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No correlation between coronal alignment of total knee arthroplasty and clinical outcomes: a prospective clinical study using 3D-CT

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to evaluate femoral and tibial as well as whole leg coronal TKA alignment using 3D-reconstructed CTs and to assess the relationship of coronal TKA alignment and clinical outcome in a large prospective series of patients. It was hypothesized that a coronal deviation of TKA position and leg alignment from the mechanical axis is correlated with poorer patients’ outcome after TKA.

Methods

A total of 81 consecutive patients who underwent primary TKA were prospectively included. The patient’s demographics such as age, gender and time from primary TKA were noted. All patients underwent clinical and radiological examination including standardized radiographs (anteroposterior and lateral weight-bearing, patellar skyline view) and CT as part of their postoperative follow-up. For assessment of TKA component position and orientation 3D-reconstructed CT was used. For clinical outcome scoring the Knee Society Score (KSS) was used at 1 and 2 years postoperatively. Linear and quadratic regression models were used to test for correlations between alignment variables and KSS (p < .05).

Results

The mean Knee Society Score was 181 ± 28 (range 52–200) 2 years postoperatively, while 78% of the patients were completely pain free and 22% had some persisting pain interfering with their daily activities. The mean mechanical whole limb alignment (HKA angle), femoral component alignment and tibial component alignment were 0°, 0.1° and −0.7°, respectively. The component position parameters, as well as the whole limb alignment measurements, did not show any statistically significant correlation with the KSS, after 1 and 2 years postoperatively.

Conclusion

In this prospective study, using 3D-CT to measure the component position, the postoperative outcome was not influenced by coronal TKA component position as well as the whole leg alignment. The findings challenge the current target of neutral coronal alignment and point towards a more individualized mechanical alignment target.

Level of evidence

Prognostic study, Level I.

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Authors’ contributions

OS carried out the CT measurements, participated in analysis of results and drafted the manuscript. FA participated in the design of the study and performed the statistical analysis. MTH designed and set up the study design, helped to analyse the data and draft the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel

    Omer Slevin

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland

    Omer Slevin & Michael T. Hirschmann

  3. Amsler Consulting, Basel, Switzerland

    Felix Amsler

Authors
  1. Omer Slevin
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Corresponding author

Correspondence to Michael T. Hirschmann.

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Conflict of interest

The author(s) declare that they have no competing interests.

Funding

There was no funding from any company of institutional foundation given for this study. There is no financial conflict here.

Ethical approval

Ethical approval was obtained from the Ethics Committee of Northwestern and Central Switzerland (EKNZ 2015-448). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Slevin, O., Amsler, F. & Hirschmann, M.T. No correlation between coronal alignment of total knee arthroplasty and clinical outcomes: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc 25, 3892–3900 (2017). https://doi.org/10.1007/s00167-016-4400-y

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