Kinematisches Alignment bei der Knie-TEP-Implantation

Das derzeitige Ziel der Knieendoprothetik ist die Verbesserung der Patientenzufriedenheit nach operativer Versorgung mittels einer Totalendoprothese. Dabei werden verschiedene Ansätze verfolgt. Eines dieser Konzepte ist die Versorgung mittels alternativer Alignmentstrategien. Das in den vergangenen Jahren meistdiskutierte Prinzip ist das sog. kinematische Alignment. Dieser Fortbildungsartikel soll die Grundprinzipien sowie die Versorgungsmöglichkeiten praktisch erläutern.

Abstract

Nowadays, kinematic alignment is a widely used alignment philosophy in total knee arthroplasty. The concept of kinematic alignment respects the patient’s individual prearthrotic anatomy and is based on the reconstruction of the femoral anatomy and thus the axes of motion of the knee joint. Only then the alignment of the tibial component is adapted to the femoral component. By means of this technique soft tissue balancing is reduced to a minimum. Due to the risk of excessive outlier alignment technical assistance or calipered techniques are recommended for precise implementation. This article attempts to provide an understanding of the fundamentals of kinematic alignment, and it focusses on how it differs from alternative alignment strategies and the way the philosophy is implemented in different surgical techniques.

Kernaussagen

• Das kinematische Alignment respektiert die patientenindividuelle präarthrotische Anatomie.

• Es basiert auf der Rekonstruktion der Femuranatomie und somit der Bewegungsachsen des Kniegelenks.

• Die Ausrichtung der tibialen Komponente wird an die Femurkomponente angepasst.

• Das Weichteilbalancing wird auf ein Minimum reduziert.

• Zur präzisen Umsetzung ist technische Hilfe in Form von computer- oder roboter-assistierter Technik empfehlenswert.

• Die Robotik kombiniert statische Parameter mit dynamischen Informationen und generiert somit ein „funktionelles Alignment“.

Schlüsselwörter

kinematic Alignment - KA - TEP - Knie - Arthrose - Roboter-assistierte Chirurgie

Keywords

kinematic alignment - KA - TKA - robotics - knee - alignment philosophy

Publication History

Article published online:
16 February 2023

• Literatur

• 1 Baker PN, Rushton S, Jameson SS. et al. Patient satisfaction with total knee replacement cannot be predicted from pre-operative variables alone: a cohort study from the National Joint Registry for England and Wales. Bone Joint J 2013; 95-B: 1359-1365 DOI: 10.1302/0301-620X.95B10.32281.
• 2 Ben-Shlomo Y, Blom A, Boulton C. et al. The National Joint Registry 17th Annual Report 2020. London: National Joint Registry; 2020. Accessed July 24, 2022 at: http://www.ncbi.nlm.nih.gov/books/NBK566660/
• 3 Bellemans J, Colyn W, Vandenneucker H. et al. The Chitranjan Ranawat Award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470: 45-53 DOI: 10.1007/s11999-011-1936-5.
• 4 MacDessi SJ, Griffiths-Jones W, Harris IA. et al. Coronal plane alignment of the knee (CPAK) classification: a new system for describing knee phenotypes. Bone Joint J 2021; 103-B: 329-337 DOI: 10.1302/0301-620X.103B2.BJJ-2020-1050.R1.
• 5 Rivière C, Iranpour F, Auvinet E. et al. Alignment options for total knee arthroplasty: a systematic review. Orthop Traumatol Surg Res 2017; 103: 1047-1056 DOI: 10.1016/j.otsr.2017.07.010.
• 6 Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee arthroplasty: a meta-analysis of the literature. J Arthroplasty 2017; 32: 2028-2032.e1 DOI: 10.1016/j.arth.2017.02.041.
• 7 Takahashi T, Ansari J, Pandit H. Kinematically aligned total knee arthroplasty or mechanically aligned total knee arthroplasty. J Knee Surg 2018; 31: 999-1006 DOI: 10.1055/s-0038-1632378.
• 8 Woon JTK, Zeng ISL, Calliess T. et al. Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials. Arch Orthop Trauma Surg 2018; 138: 1293-1303 DOI: 10.1007/s00402-018-2988-8.
• 9 Hirschmann MT, Moser LB, Amsler F. et al. Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 2019; 27: 1394-1402 DOI: 10.1007/s00167-019-05509-z.
• 10 Hollister AM, Jatana S, Singh AK. et al. The axes of rotation of the knee. Clin Orthop Relat Res 1993; (290) 259-268
• 11 Eckhoff DG, Bach JM, Spitzer VM. et al. Three-dimensional morphology and kinematics of the distal part of the femur viewed in virtual reality. Part II. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) S97-S104 DOI: 10.2106/00004623-200300004-00012.
• 12 Kapandji A. The Physiology of the Joints, Volume 2: The lower Limb. 6; Amsterdam, New York Churchill Livingstone Elsevier: 2011
• 13 Siston RA. The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 2005; 87: 2276-2280 DOI: 10.2106/JBJS.D.02945.
• 14 Hill PF, Vedi V, Williams A. et al. Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI. J Bone Joint Surg Br 2000; 82: 1196-1198 DOI: 10.1302/0301-620x.82b8.10716.
• 15 Murakami K, Hamai S, Okazaki K. et al. In vivo kinematics of healthy male knees during squat and golf swing using image-matching techniques. Knee 2016; 23: 221-226 DOI: 10.1016/j.knee.2015.08.004.
• 16 Pinskerova V, Johal P, Nakagawa S. et al. Does the femur roll-back with flexion?. J Bone Joint Surg Br 2004; 86: 925-931 DOI: 10.1302/0301-620x.86b6.14589.
• 17 Howell SM. Calipered kinematically aligned total knee arthroplasty: an accurate technique that improves patient outcomes and implant survival. Orthopedics 2019; 42: 126-135 DOI: 10.3928/01477447-20190424-02.
• 18 Winnock de Grave P, Luyckx T, Claeys K. et al. Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2022; 30: 488-499 DOI: 10.1007/s00167-020-06165-4.
• 19 Yeo J-H, Seon J-K, Lee D-H. et al. No difference in outcomes and gait analysis between mechanical and kinematic knee alignment methods using robotic total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27: 1142-1147 DOI: 10.1007/s00167-018-5133-x.
• 20 Yim J-H, Song E-K, Khan MS. et al. A comparison of classical and anatomical total knee alignment methods in robotic total knee arthroplasty: classical and anatomical knee alignment methods in TKA. J Arthroplasty 2013; 28: 932-937 DOI: 10.1016/j.arth.2013.01.013.
• 21 Kayani B, Konan S, Tahmassebi J. et al. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B: 930-937 DOI: 10.1302/0301-620X.100B7.BJJ-2017-1449.R1.
• 22 Marchand RC, Sodhi N, Anis HK. et al. One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 2019; 32: 1063-1068 DOI: 10.1055/s-0039-1683977.
• 23 Jeremić D, Haaker R. Technik des Balancings durch Knochenschnitte. Orthopäde 2020; 49: 611-616 DOI: 10.1007/s00132-020-03923-7.
• 24 Ettinger M, Tsmassiotis S, Nedopil AJ. et al. Messschablonentechnik des kinematischen Alignments. Orthopäde 2020; 49: 593-596 DOI: 10.1007/s00132-020-03925-5.
• 25 Sires JD, Craik JD, Wilson CJ. Accuracy of bone resection in MAKO total knee robotic-assisted surgery. J Knee Surg 2021; 34: 745-748 DOI: 10.1055/s-0039-1700570.
• 26 Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty. J Arthroplasty 2009; 24 (06) S39-S43 DOI: 10.1016/j.arth.2009.04.034.
• 27 Kim Y-H, Park J-W, Kim J-S. et al. The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis. Int Orthop (SICOT) 2014; 38: 379-385 DOI: 10.1007/s00264-013-2097-9.
• 28 Ritter MA, Davis KE, Meding JB. et al. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg 2011; 93: 1588-1596 DOI: 10.2106/JBJS.J.00772.
• 29 Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018; 33: 3678-3684 DOI: 10.1016/j.arth.2018.07.020.
• 30 Laende EK, Richardson CG, Dunbar MJ. A randomized controlled trial of tibial component migration with kinematic alignment using patient-specific instrumentation versus mechanical alignment using computer-assisted surgery in total knee arthroplasty. Bone Joint J 2019; 101-B: 929-940 DOI: 10.1302/0301-620X.101B8.BJJ-2018-0755.R3.
• 31 Abdel MP, Ollivier M, Parratte S. et al. Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise follow-up at 20 years. J Bone Joint Surg 2018; 100: 472-478 DOI: 10.2106/JBJS.16.01587.
• 32 Kim YH, Park JW, Kim JS. Computer-navigated versus conventional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am 2012; 94: 2017-2024 DOI: 10.2106/JBJS.L.00142.
• 33 Magnussen RA, Weppe F, Demey G. et al. Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res 2011; 469: 3443-3450 DOI: 10.1007/s11999-011-1988-6.
• 34 Sappey-Marinier E, Shatrov J, Batailler C. et al. Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study. Knee Surg Sports Traumatol Arthrosc 2022; 30: 2838-2845 DOI: 10.1007/s00167-021-06714-5.
• 35 Blakeney W, Clément J, Desmeules F. et al. Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2019; 27: 1410-1417 DOI: 10.1007/s00167-018-5174-1.
• 36 Niki Y, Nagura T, Nagai K. et al. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1629-1635 DOI: 10.1007/s00167-017-4788-z.
• 37 MacDessi SJ, Griffiths-Jones W, Chen DB. et al. Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial. Bone Joint J 2020; 102-B -124 DOI: 10.1302/0301-620X.102B1.BJJ-2019-0674.R2.