26 cm accuracy and produces human-comparable measurements on both healthy and pathological knees. This work represents the first deep learning regression model for automated patellofemoral annotation trained on both physiologic and pathologic CT imaging at this scale. This novel model can enhance our ability to analyze the anatomy of the patellofemoral compartment at scale.
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Affiliation(s)
- Zelong Liu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander Zhou
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Valentin Fauveau
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Justine Lee
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Philip Marcadis
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Zahi A. Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jimmy J. Chan
- Department of Orthopedics and Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James Gladstone
- Department of Orthopedics and Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xueyan Mei
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mingqian Huang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Rivière C, Villet L, Roby GB. Anatomical restoration of the anterior femoral compartment when performing KATKA: the end of the flush anterior femoral cut dogma! Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07405-z. [PMID: 37004532 DOI: 10.1007/s00167-023-07405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/19/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Charles Rivière
- Clinique du Sport Bordeaux-Mérignac, 04 Rue Georges Negrevergne, 33700, Mérignac, France.
- Bordeaux Arthroplasty Research Institute, Centre de l'Arthrose, 06 Rue Georges Negrevergne, 33700, Mérignac, France.
- Personalized Arthroplasty Society, Atlanta, GA, USA.
| | - Loïc Villet
- Clinique du Sport Bordeaux-Mérignac, 04 Rue Georges Negrevergne, 33700, Mérignac, France
- Bordeaux Arthroplasty Research Institute, Centre de l'Arthrose, 06 Rue Georges Negrevergne, 33700, Mérignac, France
- Personalized Arthroplasty Society, Atlanta, GA, USA
| | - Gabriel B Roby
- Clinique du Sport Bordeaux-Mérignac, 04 Rue Georges Negrevergne, 33700, Mérignac, France
- Bordeaux Arthroplasty Research Institute, Centre de l'Arthrose, 06 Rue Georges Negrevergne, 33700, Mérignac, France
- Personalized Arthroplasty Society, Atlanta, GA, USA
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Personalisation and customisation in total knee arthroplasty: the paradox of custom knee implants. Knee Surg Sports Traumatol Arthrosc 2023; 31:1193-1195. [PMID: 36934205 DOI: 10.1007/s00167-023-07385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
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Shatrov J, Coulin B, Batailler C, Servien E, Walter B, Lustig S. Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology. INTERNATIONAL ORTHOPAEDICS 2023; 47:329-341. [PMID: 36112197 PMCID: PMC9877070 DOI: 10.1007/s00264-022-05570-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove. METHODS One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial-lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°-40°) and deep flexion (70°-80°). RESULTS Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion. CONCLUSION Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.
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Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Sydney Orthopaedic Research Institute at Landmark Orthopaedics, St. Leonards, Sydney, Australia
| | - Benoit Coulin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Bill Walter
- University of Sydney, St Leonards, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Sebastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
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Lustig S, Servien E, Batailler C. How to optimize patellar tracking in knee arthroplasty? Orthop Traumatol Surg Res 2023; 109:103458. [PMID: 36302447 DOI: 10.1016/j.otsr.2022.103458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/04/2022] [Indexed: 12/24/2022]
Abstract
Good patellar tracking is needed for functionally successful total knee arthroplasty (TKA), and depends on several factors. The aim of the present Instructional Lecture is to identify the main factors and how to control them so as to optimize patellar tracking: more or less "patella-friendly" prosthetic trochlea design, requiring precise assessment and choice of model; patellar component design; type of tibial implant; surgical approach and management of peripatellar structures, and any lateral release; distal and posterior femoral bone cuts, determining femorotibial alignment, femoral component rotation and patellar height; tibial implant rotation with respect to the anterior tibial tubercle; patellar cut characteristics in resurfacing. In case of instability or patellar maltracking despite correct implant positioning, there are 2 main surgical techniques: medial patellofemoral ligament reconstruction, and anterior tibial tubercle medialization. To obtain optimal patellar tracking, correction of other factors should be associated: trochlear component design, distal and posterior femoral bone cuts, tibial implant positioning, patellar component shape and positioning, etc.
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Affiliation(s)
- Sébastien Lustig
- Service de chirurgie orthopédique et médecine du sport, centre d'Excellence FIFA, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Elvire Servien
- Service de chirurgie orthopédique et médecine du sport, centre d'Excellence FIFA, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cécile Batailler
- Service de chirurgie orthopédique et médecine du sport, centre d'Excellence FIFA, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Patient-reported impairment following TKA is reduced when a computationally simulated predicted ideal alignment is achieved. Knee Surg Sports Traumatol Arthrosc 2023; 31:1098-1105. [PMID: 36446908 PMCID: PMC9957835 DOI: 10.1007/s00167-022-07225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Joint dynamics following Total Knee Arthroplasty (TKA) may influence patient-reported outcome. Simulations allow many knee alignment approaches to a single patient to be considered prior to surgery. The simulated kinematics can be matched to patient-reported outcome to predict kinematic patterns most likely to give the best outcome. This study aims to validate one such previously developed algorithm based on a simulated deep knee bend (the Dynamic Knee Score, DKS). METHODS 1074 TKA patients with pre- and post-operative Computerised Tomography (CT) scans and 12-month post-operative Knee Injury and Osteoarthritis Outcomes (KOOS) Scores were identified from the 360 Med Care Joint Registry. Landmarking and registration of implant position was performed on all CT scans, and each of the achieved TKAs was computationally simulated and received a predictive outcome score from the DKS. In addition, a set of potential alternative surgical plans which might have been followed were simulated. Comparison of patient-reported issues and DKS score was evaluated in a counter-factual study design. RESULTS Patient-reported impairment with the knee catching and squatting was shown to be 30% lower (p = 0.005) and 22% lower (p = 0.026) in patients where the best possible DKS result was the one surgically achieved. Similar findings were found relating attainment of the best tibial slope and posterior femoral resection DKS plans to patient-reported difficulty straightening the knee (40% less likely, p < 0.001) and descending stairs (35% less likely, p = 0.006). CONCLUSION The DKS has been shown to correlate with presence of patient-reported impairments post-TKA and the resultant algorithm can be applied in a pre-operative planning setting. Outcome optimization in the future may come from patient-specific selection of an alignment strategy and simulations may be a technological enabler of this trend. LEVEL OF EVIDENCE III (Retrospective Cohort Study).
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Mismatch between trochlear coronal alignment of arthritic knees and currently available prosthesis: a morphological analysis of 4116 knees and 45 implant designs. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07251-5. [PMID: 36456826 DOI: 10.1007/s00167-022-07251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE In up to a fifth of total knee replacements (TKR), surgeons are not capable of achieving good clinical and functional results. Despite comprehensive diagnostic workup, an underlying cause is not always identified in these patients. The purpose of this study is to compare native and prosthetic trochlear anatomies, to evaluate a potential source of morphologic mismatch and theoretically, of poor clinical outcomes. METHODS Native trochlear angles of 4116 knee CTs from 360 Knee Systems database of arthritic pre-operative TKR patients were evaluated. A semi-automated tridimensional analysis was performed to define the native trochlear angle in the coronal plane (NTA) among other 142 parameters. An active search was conducted to identify currently available TKR models; prosthetic trochlear orientation in the coronal plane (PTA) was extracted from the technical data provided by manufacturers. RESULTS The mean native trochlear angle (NTA) was 1.6° ± 6.6° (valgus) with a range from - 23.8° (varus) to 30.3°(valgus). A valgus NTA was present in 60.6% of the knees and 39.4% of them had a varus NTA. 89 TKR models were identified; trochlear details were available for 45 of them, of which 93% were designed with a valgus orientation of the prosthetic trochlear angle (PTA) and 6.9% showed a neutral (0°) PTA. Varus alignment of PTA was not present in any system. Angular numeric values for PTA were available for 34 models; these ranged from 0° to 15° of valgus, with a median value of 6.18° (SD ± 2.88°). CONCLUSION This study shows a significant mismatch between native and prosthetic trochlear angles. A relevant proportion of the studied knees (41.45%) fall out of the trochlear angle range of currently available implants; representing a potential source for biomechanical imbalance. While further research is warranted to fully understand the clinical implications of the present study, manufacturers may need to take these findings into account for future implant designs. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Sappey-Marinier E, Howell SM, Nedopil AJ, Hull ML. The Trochlear Groove of a Femoral Component Designed for Kinematic Alignment Is Lateral to the Quadriceps Line of Force and Better Laterally Covers the Anterior Femoral Resection Than a Mechanical Alignment Design. J Pers Med 2022; 12:jpm12101724. [PMID: 36294863 PMCID: PMC9605321 DOI: 10.3390/jpm12101724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: A concern about kinematically aligned (KA) total knee arthroplasty (TKA) is that it relies on femoral components designed for mechanical alignment (MAd-FC) that could affect patellar tracking, in part, because of a trochlear groove orientation that is typically 6° from vertical. KA sets the femoral component coincident to the patient’s pre-arthritic distal and posterior femoral joint lines and restores the Q-angle, which varies widely. Relative to KA and the native knee, aligning the femoral component with MA changes most distal joint lines and Q-angles, and rotates the posterior joint line externally laterally covering the anterior femoral resection. Whether switching from a MAd- to a KAd-FC with a wider trochlear groove orientation of 20.5° from vertical results in radiographic measures known to promote patellar tracking is unknown. The primary aim was to determine whether a KAd-FC sets the trochlear groove lateral to the quadriceps line of force (QLF), better laterally covers the anterior femoral resection, and reduces lateral patella tilt relative to a MAd-FC. The secondary objective was to determine at six weeks whether the KAd-FC resulted in a higher complication rate, less knee extension and flexion, and lower clinical outcomes. Methods: Between April 2019 and July 2022, two surgeons performed sequential bilateral unrestricted caliper-verified KA TKA with manual instruments on thirty-six patients with a KAd- and MAd-FC in opposite knees. An observer measured the angle between a line best-fit to the deepest valley of the trochlea and a line representing the QLF that indicated the patient’s Q-angle. When the trochlear groove was lateral or medial relative to the QLF, the angle is denoted + or −, and the femoral component included or excluded the patient’s Q-angle, respectively. Software measured the lateral undercoverage of the anterior femoral resection on a Computed Tomography (CT) scan, and the patella tilt angle (PTA) on a skyline radiograph. Complications, knee extension and flexion measurements, Oxford Knee Score, KOOS Jr, and Forgotten Joint Score were recorded pre- and post-operatively (at 6 weeks). A paired Student’s T-test determined the difference between the KA TKAs with a KAd-FC and MAd-FC with a significance set at p < 0.05. Results: The final analysis included thirty-five patients. The 20.5° trochlear groove of the KAd-FC was lateral to the QLF in 100% (15 ± 3°) of TKAs, which was greater than the 69% (1 ± 3°) lateral to the QLF with the 6° trochlear groove of the MAd-FC (p < 0.001). The KAd-FC’s 2 ± 1.9 mm lateral undercoverage of the anterior femoral resection was less than the 4.4 ± 1.5 mm for the MAd-FC (p < 0.001). The PTA, complication rate, knee extension and flexion, and clinical outcome measures did not differ between component designs. Conclusions: The KA TKA with a KAd-FC resulted in a trochlear groove lateral to the QLF that included the Q-angle in all patients, and negligible lateral undercoverage of the anterior femoral resection. These newly described radiographic parameters could be helpful when investigating femoral components designed for KA with the intent of promoting patellofemoral kinematics.
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Affiliation(s)
- Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143, USA
- Correspondence:
| | - Stephen M. Howell
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Alexander J. Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074 Würzburg, Germany
| | - Maury L. Hull
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
- Department of Orthopedic Surgery, University of California, Davis, CA 95818, USA
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23
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Sadoghi P, Vendittoli PA, Lustig S, Leal J, Graichen H, Rivière C, Hirschmann M. Less religion and more science in the discussion of personalized alignment in total knee arthroplasty: we need to lead the transition process! Knee Surg Sports Traumatol Arthrosc 2022; 30:2883-2885. [PMID: 35906411 DOI: 10.1007/s00167-022-07079-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Pascal-André Vendittoli
- Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, 5415 Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada
| | - Sebastien Lustig
- Service de Chirurgie Orthopédique, Centre Albert-Trillat, CHU de Lyon-Nord, Lyon, France
| | - Joan Leal
- Department of Orthopaedic Surgery, Hospital Sant Joan de Déu de Manresa, Fundació Althaia (Spain), Universitat de Vic, Doctor Joan Soler 1-3, 08243, Manresa, Spain
| | - Heiko Graichen
- Department of Arthroplasty, Sports Medicine and Traumatology, Orthopaedic Hospital Lindenlohe, Indanone 18, 92421, Schwandorf, Germany
| | - Charles Rivière
- Bordeaux Arthroplasty Research Institute-Clinique du Sport Bordeaux-Mérignac, 04-06 rue Georges Negrevergne, 33700, Mérignac, France
| | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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24
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Hazratwala K, O'Callaghan WB, Dhariwal S, Wilkinson MPR. Wide variation in tibial slopes and trochlear angles in the arthritic knee: a CT evaluation of 4116 pre-operative knees. Knee Surg Sports Traumatol Arthrosc 2022; 30:3049-3060. [PMID: 34487188 DOI: 10.1007/s00167-021-06725-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 08/24/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE As surgeons continue to grapple with persistent issues of patient dissatisfaction post-TKA, the literature has focused on the coronal plane when considering alignment strategies but has largely ignored the sagittal and axial planes. The purpose of this retrospective observational cohort study is to evaluate variability in knee anatomy and alignment beyond the coronal plane and rationalise how this relates to existing arthroplasty alignment philosophies. METHODS 4116 knee CTs from 360 Knee Systems© database of arthritic pre-operative TKA patients were evaluated. Standardised bony landmarks were used in each CT to determine the hip-knee angle, medial proximal tibial angle, lateral distal femoral angle, medial plateau posterior tibial slope, lateral plateau posterior tibial slope, trochlea angle (TA) to distal femoral angle (TA-DFA) and TA to posterior condylar angle (TA-PCA). Analysis was performed to determine the distributions of each measure across the cohort population. RESULTS Both the medial and lateral PTS ranged from 5° anterior to 25° posterior. 22.6% of patients had differential PTS greater than 5°. 14.5% have greater lateral PTS (mean difference to medial PTS of 4.8° ± 5.0°), whilst 31.0% have greater medial PTS (mean difference to lateral PTS of 5.7° ± 3.2°). 14% of TA-DFAs and 5.2% of TA-PCAs vary greater than 10°. CONCLUSION This study demonstrates a wide variation in tibial slope, differential slope between the medial and lateral tibial plateau as well as variation in the trochlear geometry. There has been an overemphasis in the literature on coronal alignment, ignoring the considerable variability present in tibial and patellofemoral morphology. Existing arthroplasty techniques are based on assumptions that may not adequately address the anatomy of morphologic outliers and could lead to dissatisfaction. LEVEL OF EVIDENCE III-retrospective cohort study.
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Affiliation(s)
- Kaushik Hazratwala
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, QLD, 4812, Australia.
| | - William B O'Callaghan
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, QLD, 4812, Australia
| | | | - Matthew P R Wilkinson
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, QLD, 4812, Australia
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25
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Matsumoto T, Takashima Y, Takayama K, Ishida K, Nakano N, Kuroda Y, Tsubosaka M, Kamenaga T, Matsushita T, Niikura T, Hayashi S, Kuroda R. Comparison between Single- and Multi-Radius Prostheses Used in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2022; 35:1004-1009. [PMID: 33368061 DOI: 10.1055/s-0040-1721413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kinematically aligned total knee arthroplasty (TKA) has gained interest for achieving more favorable clinical outcomes than mechanically aligned TKA. The present study aimed to compare the clinical outcomes of kinematically aligned TKAs using single-radius (SR) or multi-radius (MR) prostheses. Sixty modified kinematically aligned cruciate-retaining TKAs (30 SR and 30 MR type prostheses) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative and postoperative patellar tracking were compared between the two groups. Trochlea shape was also compared between the prostheses and preoperative native anatomy using three-dimensional simulation software. Total 2 years postoperatively, the range of motion and 2011 Knee Society Scores (KSS) were compared between the two groups. There were no differences in patellar maltracking including patellar lateral shift and tilt between the two groups; however, the ratio of intraoperative lateral retinacular release for adjusting patellar tracking was significantly higher in the MR group than in the SR group. Lateral and medial facet heights in both prostheses were understuffed compared with native knee anatomy, while the deepest point of the trochlear groove was significantly more medial in the MR group. The postoperative clinical outcomes showed no significant differences between the two groups. In conclusion, modified kinematically aligned TKAs using a SR or MR prosthesis showed no significant differences in clinical outcomes or patellar tracking when appropriate lateral retinacular release was performed.
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Affiliation(s)
- Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yoshinori Takashima
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Koji Takayama
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
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Parratte S, Van Overschelde P, Bandi M, Ozturk BY, Batailler C. An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique. Knee Surg Sports Traumatol Arthrosc 2022; 31:1334-1346. [PMID: 35552475 DOI: 10.1007/s00167-022-06995-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE An anatomo-functional implant positioning (AFIP) technique in total knee arthroplasty (TKA) could restore physiological ligament balance (symmetric gap in extension, asymmetric gap in flexion). The purposes were to compare (1) ligament balancing in extension and flexion after TKA in the AFIP group, (2) TKA alignment, implant positioning and patellar tracking between AFIP and adjusted mechanical alignment (aMA) techniques, (3) clinical outcomes between both groups at 12 months. METHODS All robotic-assisted TKA with an AFIP technique were included (n = 40). Exclusion criteria were genu valgum (HKA angle > 183°), extra-articular deformity more than 10°, and patellar maltracking (high-grade J-sign). One control patient with a TKA implanted by an aMA technique was matched for each case, based on age, body mass index, sex, and knee alignment. Ligament balancing (medial and lateral gaps in millimeters) in full extension and at 90° of flexion after TKA in the AFIP group was assessed with the robotic system. TKA alignment (HKA angle), implants positioning (femoral and tibial coronal axis, tibial slope, joint-line orientation), patellar tracking (patellar tilt and translation) and the Knee Society Score (KSS) at 6 and 12 months were compared between both groups. The ligament balancing was compared using a t test for paired samples in the AFIP group. The radiographic measurements and KSS scores were compared between groups using a t test for independent samples. RESULTS In the AFIP group, there was no significant difference between the medial and lateral gap laxity in extension (NS). A significant opening of the lateral gap was observed in flexion compared to extension (mean: + 2.9 mm; p < 0.0001). The mean postoperative HKA angle was comparable between both groups (177.3° ± 2.1 in the AFIP group vs 176.8° ± 3.2; NS). In the AFIP group, the femoral anatomy was restored (90.9° ± 1.6) and the tibial varus was partially corrected (87.4° ± 1.8). The improvement of Knee and Function KSS at 6 months was better in the AFIP group (59.3 ± 11.9 and 51.7 ± 20, respectively, versus 49.3 ± 9.7 and 20.8 ± 13; p < 0.001). CONCLUSION The AFIP concept allowed the restoration of the native knee alignment and a natural functional ligament pattern. With a more physiological target for ligament balancing, the AFIP technique had equivalent clinical outcomes at 12 months compared to aMA, with a faster recovery. LEVEL OF EVIDENCE III retrospective therapeutic case control series.
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Affiliation(s)
- Sébastien Parratte
- Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
- Institute for Locomotion, Aix-Marseille University, Marseille, France
| | - Philippe Van Overschelde
- Department of Orthopaedic Surgery, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | | | - Burak Yagmur Ozturk
- Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Lyon, France.
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Hull ML, Howell SM. Differences in Trochlear Morphology from Native Using a Femoral Component Interfaced with an Anatomical Patellar Prosthesis in Kinematic Alignment and Mechanical Alignment. J Knee Surg 2022; 35:625-633. [PMID: 32927493 DOI: 10.1055/s-0040-1716413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellofemoral complications following total knee arthroplasty can be traced in part to alignment of the femoral component. Kinematic alignment (KA) and mechanical alignment (MA) use the same femoral component but align the component differently. Our objective was to determine differences in trochlear morphology from native for a femoral component interfaced with an anatomical patellar prosthesis in KA and MA. Ten three-dimensional femur-cartilage models were created by combining computed tomography and laser scans of native human cadaveric femurs free of skeletal abnormalities. The femoral component was positioned using KA and MA. Measurements of the prosthetic and native trochlea were made along the arc length of the native trochlear groove and differences from native were computed for the medial-lateral and radial locations of the groove and sulcus angle. Mean medial-lateral locations of the prosthetic groove were within 1.5 and 3.5 mm of native for KA and MA, respectively. Mean radial locations of the prosthetic groove were as large as 5 mm less than native for KA and differences were greater for MA. Sulcus angles of the prosthetic trochlea were 10 degrees steeper proximally, and 10 degrees flatter distally than native for both KA and MA. Largest differences from native occurred for radial locations and sulcus angles for both KA and MA. The consistency of these results with those of other fundamentally different designs which use a modified dome (i.e., sombrero hat) patellar prosthesis highlights the need to reassess the design of the prosthetic trochlea on the part of multiple manufacturers worldwide.
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Affiliation(s)
- Maury L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, California.,Department of Mechanical Engineering, University of California Davis, Davis, California.,Department of Orthopaedic Surgery, University of California Davis, Davis, California
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California Davis, Davis, California
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28
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Bonnin MP, Beckers L, Leon A, Chauveau J, Müller JH, Tibesku CO, Aït-Si-Selmi T. Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment. Knee Surg Sports Traumatol Arthrosc 2022; 30:464-475. [PMID: 32681286 PMCID: PMC8866384 DOI: 10.1007/s00167-020-06153-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe a strategy for coronal alignment using a computed tomography (CT) based custom total knee arthroplasty (TKA) system, and to evaluate the agreement between the planned and postoperative Hip-Knee-Ankle (HKA) angle, Femoral Mechanical Angle (FMA) and Tibial Mechanical Angle (TMA). METHODS From a consecutive series of 918 primary TKAs, 266 (29%) knees received CT-based posterior-stabilized cemented custom TKA. In addition to a preoperative CT-scan, pre- and post-operative radiographs of weight-bearing long leg, anterior-posterior and lateral views of the knee were obtained, on which the FMA, TMA and HKA angles were measured. CT-based three-dimensional (3D) models enabled to correct for cases with bony wear by referring to the non-worn areas and to estimate the native pre-arthritic angles. The alignment technique aimed to preserve or restore constitutional alignment (CA) within predetermined limits, by defining a 'target zone' based on three criteria: 1) a ± 3° (range 87°-93°) primary tolerance for the femoral and tibial resections; 2) a ± 2° secondary tolerance for component obliquity, extending the bounds for FMA and TMA (range 85°-95°); 3) a planned HKA angle range of 175°-183°. Agreement between preoperative, planned and postoperative measurements of FMA, TMA and HKA angle were calculated using intra-class correlation coefficients (ICC). RESULTS Preoperative radiograph and CT-scan measurements revealed that, respectively, 73 (28%) and 103 (40%) knees were in the 'target zone', whereas postoperative radiographs revealed that 217 (84%) TKAs were in the 'target zone'. Deviation from the planned angles were - 0.5° ± 1.8° for FMA, - 0.5° ± 1.8° for TMA, and - 1.1° ± 2.1° for HKA angle. Finally, the agreement between the planned and achieved targets, indicated by ICC, were good for FMA (0.701), fair for TMA (0.462) and fair for HKA angle (0.472). CONCLUSION Using this strategy for coronal alignment, 84% of custom TKAs were within the 'target zone' for FMA, TMA and HKA angles. These findings support the concepts of emerging personalized medicine technologies, and emphasise the importance of accurate strategies for preoperative planning, which are key to achieving satisfactory 'personalised alignment' that can further be improved by customisation of implant components. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michel P. Bonnin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Lucas Beckers
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Augustin Leon
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Jules Chauveau
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | | | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
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29
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Nedopil AJ, Zamora T, Shelton T, Howell SM, Hull M. A Best-Fit of an Anatomic Tibial Baseplate Closely Parallels the Flexion-Extension Plane and Covers a High Percentage of the Proximal Tibia. J Knee Surg 2021; 34:1486-1494. [PMID: 32403149 DOI: 10.1055/s-0040-1710367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are no reports of in vivo internal-external (I-E) rotational alignment and coverage of the proximal tibia after performing a best-fit method of an anatomically designed and asymmetrically shaped tibial baseplate during calipered kinematically aligned (KA) total knee arthroplasty (TKA). We hypothesized that a best-fit plane sets the anterior-posterior (A-P) axis of the anatomic baseplate closely parallel to the flexion-extension (F-E) plane of the knee and covers a high percentage of the proximal tibia. A total of 145 consecutive primary TKAs were prospectively collected. The calipered KA method and verification checks set the positions and orientations of the components without ligament release in all knees without restrictions on the preoperative deformities. A best-fit method selected one of six trials of anatomic baseplates that maximized coverage and set I-E rotation parallel to and within the cortical edge of the proximal tibia. The angle between the transverse axes of the components (i.e., the deviation of the A-P axis of the anatomic baseplate from the F-E plane of the native knee) and the cross-sectional area (CSA) of the proximal tibia were measured on postoperative computerized tomographic scans. The mean deviation of the anatomic baseplate from the F-E plane was 2-degree external ± 5 degrees. The mean coverage of the proximal tibia was 87 ± 6% (CSA of baseplate from the manufacturer/CSA of proximal tibia × 100). The anatomic baseplate and best-fit method adequately set I-E rotation of the baseplate closely parallel to the F-E plane of the knee and cover a high percentage of the proximal tibia.
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Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Tomas Zamora
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile Facultad de Medicina, Santiago, Chile
| | - Trevor Shelton
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California
| | - Maury Hull
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, California.,Department of Mechanical Engineering, University of California, Davis, California.,Department of Biomedical Engineering, University of California, Davis, California
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30
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Kinematic aligned femoral rotation leads to greater patella tilt but similar clinical outcomes when compared to traditional femoral component rotation in total knee arthroplasty. A propensity score matched study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1059-1066. [PMID: 32488370 DOI: 10.1007/s00167-020-06081-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/22/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE External rotation of femoral component in total knee arthroplasty (TKA) with reference to the posterior condyles is recommended in mechanical alignment (MA) to ensure optimum patella tracking. In kinematic knee alignment (KA) technique, femoral component is more internally rotated as the femoral resection is based on flexion-extension axis. This study aims to investigate the clinical and radiological outcomes of the patellofemoral joint in patients who underwent TKA using KA versus mechanical alignment. METHODS A review of prospectively collected registry data of 378 consecutive cruciate retaining primary TKAs (P.F.C.® Total Knee System, DePuy Synthes, Massachusetts, United States) was performed. Propensity scoring was performed matching patients who received KA TKA (n = 93) to MA TKA (n = 93). Oxford Knee Score (OKS), Knee Society Score (KSS), Short-Form 36 (SF-36), range of motion as well as radiographs assessing patella tilt were compared at 6 months and 2 years after surgery. All patients received the same implant and had their patella resurfaced. RESULTS OKS, KSS, physical component of SF-36 and satisfaction rates were comparable at both 6 months and 2 years after surgery. There was moderate association between preoperative and postoperative patella tilt in KA TKA (Cramer's V = 0.260, p < 0.05). Postoperatively, KA group had a greater number of patients with lateral patella tilt compared to the mechanical group (12 [12.9%] vs 1 [1.1%], p < 0.001). Patella tilts, however, resolved two years after surgery. CONCLUSION The relative internal rotation of the femoral component in KA TKA results in greater incidence of lateral patella tilt postoperatively. Nevertheless, patella tilt resolution was noted at 2 years. LEVEL OF EVIDENCE Level III Evidence-Retrospective Cohort Study.
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31
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Jeremić DV, Massouh WM, Sivaloganathan S, Rosali AR, Haaker RG, Rivière C. Short-term follow-up of kinematically vs. mechanically aligned total knee arthroplasty with medial pivot components: A case-control study. Orthop Traumatol Surg Res 2020; 106:921-927. [PMID: 32522532 DOI: 10.1016/j.otsr.2020.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/29/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The kinematic alignment (KA) technique for total knee arthroplasty (TKA) and the medial pivot (MP) component design are two options promoting a physiologic prosthetic knee kinematics when used in combination that could improve TKA outcomes. Case-control study is initiated to compare the 1-year radio-clinical outcomes between kinematic alignment medial pivot total knee arthroplasty (KA MP-TKAs) and mechanical alignment medial pivot total knee arthroplasty (MA MP-TKA). Goal of a study was to answer the following questions: Do KA MP-TKAs patients have improved functional outcomes compared to MA MP-TKAs patients? (Q1); Do prosthetic knee and lower limb alignments differ between KA and MA patients (Q2)? And does kinematic implantation of MP TKA has higher risk of reoperations and revisions (Q3)? MATERIAL AND METHODS A case-control study was carried out to compare the 1-year clinical and radiographic outcomes between 24 consecutive KA-TKA patients and 24 matched MA-TKA patients. All patients had implantation with manual instruments and a cemented medial pivot TKA with excision of the PCL. All data were collected prospectively, and outcome scores were patient reported. RESULTS KA patients had superior values in Forgotten Joint Score (FJS) at 1-year (KA 77 vs. MA 51) (p=0.05) follow-up. After one year KA patients scored better in objective section of the new Knee Society Score (KSS) (p=0.02), and in sport section of the Knee Osteoarthritis Outcome Score (KOOS) (p=0.01). Eleven out of 24 patients (46%) in KA group and 7/24 patients (29%) in MA group had limb alignment out of 180°±3°, whereas 17/24 (70%) of KA patients, and 14/24 (58%) of MA patients had orientation of tibial component with more than 3° of varus. No reoperation or revision occurred in either group. DISCUSSION/CONCLUSION The KA of MP TKA design seems to have a good efficacy at early-term, with some 1-year functional performance higher to the ones from MA MP TKAs. Further research is needed to define if those early results will last over time. LEVEL OF EVIDENCE III, case-controlled study.
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Affiliation(s)
- Dragan V Jeremić
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany.
| | - Wissam M Massouh
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany
| | | | - Almeric R Rosali
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany
| | - Rolf G Haaker
- Clinic for Orthopedic Surgery, St.-Vincenz Hospital, Brakel, Germany
| | - Charles Rivière
- MSK Lab - Imperial College London, White City Campus, The Lister Hospital, Chelsea Bridge, London, UK; Centre de l'Arthrose, Bordeaux-Mérignac, France
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Abstract
Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee. Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA. Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy. No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment. Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival.
Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010
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Affiliation(s)
- Sohail Nisar
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, UK.,Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals Trust, UK
| | | | - Charles Rivière
- MSK Lab - Imperial College London, White City Campus, London, UK.,The Lister Hospital, Chelsea Bridge, London, UK.,Centre de l'Arthrose - Clinique du Sport, Bordeaux-Mérignac, France
| | | | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, UK.,Leeds Teaching Hospitals Trust, UK
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Kinematically aligned TKA restores physiological patellofemoral biomechanics in the sagittal plane during a deep knee bend. Knee Surg Sports Traumatol Arthrosc 2020; 28:1497-1507. [PMID: 31147726 DOI: 10.1007/s00167-019-05547-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Although patellofemoral complications after kinematically aligned (KA) TKA are infrequent, the patellar flexion angle and proximal-distal patellar contact location through flexion, and incidence of patellar loss of contact at full extension are unknown. The present study determined whether the patellar flexion angle and proximal-distal patellar contact location of a KA TKA performed with anatomic, fixed-bearing, posterior cruciate-retaining (PCR) components differed from those of the native contralateral knee during a deep knee bend, and determined the incidence of patellar loss of contact at full extension for KA TKA only. METHODS During a deep knee bend from full extension to maximum flexion, both knees were imaged in a lateral view using single-plane fluoroscopy for 25 patients with a calipered KA TKA and a healthy native knee in the contralateral limb. The patellar flexion angle and proximal-distal patellar contact location were measured on images from full extension to maximum flexion in 30° increments. Paired t tests at each flexion angle determined the significance of the difference between the KA TKA knees and the native contralateral knees. In the KA TKA knees, the incidence of patellar loss of contact at full extension was determined. Patient-reported outcome scores also were recorded including the Oxford Knee Score. RESULTS Mean patellar flexion angles were not different between the KA TKA knees and the native contralateral knees throughout the motion arc. The largest statistically significant difference in the mean proximal-distal patellar contact locations was 4 mm. The incidence of patellar loss of contact in the KA TKA knees at full extension was 8% (2 of 25 patients). The median Oxford Knee Score was 46 out of 48. CONCLUSIONS Calipered KA TKA performed with anatomic, fixed-bearing, PCR components restored patellar flexion angles to native and largely restored the proximal-distal patellar contact locations, which at most differed from the native contralateral knee by approximately 10% of the mean proximal-distal patellar length. In the KA TKA knees, the incidence of patellar loss of contact was infrequent. These objective biomechanical results are consistent with the relatively high subjective patient-reported outcome scores herein and support the low incidence of patellofemoral complications following KA TKA previously reported. LEVEL OF EVIDENCE Therapeutic, level III.
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Kim KK, Howell SM, Won YY. Kinematically Aligned Total Knee Arthroplasty with Patient-Specific Instrument. Yonsei Med J 2020; 61:201-209. [PMID: 32102120 PMCID: PMC7044694 DOI: 10.3349/ymj.2020.61.3.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/30/2019] [Indexed: 11/27/2022] Open
Abstract
Kinematically aligned total knee arthroplasty (TKA) is a new alignment technique. Kinematic alignment corrects arthritic deformity to the patient's constitutional alignment in order to position the femoral and tibial components, as well as to restore the knee's natural tibial-femoral articular surface, alignment, and natural laxity. Kinematic knee motion moves around a single flexion-extension axis of the distal femur, passing through the center of cylindrically shaped posterior femoral condyles. Since it can be difficult to locate cylindrical axis with conventional instrument, patient-specific instrument (PSI) is used to align the kinematic axes. PSI was recently introduced as a new technology with the goal of improving the accuracy of operative technique, avoiding practical issues related to the complexity of navigation and robotic system, such as the costs and higher number of personnel required. There are several limitations to implement the kinematically aligned TKA with the implant for mechanical alignment. Therefore, it is important to design an implant with the optimal shape for restoring natural knee kinematics that might improve patient-reported satisfaction and function.
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Affiliation(s)
- Kwang Kyoun Kim
- Department of Orthopaedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California at Davis, Davis, CA, USA
| | - Ye Yeon Won
- Department of Orthopedic Surgery, Ajou University College of Medicine, Suwon, Korea.
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McEwen PJ, Dlaska CE, Jovanovic IA, Doma K, Brandon BJ. Computer-Assisted Kinematic and Mechanical Axis Total Knee Arthroplasty: A Prospective Randomized Controlled Trial of Bilateral Simultaneous Surgery. J Arthroplasty 2020; 35:443-450. [PMID: 31591010 DOI: 10.1016/j.arth.2019.08.064] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Randomized controlled trials of kinematic alignment (KA) and mechanical alignment (MA) in primary total knee arthroplasty (TKA) have to date demonstrated at least equivalence of KA in terms of clinical outcomes. No trial of bilateral TKA has been conducted so patient preference for one technique over the other is unknown. METHODS Forty-one participants underwent computer-assisted bilateral TKA. The outcome measures were as follows: (1) joint range of motion and functional scores including the KOOS, the KOOS JR, Oxford Knee Score, and the Forgotten Joint Score at a minimum of 2 years; (2) preference and perception of limb symmetry; (3) intraoperative alignment data; (4) release and gap balance data; and (5) postoperative radiographic joint angles. RESULTS There were no significant differences with respect to flexion range (P = .970) or functional scores (mean KOOS, P = .941; KOOS JR, P = .685; Oxford Knee Score, P = .578; FJS, P = .542). Significantly more participants who favored one knee preferred their KA TKA (P = .03); however, half of the patients had no preference and the overall numbers were small. Only 3 participants perceived any limb asymmetry (P < .001). More releases were required in the MA group (P = .018). Standing hip-knee-ankle angle means and frequency distributions were similar (P = .097 and P = .097, respectively). CONCLUSION Clinical outcomes were equivalent at 2 years. Significantly more participants preferred their KA joint. Fewer releases were required using a KA technique. Participants were visually insensitive to modest hip-knee-ankle angle asymmetry. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Peter J McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia; North Queensland Knee, Mater Health Services North Queensland, Townsville, Queensland, Australia
| | - Constantine E Dlaska
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Ivana A Jovanovic
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Kenji Doma
- College of Healthcare Science, James Cook University, Townsville, Queensland, Australia
| | - Benjamin J Brandon
- The Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
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Koh IJ, Lin CC, Patel NA, Chalmers CE, Maniglio M, Han SB, McGarry MH, Lee TQ. Kinematically aligned total knee arthroplasty reproduces more native rollback and laxity than mechanically aligned total knee arthroplasty: A matched pair cadaveric study. Orthop Traumatol Surg Res 2019; 105:605-611. [PMID: 31006644 DOI: 10.1016/j.otsr.2019.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A growing body of evidence supports that kinematically aligned (KA) total knee arthroplasty (TKA) provides superior clinical outcomes and satisfaction than mechanically aligned (MA) TKA. In theory, KA TKA would restore knee kinematics closer to the native condition than MA TKA, but the current biomechanical evidence is lacking. HYPOTHESIS KA TKA would restore knee biomechanics to the native condition better than MA TKA. METHODS Seven pairs of cadavers were tested. For each pair, one knee was randomly assigned to KA TKA and the other to MA TKA. During KA TKA, the sizes of femur and tibia resections were equivalent to implant thickness to align with the patient-specific joint line. MA TKA was performed using conventional measured resection techniques. All specimens were mounted on a customized knee-testing system and digitized. Knee motions measured during flexion included rollback, axial tibiofemoral rotation, and laxities, specifically varus-valgus laxity, anterior-posterior translation, and internal-external rotation. RESULTS The pattern of knee motion following KA TKA was similar to the native knee. However, following MA TKA, both medial and lateral rollback and tibiofemoral axial rotation were decreased relative to those of the native knee. Valgus laxity was restored only after KA TKA, whereas varus laxity was restored only after MA TKA. Anterior translation was increased regardless of the alignment strategy. In addition, rotational laxities were restored after KA TKA, but external rotation laxity increased after MA TKA. CONCLUSION KA TKA restores femoral rollback and laxity to the native condition better than MA TKA. KA TKA may enhance functional performance and provide a more normal knee sensation. LEVEL OF EVIDENCE II, Controlled laboratory study.
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Affiliation(s)
- In Jun Koh
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, 03312 Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea.
| | - Charles C Lin
- University of California, Irvine, School of Medicine, 92697 Irvine, CA, United States
| | - Nilay A Patel
- Department of Orthopaedic Surgery, University of California, Irvine, UCI Medical Center, route 81, 101 City Drive South, 92868 Orange, CA, United States
| | - Christen E Chalmers
- University of California, Irvine, School of Medicine, 92697 Irvine, CA, United States
| | - Mauro Maniglio
- Department of Orthopaedics and Traumatology; Inselspital Bern, University Hospital, Bern, Switzerland
| | - Sung Bin Han
- Joint Replacement Center, Eunpyeong St. Mary's Hospital, 03312 Seoul, Republic of Korea
| | - Michelle H McGarry
- Congress Medical Foundation, 800 South Raymond Pasadena, 91105 CA, United States
| | - Thay Q Lee
- Congress Medical Foundation, 800 South Raymond Pasadena, 91105 CA, United States
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Howell SM. Calipered Kinematically Aligned Total Knee Arthroplasty: An Accurate Technique That Improves Patient Outcomes and Implant Survival. Orthopedics 2019; 42:126-135. [PMID: 31099877 DOI: 10.3928/01477447-20190424-02] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Kinematic alignment performed with caliper measurements and verification checks accurately co-align the femoral and tibial components with the 3 axes and joint lines of the native knee without ligament release and without restrictions on the degree of preoperative varus, valgus, flexion, and extension deformities and the degree of postoperative correction. [Orthopedics. 2019; 42(3):126-135.].
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Kinematic alignment in total knee arthroplasty leads to a better restoration of patellar kinematics compared to mechanic alignment. Knee Surg Sports Traumatol Arthrosc 2019; 27:1529-1534. [PMID: 30421165 DOI: 10.1007/s00167-018-5284-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The influence of different implantation techniques in TKA on tibiofemoral kinematics was analysed in few investigations so far. However, the influence on patellar kinematics remain unclear. The aim of the present investigation was to compare patellar kinematics of the natural knee with those of knees after both kinematically and mechanically aligned TKAs. METHODS Patellar kinematics of ten cadaveric knees before and after TKAs implanted using both a kinematic and mechanic alignment technique were investigated and compared using a commercial optical computer navigation system. RESULTS There was a statistically significant difference between natural patellar kinematics and both implantation techniques analysing mediolateral shift. Patellar lateral tilt showed significant better results in the kinematically compared to the mechanically aligned TKAs. In terms of patella rotation, the patella of both mechanically and kinematically aligned TKAs showed significant higher values for external rotation compared to the natural knee. Regarding epicondylar distance again a significant better restoration of natural kinematics could be found in the kinematically aligned TKAs. CONCLUSION Kinematically aligned TKAs showed a better overall restoration of patellar kinematics compared to a conventional mechanical alignment technique. In terms of clinical usefulness, the present study highlights the potential benefit for clinical outcome using a kinematically aligned implantation technique in TKA to achieve a better restoration of natural patellofemoral kinematics.
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Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion. Knee Surg Sports Traumatol Arthrosc 2019; 27:1520-1528. [PMID: 30370439 DOI: 10.1007/s00167-018-5270-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The implant positioning for kinematically aligned total knee arthroplasty (TKA) differs fundamentally from conventional mechanically aligned TKA. This difference may affect patellofemoral (PF) biomechanics after TKA. This cadaveric study tested the hypothesis that kinematically aligned TKA would restore PF biomechanics to the native condition better than mechanically aligned TKA. METHODS Seven pairs (14 knees) of fresh-frozen cadavers were tested. All specimens were mounted on a customized knee-testing system and digitized using a Microscribe 3DLX instrument (Revware Inc., Raleigh, NC, USA) to measure patellar kinematics in terms of patellar varus/valgus rotation, medial/lateral position, flexion/extension rotation and proximal/distal position at knee flexion angles of 0°, 30°, 60°, 90°, and 120°. The medial and lateral PF joint contact pressure distributions at 120° of knee flexion were measured using a K-scan system (Tekscan Inc., Boston, MA, USA). All patellae remained unresurfaced. For each pair, one knee was randomly assigned to kinematically aligned TKA and the other to mechanically aligned TKA performed using the conventional measured resection technique. During kinematically aligned TKA, the amount of femur and tibia resected was equivalent to implant thickness to maintain the patient-specific joint line. All patellar kinematics were measured and compared between the native condition and after surgery. RESULTS The patellae of mechanically aligned TKA rotated more valgus and was positioned more laterally compared with those of kinematically aligned TKA at knee flexion angles ≥ 90°. Neither the patellar flexion/extension rotation nor the proximal/distal position differed between either prosthetic knee design and the native knee at all flexion angles. The contact pressure distribution between the medial and lateral PF joint after kinematically aligned TKA were similar to those of the native knee, while the lateral PF joint contact pressure after mechanically aligned TKA was higher than that of the native knee (p = 0.038). CONCLUSIONS Kinematically aligned TKA better restores patellar kinematics and PF contact pressure distribution to the native condition than mechanically aligned TKA during deep knee flexion. These findings provide clues to understand why kinematically aligned TKA is associated with less anterior knee pain and better PF functional performance compared to mechanically aligned TKA. Patients undergoing kinematically aligned TKA may experience a more normal feeling during deep knee flexion activities.
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Lozano R, Campanelli V, Howell S, Hull M. Kinematic alignment more closely restores the groove location and the sulcus angle of the native trochlea than mechanical alignment: implications for prosthetic design. Knee Surg Sports Traumatol Arthrosc 2019; 27:1504-1513. [PMID: 30357423 DOI: 10.1007/s00167-018-5220-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Kinematic alignment (KA) and mechanical alignment (MA) position the prosthetic trochlea that guides patellar tracking differently. The present study determined whether KA or MA more closely restores the groove location and sulcus angle of the prosthetic trochlea to the native trochlea for three femoral component designs. METHODS Ten 3D femur-cartilage models were created by combining computer tomographic (CT) and laser scans of native human cadaveric femurs. Three femoral component designs were positioned using KA and MA. Measurements of the prosthetic and native trochlea were made along the arc length of the native trochlear groove. The alignment technique with the smaller absolute difference between prosthetic and native for the medial-lateral and radial locations of the groove and sulcus angle of the trochlea more closely restored the native trochlea. RESULTS For three femoral component designs, KA more closely restored to native the mean medial-lateral location (p = 0.0033 to < 0.0001) and mean radial location (p = 0.0150 to < 0.0001) than MA. For two femoral component designs, KA more closely restored to native the mean sulcus angle (p = 0.0326 to 0.0006) than MA. However, the differences in the mean sulcus angles between KA and MA were less than 2° for all three designs. CONCLUSION KA more closely restored the native trochlea, which explains why the reported risk of patellofemoral complications for KA is not higher than MA according to five randomized clinical trials. Small design modifications of the medial-lateral and radial locations and sulcus angle are strategies for restoring the native trochlea. Such modifications might further reduce the risk of patellofemoral complications. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rocio Lozano
- Department of Biomedical Engineering, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | | | - Stephen Howell
- Department of Biomedical Engineering, University of California Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Maury Hull
- Department of Biomedical Engineering, University of California Davis, One Shields Ave, Davis, CA, 95616, USA. .,Department of Mechanical Engineering, University of California Davis, One Shields Ave, Davis, CA, 95616, USA. .,Department of Orthopaedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA.
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Poor relationship between frontal tibiofemoral and trochlear anatomic parameters: Implications for designing a trochlea for kinematic alignment. Knee 2019; 26:106-114. [PMID: 30545677 DOI: 10.1016/j.knee.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/12/2018] [Accepted: 11/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The kinematic alignment (KA) technique for total knee arthroplasty (TKA) is an emerging implant positioning philosophy that aims to restore constitutional knee anatomy to improve knee kinematics. At present, the KA technique aims to reconstruct native femorotibial (FT) joint alignment, however there is still insufficient consideration towards the inter-individual trochlear anatomy variability. Poor trochlear restoration may compromise clinical outcomes. Our study aimed at assessing the anatomical relationship between the native trochlea and other FT anatomical parameters. METHODS Fifty-eight preoperative CT scans of low-grade knee arthritic patients were segmented to create 3D bone models. The FT and the PF anatomical parameters were measured using in-house software. Values were compared between different groups of lower limb and FT joint line (JL) orientation, and correlations between FT and PF anatomical parameters were assessed. RESULTS We were unable to detect any significant correlation between groove orientation (frontal and axial) or groove radius and either the hip-knee-ankle (HKA), or the lateral distal femoral (LDFA), or the medial proximal tibial (MPTA), or the FTJL-mechanical axis (FTJLMAA) Angles. When considering the correlation within sub-groups of limb or JL orientation, we only found a positive correlation (r = 0.464, p = 0.022) in the varus lower limb (HKA ≤ 180°) sub-group between groove frontal orientation and LDFA. CONCLUSION Our study shows that the determination of several limb, knee, and JL parameters is of poor value to predict individual trochlea anatomy. This raises the issue of how to improve femoral component design to achieve individualised FT and PF anatomical restoration with KATKA. LEVEL OF EVIDENCE Level 1 - computational study.
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Howell SM, Shelton TJ, Hull ML. Implant Survival and Function Ten Years After Kinematically Aligned Total Knee Arthroplasty. J Arthroplasty 2018; 33:3678-3684. [PMID: 30122435 DOI: 10.1016/j.arth.2018.07.020] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Alignment in the varus or valgus outlier range of the tibial component, knee, and limb might adversely affect the long-term results of kinematically aligned total knee arthroplasty (TKA) particularly when patients are selected without restricting the degree of preoperative varus-valgus and flexion deformity. METHODS A retrospective review of all patients treated in 2007 with a primary TKA determined the 10-year implant survivorship, yearly revision rate, Oxford Knee Score, and WOMAC. All 222 knees (217 patients) were aligned kinematically using patient-specific instrumentation without restricting the degree of preoperative deformity and with the restoration of the native joint lines and limb alignment. Mechanical alignment criteria categorized the alignments of the tibial component, knee, and limb as in-range or in a varus or valgus outlier range. RESULTS The implant survivorship (yearly revision rate) was 97.5% (0.3%) for revision for any reason and 98.4% (0.2%) for aseptic failure. The percentage postoperatively aligned in the varus outlier (valgus outlier) range was 78% (0%) for the angle between the tibial component and mechanical axis of the tibia, 31% (5%) for the tibiofemoral angle of the knee according to the criteria by Ritter et al, and 7% (21%) for the hip-knee-ankle angle of the limb according to the criteria by Parratte et al. Patients grouped in the varus outlier range, valgus outlier range, and in-range had similar implant survival and function scores. The 10-year Oxford Knee Score (48 best) and WOMAC (0 best) averaged 43 and 7 points, respectively. CONCLUSION With the limitation that a large case series unlikely represents the full range of preoperative deformities and native alignments, treatment of patients with kinematically aligned TKA with patient-specific instrumentation without restricting the preoperative deformity did not adversely affect the 10-year implant survival, yearly revision rate, and level of function. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Davis, CA
| | - Trevor J Shelton
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, Davis, CA; Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA; Department of Mechanical Engineering, University of California, Davis, Davis, CA
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Rivière C, Dhaif F, Shah H, Ali A, Auvinet E, Aframian A, Cobb J, Howell S, Harris S. Kinematic alignment of current TKA implants does not restore the native trochlear anatomy. Orthop Traumatol Surg Res 2018; 104:983-995. [PMID: 29960090 DOI: 10.1016/j.otsr.2018.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Preserving constitutional patellofemoral anatomy, and thus producing physiological patellofemoral kinematics, could prevent patellofemoral complications and improve clinical outcomes after kinematically aligned TKA (KA TKA). Our study aims 1) to compare the native and prosthetic trochleae (planned or implanted), and 2) to estimate the safety of implanting a larger Persona® femoral component size matching the proximal lateral trochlea facet height (flange area) in order to reduce the native articular surfaces understuffing generated by the prosthetic KA trochlea. METHODS Persona® femoral component 3D model was virtually kinematically aligned on 3D bone-cartilage models of healthy knees by using a conventional KA technique (group 1, 36models, planned KA TKA) or an alternative KA technique (AT KA TKA) aiming to match the proximal (flange area) lateral facet height (10 models, planned AT KA TKA). Also, 13postoperative bone-implant (KA Persona®) models were co-registered to the same coordinate geometry as their preoperative bone-cartilage models (group 2implanted KA TKA). In-house analysis software was used to compare native and prosthetic trochlea articular surfaces and medio-lateral implant overhangs for every group. RESULTS The planned and performed prosthetic trochleae were similar and valgus oriented (6.1 and 8.5, respectively), substantially proximally understuffed compared to the native trochlea. The AT KA TKAs shows a high rate of native trochlea surface overstuffing (70%, 90%, and 100% for lateral facet, groove, medial facet) and mediolateral implant overhang (60%). There was no overstuffing with conventional KA TKAs having their anterior femoral cut flush. CONCLUSION We found that with both the planned and implanted femoral components, the KA Persona® trochlea was more valgus oriented and understuffed compared to the native trochlear anatomy. In addition, restoring the lateral trochlea facet height by increasing the femoral component size generated a high rate of trochlea overstuffing and mediolateral implant overhang. While restoring a native trochlea with KA TKA is not possible, the clinical impact of this is low, especially on PF complications. In current practice it is better to undersize the implants even if it does not restore the native anatomy. Longer follow-up is needed for KA TKAs performed with current implant, and the debate of developing new, more anatomic, implants specifically designed for KA technique is now opened. LEVEL OF EVIDENCE II, Laboratory controlled study.
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Affiliation(s)
- Charles Rivière
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom.
| | - Fatima Dhaif
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
| | - Hemina Shah
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
| | - Adam Ali
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
| | - Edouard Auvinet
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
| | - Arash Aframian
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
| | - Justin Cobb
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
| | | | - Simon Harris
- The MSK Lab, Imperial college Charing Cross Hospital, London, United Kingdom
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