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Prospective parallel randomised controlled trial on non-inferiority of individual femoral valgus cut angle to fixed resection angle of 7 degrees in total knee arthroplasty
ESSKA Academy. Zadoroznijs S. Nov 8, 2019; 284353; epEKA-03 Topic: Joint Replacement
Dr. Sergejs Zadoroznijs
Dr. Sergejs Zadoroznijs
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Prospective parallel randomised controlled trial on non-inferiority of individual femoral valgus cut angle to fixed resection angle of 7 degrees in total knee arthroplasty

ePoster - epEKA-03

Topic: TKA

Zadoroznijs S.
University of Latvia / Hospital of Traumatology and Orthopaedics, Riga, Latvia

Introduction: Neutral coronal alignment in total knee arthroplasty (TKA) is believed to lead to better implant survival, thus every step in achieving it is crucial.
Objectives: As we routinely use long leg radiograms and digital templating, we aimed to determine whether TKA using individual femoral valgus cut angle (IFVCA) is non-inferior to fixed femoral resection angle (FRA) of 7°.
Aims: The aim is to achieve a neutral alignment of the knee and thus, possibly, better clinical result.
Methods: A single centre, single-blind, two group, prospective parallel randomised controlled trial with equal randomisation 1:1 was performed on patients coming for elective TKA from January 2013 to April 2014. The investigator was randomizing the patients into group A (using IFVCA) and B (FRA). Femoral anatomic-mechanical angle (AMA) was measured for group A and then rounded to the nearest integer to be used as IFVCA. A control visit was performed one year after TKA.Primary outcome measures - femoral component absolute coronal angular deviation (FACAD) and knee absolute coronal deformity (KACD). The 95% upper confidence limit was 1,4° difference in means (M), establishing noninferiority. Secondary outcome measures - clinical scores (pain NRS, KOOS and KSS) and their change 1 year after TKA.
Results: In total 95 patients were randomized. Baseline characteristics are summarised in a table. [tab_02] Per-protocol analysis was performed on 70 patients. Their primary outcomes are summarised in a table. [tab_03] Mean AMA was 7,1, SD 1,1, range 4,2 to 10,3. Primary outcomes after excluding AMA 5,5 to 8,4 summarised in a table. [tab_01] Secondary outcome measures did not differ between groups (p>0,05). KACD showed a non-significant weak correlation with the clinical scores and their changes.
Conclusions: Femoral resection in TKA using IFVCA leads to non-inferior (or even superior in case of extreme AMA) deformity correction to FRA of 7 degrees. A better deformity correction is not a guarantee of a better clinical outcome.
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