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Does A Kinematically Aligned Total Knee Arthroplasty Restore Function Without Failure Regardless of Alignment Category?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Kinematically aligned TKA restores function by aligning the femoral and tibial components to the normal or prearthritic joint lines of the knee. However, aligning the components to the joint lines of the normal knee also aligns the tibial component in varus, creating concern that varus alignment might result in poor function and early catastrophic failure.

Questions/Purposes

We therefore determined whether function and the incidence of catastrophic failure were different when the tibial component, knee, and limb alignment were in a specified normal range, varus outlier, or valgus outlier.

Methods

We prospectively followed all 198 patients (214 knees) who underwent TKAs between February and October 2008. We treated each knee in this cohort of patients with a kinematically aligned, cruciate-retaining prosthesis implanted using patient-specific guides. From a long-leg scanogram, we measured and categorized alignment of the tibial component as in range (≤ 0°) or a varus outlier (> 0°), alignment of the knee as in range (between −2.5° to −7.4° valgus) or a varus (> −2.5°) or valgus (< −7.4°) outlier, and alignment of the limb as in range (0° ± 3°) or a varus (> 3°) or valgus (< −3°) outlier. We assessed function using the Oxford Knee Score and WOMAC™ score, and reported catastrophic failure as the incidence of revision attributable to loosening, wear, and instability of the femoral or tibial components. The minimum followup was 31 months (mean, 38 months; range, 31–43 months).

Results

The mean Oxford Knee Score of 43 and WOMAC™ score of 92 were similar between the three alignment categories. The incidence of catastrophic failure in each alignment category was zero.

Conclusions

Kinematically aligned TKA restores function without catastrophic failure regardless of the alignment category. Because 75% of patients had their tibial component categorized as a varus outlier and also had high function and a zero incidence of catastrophic failure, the concern that kinematic alignment compromises function and places the components at a high risk for catastrophic failure is unfounded and should be of interest to surgeons committed to cutting the tibia perpendicular to the mechanical axis of the tibia.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the imaging department and technicians at Methodist Hospital for performing the CT scanograms.

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, University of California at Davis, Davis, CA, USA

    Stephen M. Howell MD & Maury L. Hull PhD

  2. 8100 Timberlake, Suite F, Sacramento, CA, 95823, USA

    Stephen M. Howell MD

  3. Medical School University of California at Davis, Sacramento, CA, USA

    Stacey J. Howell BS

  4. Division of Stryker Orthopedics, Employee Otismed, Inc., Alamda, CA, USA

    Kyle T. Kuznik BS

  5. Undergraduate University of California at Santa Barbara, Santa Barabara, CA, USA

    Joe Cohen

Authors
  1. Stephen M. Howell MD
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  2. Stacey J. Howell BS
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  3. Kyle T. Kuznik BS
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  4. Joe Cohen
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  5. Maury L. Hull PhD
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Corresponding author

Correspondence to Stephen M. Howell MD.

Additional information

One of the authors certifies that he (KTK) is an employee of Stryker Orthopedics (Mahwah, NJ, USA). One author (SMH) is a consultant for Stryker Orthopedics (Mahwah, NJ, USA). All other authors certify that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Methodist Hospital, Sacramento, CA, USA, and at the Department of Mechanical Engineering, University of California at Davis, Davis, CA, USA.

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Howell, S.M., Howell, S.J., Kuznik, K.T. et al. Does A Kinematically Aligned Total Knee Arthroplasty Restore Function Without Failure Regardless of Alignment Category?. Clin Orthop Relat Res 471, 1000–1007 (2013). https://doi.org/10.1007/s11999-012-2613-z

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  • DOI: https://doi.org/10.1007/s11999-012-2613-z

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