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Current TKA alignment concepts change the coronal alignment of OA patients
ESSKA Academy. Moser L. Nov 8, 2019; 284365; epEKA-22 Topic: Joint Replacement
Dr. Lukas Moser
Dr. Lukas Moser
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Current TKA alignment concepts change the coronal alignment of OA patients

ePoster - epEKA-22

Topic: TKA

Hess S.1, Moser L.1, Behrend H.2, Hirschmann M.1
1Kantonsspital Baselland, Basel, Switzerland, 2Kantonsspital St. Gallen, St. Gallen, Switzerland

Background: Coronal alignment is a key factor for a good outcome after total knee arthroplasty (TKA). However, the optimal alignment is still under debate. Several studies reported better functional outcomes for patients with a preoperative varus when their postoperative alignment was still in slight varus. These results raise the question if the goal for the TKA alignment should be defined according to the native alignment of the patient. Interestingly, the number of patients with a change in alignment, pre- to postoperative, has not been evaluated in greater detail. The purpose of these study was to compare the coronal alignment goals of different TKA concepts to the alignment of OA patients. To enable a detailed comparison the recently introduced functional knee phenotypes were used.
Methods: Preoperative CT scans of osteoarthritic knees collected between January 2017 and December 2019 in the KneePLAN 3D database (Symbios Orthopédie S.A.) were scanned for patients meeting the inclusion criteria: age>50 and < 90, no signs of previous fractures, osteotomies and rheumatoid arthritis. A total of 2764 patients (male:female ratio 1096:1668) with a mean age ± standard deviation of 70±8.5 years were included. Each leg was phenotyped according to the functional knee phenotype concept. The alignment goals of the three most used TKA alignment concepts were correlated with these different phenotypes. The mechanical TKA concept was linked to phenotype: NEUHKA0°VARFMA3°VALTMA3° and the anatomical TKA concept to: NEUHKA0°NEUFMA0°NEUTMA0°. An adaption of the restricted kinematic (rKA) TKA alignment concept could be linked to nine functional knee phenotypes. The percentage of the population with these functional knee phenotypes was assessed. Additionally, the number of patients within the range of the original rKA alignment was calculated.
Results: A mechanical phenotype was found in 1.0% of the males and in 0.4% of the females. An anatomical phenotype was found in 3.7% of the males and 3.9% in of the females. Seven of the nine phenotypes linked to a rKA TKA alignment concept were found (4 male, 7 female, 4 mutual), representing 7.2% of all males and 7.7% of all females. An alignment within the zones of the original rKA concept was found in 16.8% of the males and 32.2% of the females.
Conclusion: Current TKA alignment concepts change the alignment of OA patients in most cases, which might be one reason for the relatively high percentage of unhappy patients.
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