The importance of joint line obliquity: a radiological analysis of restricted boundaries in normal knee phenotypes to inform surgical decision making in kinematically aligned total knee arthroplasty

Purpose Restricted kinematic alignment (rKA) in total knee arthroplasty (TKA) aims to restore native soft tissue laxities while limiting alignment extremes that risk prosthetic failure. However, there is no consensus where restricted boundaries (RB) should be set. This study aims to determine the pr...

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Veröffentlicht in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Jg. 30; H. 9; S. 2931 - 2940
Hauptverfasser: MacDessi, Samuel J., Allom, Richard J., Griffiths-Jones, Will, Chen, Darren B., Wood, Jil A., Bellemans, Johan
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2022
John Wiley & Sons, Inc
Schlagworte:
Alignment
Ankle
Arthroplasty (knee)
Biomedical materials
Boundaries
Constraining
Decision making
Hip
Joint replacement surgery
Joints (anatomy)
Kinematics
Knee
Limbs
Medicine
Medicine & Public Health
Orthopaedic implants
Orthopedics
Phenotypes
Prostheses
Restoration
Soft tissues
Sports Medicine
Constitutional alignment
Restricted boundaries
Kinematic alignment
Total knee arthroplasty
Adjusted mechanical alignment
Restricted kinematic alignment
ISSN:0942-2056, 1433-7347, 1433-7347
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Zusammenfassung:Purpose Restricted kinematic alignment (rKA) in total knee arthroplasty (TKA) aims to restore native soft tissue laxities while limiting alignment extremes that risk prosthetic failure. However, there is no consensus where restricted boundaries (RB) should be set. This study aims to determine the proportion of limbs in which constitutional alignment and joint line obliquity (JLO) would be restored with various RB scenarios, to inform decision making in rKA TKA. Methods The mechanical hip–knee–ankle (mHKA) angle, arithmetic hip–knee–ankle (aHKA) angle, lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured on radiographs of 500 normal knees. Incrementally wider RBs were then applied. The proportion of limbs within each increment was determined when RBs were applied only to HKA, or to HKA, LDFA and MPTA together. In addition, the proportion of limbs within published adjusted mechanical alignment (aMA) and rKA protocols were determined, as well as those within one, two and three standard deviations of the means for HKA, LDFA and MPTA. Results When restrictions to mHKA alone were applied, 74.0% and 97.8% of knees were captured with boundaries of ± 3° and ± 6° respectively. However, when the same boundaries to HKA were also applied to MPTA and LDFA, 36.2% and 91.0% of knees were captured respectively, highlighting the limiting effect that JLO has on restoration of normal knee phenotypes. When comparing previously published boundaries, aMA of 0° ± 3° captured 36.2%; rKA of 0° ± 3 for HKA and 85° to 95° for LDFA/MPTA captured 67.8%; rKA of − 5° to 4° HKA and 86°–93° for LDFA/MPTA captured 63%; and rKA of − 6° to + 3° for HKA and 84°–93° for LDFA/MPTA captured 85.4%. Conclusion The greatest proportions of normal knee phenotypes were captured with boundaries that were centred around population means for HKA and JLO. Further, these findings demonstrate that restricting the JLO has a significant limiting influence on restoration of normal knee phenotypes beyond that of restricting HKA alone. Level of evidence III.
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ISSN:0942-2056
1433-7347
1433-7347
DOI:10.1007/s00167-022-06872-0