Download PDF
J Knee Surg 2022; 35(06): 634-639
DOI: 10.1055/s-0040-1716494
Original Article

Kinematically Aligned Total Knee Arthroplasty Did Not Show Superior Patient-Reported Outcome Measures: An Updated Meta-analysis of Randomized Controlled Trials with at Least 2-Year Follow-up

Shuhei Hiyama
1   Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
,
Tsuneari Takahashi 
1   Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
,
Katsushi Takeshita
1   Department of Orthopedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Kinematically aligned total knee arthroplasty (KATKA) was developed to improve the anatomical alignment of knee prostheses, assisting in restoring the native alignment of the knee and promoting physiological kinematics. Early clinical results were encouraging, showing better functional outcomes than with mechanically aligned total knee arthroplasty (MATKA). However, there have been concerns about implant survival, and follow-up at 10 years or more has not been reported. In addition, randomized controlled trials (RCTs) comparing KATKA with MATKA have reported inconsistent results. The current meta-analysis of RCTs with a minimum of 2 years of follow-up investigated the clinical and radiological differences between KATKA and MATKA. A systematic review of the English language literature resulted in the inclusion of four RCTs. The meta-analysis found no significant difference in any of the following parameters: postoperative range of motion for flexion (mean difference for KATKA − MATKA [MD], 1.7 degrees; 95% confidence interval [CI], −1.4 to 4.8 degrees; p = 0.29) and extension (MD, 0.10 degrees; 95% CI, −0.99 to 1.2 degrees; p = 0.86); Oxford Knee Score (MD, 0.10 points; 95% CI, −1.5 to 1.7 points; p = 0.90); Knee Society Score (MD, 1.6 points; 95% CI, −2.8 to 6.0 points; p = 0.49); and Knee Function Score (MD, 1.4 points; 95% CI, −4.9 to 7.8 points; p = 0.66). In addition, there was no significant difference between KATKA and MATKA in the rate of complications requiring reoperation or revision surgery (odds ratio, 1.01; 95% CI, 0.25–4.09; p = 0.99) or in the length of hospital stay (MD, 1.0 days; 95% CI, −0.2 to 2.2 days; p = 0.092). KATKA did not increase the number of patients with poor clinical results due to implant position, particularly for varus placement of the tibial component. In this meta-analysis based on four RCTs with a minimum of 2 years of follow-up, KATKA were only relevant to cruciate retaining TKA and could not be extrapolated to posterior stabilized TKA. Patient-reported outcome measures with KATKA were not superior to those with MATKA.

Keywords

knee osteoarthritis - total knee arthroplasty - kinematically aligned - mechanically aligned - outcomes

Ethical Approval

This is a meta-analysis, so ethical approval was waived.


Authors' Contributions

S.H., T.T., and K.T. designed the study, S.H. and T.T. conducted literature search, meta-analysis of the literatures, and statistical analysis. All authors read and approved the final manuscript.




Publication History

Received: 26 February 2020

Accepted: 29 July 2020

Article published online:
14 September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Deere KC, Whitehouse MR, Porter M, Blom AW, Sayers A. Assessing the non-inferiority of prosthesis constructs used in total and unicondylar knee replacements using data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man: a benchmarking study. BMJ Open 2019; 9 (04) e026736
    CrossrefPubMedGoogle Scholar
  • 2 Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. National Joint Registry for England and Wales, Data from the National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br 2007; 89 (07) 893-900
    CrossrefPubMedGoogle Scholar
  • 3 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
    CrossrefPubMedGoogle Scholar
  • 4 Howell SM, Papadopoulos S, Kuznik KT, Hull ML. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2271-2280
    CrossrefPubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 Ishida K, Shibanuma N, Takayama K, Kurosaka M, Kuroda R, Matsumoto T. Posterior reference position affects intraoperative kinematic and soft tissue balance in navigated posterior-stabilized total knee arthroplasty. J Arthroplasty 2018; 33 (09) 2851-2857
    CrossrefPubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Teeter MG, Naudie DD, McCalden RW. et al. Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (06) 1610-1617
    CrossrefPubMedGoogle Scholar
  • 10 Takahashi T, Ansari J, Pandit HG. Kinematically aligned total knee arthroplasty or mechanically aligned total knee arthroplasty. J Knee Surg 2018; 31 (10) 999-1006
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 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
    CrossrefPubMedGoogle Scholar
  • 15 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 (08) 929-940
    CrossrefPubMedGoogle Scholar
  • 16 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 (01) 117-124
    CrossrefPubMedGoogle Scholar
  • 17 McEwen PJ, Dlaska CE, Jovanovic IA, Doma K, Brandon BJ. Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery. J Arthroplasty 2020; 35 (02) 443-450
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
    CrossrefPubMedGoogle Scholar
  • 20 Barili F, Parolari A, Kappetein PA, Freemantle N. Statistical primer: heterogeneity, random- or fixed-effects model analyses?. Interact Cardiovasc Thorac Surg 2018; 27 (03) 317-321
    CrossrefPubMedGoogle Scholar
  • 21 Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009; 24 (04) 570-578
    CrossrefPubMedGoogle Scholar
  • 22 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (04) 560-569
    CrossrefPubMedGoogle Scholar
  • 23 Huang NF, Dowsey MM, Ee E, Stoney JD, Babazadeh S, Choong PF. Coronal alignment correlates with outcome after total knee arthroplasty: five-year follow-up of a randomized controlled trial. J Arthroplasty 2012; 27 (09) 1737-1741
    CrossrefPubMedGoogle Scholar
  • 24 Magnussen RA, Weppe F, Demey G, Servien E, Lustig S. Residual varus alignment does not compromise results of TKAs in patients with preoperative varus. Clin Orthop Relat Res 2011; 469 (12) 3443-3450
    CrossrefPubMedGoogle Scholar
  • 25 Jenny JY, Louis P, Diesinger Y. High activity arthroplasty score has a lower ceiling effect than standard scores after knee arthroplasty. J Arthroplasty 2014; 29 (04) 719-721
    CrossrefPubMedGoogle Scholar
  • 26 Niki Y, Nagura T, Kobayashi S, Udagawa K, Harato K. Who will benefit from kinematically aligned total knee arthroplasty? Perspectives on patient-reported outcome measures. J Arthroplasty 2020; 35 (02) 438-442.e2
    CrossrefPubMedGoogle Scholar
  • 27 Twiggs JG, Wakelin EA, Roe JP. et al. Patient-specific simulated dynamics after total knee arthroplasty correlate with patient-reported outcomes. J Arthroplasty 2018; 33 (09) 2843-2850
    CrossrefPubMedGoogle Scholar
  • 28 Varadarajan KM, Harry RE, Johnson T, Li G. Can in vitro systems capture the characteristic differences between the flexion-extension kinematics of the healthy and TKA knee?. Med Eng Phys 2009; 31 (08) 899-906
    CrossrefPubMedGoogle Scholar
  • 29 Wilson DA, Astephen Wilson JL, Richardson G, Dunbar MJ. Changes in the functional flexion axis of the knee before and after total knee arthroplasty using a navigation system. J Arthroplasty 2014; 29 (07) 1388-1393
    CrossrefPubMedGoogle Scholar
  • 30 Tanikawa H, Tada M, Harato K, Okuma K, Nagura T. Influence of total knee arthroplasty on patellar kinematics and patellofemoral pressure. J Arthroplasty 2017; 32 (01) 280-285
    CrossrefPubMedGoogle Scholar
  • 31 Nedopil AJ, Howell SM, Hull ML. Does malrotation of the tibial and femoral components compromise function in kinematically aligned total knee arthroplasty?. Orthop Clin North Am 2016; 47 (01) 41-50
    CrossrefPubMedGoogle Scholar
  • 32 Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee arthroplasty: a meta-analysis of the literature. J Arthroplasty 2017; 32 (06) 2028-2032.e1
    CrossrefPubMedGoogle Scholar
  • 33 Li Y, Wang S, Wang Y, Yang M. Does kinematic alignment improve short-term functional outcomes after total knee arthroplasty compared with mechanical alignment? A systematic review and meta-analysis. J Knee Surg 2018; 31 (01) 78-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Schotanus MGM, Thijs E, Heijmans M, Vos R, Kort NP. Favourable alignment outcomes with MRI-based patient-specific instruments in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26 (09) 2659-2668
    CrossrefPubMedGoogle Scholar
  • 35 Luo Z, Zhou K, Peng L, Shang Q, Pei F, Zhou Z. Similar results with kinematic and mechanical alignment applied in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28 (06) 1720-1735
    CrossrefPubMedGoogle Scholar