J Knee Surg 2018; 31(10): 999-1006
DOI: 10.1055/s-0038-1632378
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Kinematically Aligned Total Knee Arthroplasty or Mechanically Aligned Total Knee Arthroplasty

Tsuneari Takahashi
1   Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
2   Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
,
Juned Ansari
3   Department of Orthopaedic Surgery, Chapel Allerton Hospital, Leeds, West Yorkshire, United Kingdom
,
Hemant G. Pandit
1   Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, West Yorkshire, United Kingdom
› Institutsangaben
Funding None.
Weitere Informationen

Publikationsverlauf

14. August 2017

07. Januar 2018

Publikationsdatum:
14. Februar 2018 (online)

Abstract

Kinematically aligned total knee arthroplasty (KATKA) was developed to more anatomically align the knee prosthesis to restore the native alignment of the knee and promote physiological kinematics. Even though there are concerns with implant survival, and follow-up at 10 years or more after KATKA has not been reported, there is a negligible incidence of failure of a tibial component at 2 to 9 years. Early clinical results with this technique are encouraging and demonstrate better functional outcomes compared with mechanically aligned TKA (MATKA). The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether there are any clinical differences between KATKA and MATKA. The authors conducted a systematic review of the English literature. Five randomized controlled trials (RCTs) which compared clinical outcomes of KATKA and MATKA were finally included. Four RCTs used patient-specific instrument, and one RCT used navigation. Data were extracted and meta-analysis was conducted. KATKA patients had better outcomes: Mean difference between KATKA and MATKA and p-value are presented in brackets after each variable: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (–12.5; p < 0.0001), Oxford Knee Score (OKS) (2.3; p = 0.030), combined Knee Society Score (C-KSS) (13.1; p < 0.0001), Knee Function Score (KFS) (6.4; p = 0.0070), and postoperative range of motion (ROM) (4.1°; p = 0.0010). There was no significant difference concerning the complication rates which needed reoperations or revision surgery (odds ratio, 1.01; p = 0.99). KATKA components had a more femoral valgus (–1.8°; p < 0.0001), more tibial varus (1.2°; p = 0.0001), and more tibial slope (1.2°; p = 0.0001), all being statistically significantly different. Better clinical outcomes were obtained in KATKA and component placement in KATKA is significantly different from that in MATKA. There was no increase of patients with poor clinical results due to implant position especially for varus placement of tibial component. This systematic review of five RCTs suggests that KATKA is of potential alternative method to MATKA since the risk of revision for tibial loosening is negligible compared with MATKA for the same follow-up period.

Authors' Contributions

T.T., J.A., and H.P. designed the study, conducted literature search, systematic review of the literature, and statistical analysis. All authors read and approved the final manuscript.


Ethical Approval

This is a systematic review so ethical approval was waived.


 
  • References

  • 1 National Joint Registry for England Wales Northern Ireland and Isle of Man. Annual report. In: Hemel Hempstead: National Joint Registry; 2015
  • 2 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59 (01) 77-79
  • 3 Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983; (173) 178-183
  • 4 Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res 1985; (192) 13-22
  • 5 Tew M, Waugh W. Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg Br 1985; 67 (04) 551-556
  • 6 Aglietti P, Buzzi R. Posteriorly stabilised total-condylar knee replacement. Three to eight years' follow-up of 85 knees. J Bone Joint Surg Br 1988; 70 (02) 211-216
  • 7 Oussedik S, Abdel MP, Cross MB, Haddad FS. Alignment and fixation in total knee arthroplasty: changing paradigms. Bone Joint J 2015; 97-B (10, Suppl A) 16-19
  • 8 Gu Y, Roth JD, Howell SM, Hull ML. How frequently do four methods for mechanically aligning a total knee arthroplasty cause collateral ligament imbalance and change alignment from normal in white patients? AAOS exhibit selection. J Bone Joint Surg Am 2014; 96 (12) e101
  • 9 Luyckx T, Vanhoorebeeck F, Bellemans J. Should we aim at undercorrection when doing a total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2015; 23 (06) 1706-1712
  • 10 Gu Y, Howell SM, Hull ML. Simulation of total knee arthroplasty in 5° or 7° valgus: a study of gap imbalances and changes in limb and knee alignments from native. J Orthop Res 2017; 35 (09) 2031-2039
  • 11 Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017; 99-B (05) 640-646
  • 12 Howell SM, Kuznik K, Hull ML, Siston RA. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 2008; 31 (09) 857-863
  • 13 Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category?. Clin Orthop Relat Res 2013; 471 (03) 1000-1007
  • 14 Howell SM, Papadopoulos S, Kuznik K, Ghaly LR, Hull ML. Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty?. Int Orthop 2015; 39 (11) 2117-2124
  • 15 Howell SM, Howell SJ, Hull ML. Assessment of the radii of the medial and lateral femoral condyles in varus and valgus knees with osteoarthritis. J Bone Joint Surg Am 2010; 92 (01) 98-104
  • 16 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
  • 17 Dossett HG, Swartz GJ, Estrada NA, LeFevre GW, Kwasman BG. Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics 2012; 35 (02) e160-e169
  • 18 Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med 2014; 7 (02) 89-95
  • 19 Nedopil AJ, Singh AK, Howell SM, Hull ML. Does Calipered Kinematically Aligned TKA Restore Native Left to Right Symmetry of the Lower Limb and Improve Function?. J Arthroplasty 2018; 33: 398-406
  • 20 Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011; 93 (17) 1588-1596
  • 21 Nedopil AJ, Howell SM, Hull ML. What mechanisms are associated with tibial component failure after kinematically-aligned total knee arthroplasty?. Int Orthop 2017; 41 (08) 1561-1569
  • 22 Shelton TJ, Nedopil AJ, Howell SM, Hull ML. Do varus or valgus outliers have higher forces in the medial or lateral compartments than those which are in-range after a kinematically aligned total knee arthroplasty? Limb and joint line alignment after kinematically aligned total knee arthroplasty. Bone Joint J 2017; 99-B (10) 1319-1328
  • 23 Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Joint J 2014; 96-B (07) 907-913
  • 24 Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1743-1748
  • 25 Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD. The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone Joint J 2016; 98-B (10) 1360-1368
  • 26 Young SW, Walker ML, Bayan A, Briant-Evans T, Pavlou P, Farrington B. The Chitranjan S. Ranawat Award: no difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial. Clin Orthop Relat Res 2017; 475 (01) 9-20
  • 27 Tao KM, Li XQ, Zhou QH, Moher D, Ling CQ, Yu WF. From QUOROM to PRISMA: a survey of high-impact medical journals' instructions to authors and a review of systematic reviews in anesthesia literature. PLoS One 2011; 6 (11) e27611
  • 28 Eckhoff DG, Bach JM, Spitzer VM. , et al. Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Joint Surg Am 2005; 87 (Suppl. 02) 71-80
  • 29 Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012; 470 (01) 45-53
  • 30 Hungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clin Orthop Relat Res 1985; (192) 23-33
  • 31 Coughlin KM, Incavo SJ, Churchill DL, Beynnon BD. Tibial axis and patellar position relative to the femoral epicondylar axis during squatting. J Arthroplasty 2003; 18 (08) 1048-1055
  • 32 Niki Y, Sassa T, Nagai K, Harato K, Kobayashi S, Yamashita T. Mechanically aligned total knee arthroplasty carries a risk of bony gap changes and flexion-extension axis displacement. Knee Surg Sports Traumatol Arthrosc 2017; 25 (11) 3452-3458
  • 33 Bellemans J, Vandenneucker H, Van Lauwe J, Victor J. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing. J Arthroplasty 2010; 25 (07) 1151-1156
  • 34 Shetty GM, Mullaji A, Bhayde S, Nha KW, Oh HK. Factors contributing to inherent varus alignment of lower limb in normal Asian adults: role of tibial plateau inclination. Knee 2014; 21 (02) 544-548
  • 35 Song MH, Yoo SH, Kang SW, Kim YJ, Park GT, Pyeun YS. Errata to “Coronal Alignment of the Lower Limb and the Incidence of Constitutional Varus Knee in Korean Females”. Knee Surg Relat Res 2015; 27 (03) 197