Current TKA alignment concepts do not aim to achieve the native coronal alignment of a patient
ESSKA Academy. Moser L. 11/08/19; 285245; epEKA-21 Topic: Joint Replacement
Dr. Lukas Moser
Dr. Lukas Moser
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Abstract
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Background: Coronal alignment is a key factor for a good outcome after total knee arthroplasty (TKA) but the optimal alignment has been under debate in recent years. 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 TKA alignment goals have not been compared with the native alignment of non-osteoarthritic knees yet. The purpose of this study was therefore to compare the coronal alignment goals of different TKA concepts to the alignment found in native non-osteoarthritic knees. To enable a detailed comparison the recently introduced functional knee phenotypes were used.
Methods: The hospital registry was searched for patients older than 16 and younger than 45 years, who received a CT according to the Imperial Knee Protocol. Patients with prosthesis, osteoarthritis, fractures or injury of the collateral ligaments were excluded. Finally, 308 non-osteoarthritic knees of 160 patients remained (102 males and 58 females, mean age ± standard deviation (SD) 30±7 years). The alignment of 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 different functional knee phenotypes. The mechanical TKA concept was linked to functional knee phenotype: NEUHKA0°VARFMA3°VALTMA3° and the anatomical TKA concept to: NEUHKA0°NEUFMA0°NEUTMA0°. The restricted kinematic TKA concept could be linked to nine functional knee phenotypes. The percentage of the population with these functional knee phenotypes was assessed.
Results: A mechanical functional knee phenotype (NEUHKA0°VARFMA3°VALTMA3°) was found in 5.6% of the male and in 3.6% of the female population. An anatomical functional knee phenotype (NEUHKA0°NEUFMA0°NEUTMA0°) was found in 18% of the male and 17% in female population. Four of the nine phenotypes linked to a restricted kinematic TKA alignment concept were found in this population (3 male, 4 female, 3 mutual). They represented 31.3% of all males and 45.1% of all females.
Conclusion: The current TKA alignment concepts do not aim to achieve the native coronal alignment of the patient, which might be one reason for the relatively high percentage
Background: Coronal alignment is a key factor for a good outcome after total knee arthroplasty (TKA) but the optimal alignment has been under debate in recent years. 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 TKA alignment goals have not been compared with the native alignment of non-osteoarthritic knees yet. The purpose of this study was therefore to compare the coronal alignment goals of different TKA concepts to the alignment found in native non-osteoarthritic knees. To enable a detailed comparison the recently introduced functional knee phenotypes were used.
Methods: The hospital registry was searched for patients older than 16 and younger than 45 years, who received a CT according to the Imperial Knee Protocol. Patients with prosthesis, osteoarthritis, fractures or injury of the collateral ligaments were excluded. Finally, 308 non-osteoarthritic knees of 160 patients remained (102 males and 58 females, mean age ± standard deviation (SD) 30±7 years). The alignment of 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 different functional knee phenotypes. The mechanical TKA concept was linked to functional knee phenotype: NEUHKA0°VARFMA3°VALTMA3° and the anatomical TKA concept to: NEUHKA0°NEUFMA0°NEUTMA0°. The restricted kinematic TKA concept could be linked to nine functional knee phenotypes. The percentage of the population with these functional knee phenotypes was assessed.
Results: A mechanical functional knee phenotype (NEUHKA0°VARFMA3°VALTMA3°) was found in 5.6% of the male and in 3.6% of the female population. An anatomical functional knee phenotype (NEUHKA0°NEUFMA0°NEUTMA0°) was found in 18% of the male and 17% in female population. Four of the nine phenotypes linked to a restricted kinematic TKA alignment concept were found in this population (3 male, 4 female, 3 mutual). They represented 31.3% of all males and 45.1% of all females.
Conclusion: The current TKA alignment concepts do not aim to achieve the native coronal alignment of the patient, which might be one reason for the relatively high percentage
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