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Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements.

Methods

This is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing.

Results

The mean FMA was 91.3 ± 2.2° (range 82°–97°), the mean TMA was 85.7 ± 2.5° (range 75°–98°), the mean aHKA was 177.0 ± 3.0° (range 164°–185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°–192°). No significant difference was observed between aHKA and vcHKA (p = 0.06). A significant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001).

Conclusion

This study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre-arthritic coronal alignment of the knee for the extension gap.

Level of evidence

IV.

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Funding

No specific grants were received from public, private for-profit and non-profit organizations for this study.

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Authors and Affiliations

  1. Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix Rousse, Hopital de La Croix Rousse, 69004, Lyon, France

    E. Sappey-Marinier, P. Meynard, J. Shatrov, A. Schmidt, C. Batailler, E. Servien & S. Lustig

  2. Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France

    E. Sappey-Marinier, L. Cheze, C. Batailler & S. Lustig

  3. Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia

    J. Shatrov

  4. University of Notre Dame Australia, Sydney, Australia

    J. Shatrov

  5. Hornsby and Ku-Ring Hospital, Sydney, Australia

    J. Shatrov

  6. LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France

    E. Servien

Authors
  1. E. Sappey-Marinier
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  2. P. Meynard
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  3. J. Shatrov
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  4. A. Schmidt
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  5. L. Cheze
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  6. C. Batailler
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  7. E. Servien
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  8. S. Lustig
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Corresponding author

Correspondence to E. Sappey-Marinier.

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Conflict of interest

Prof. Sébastien Lustig has performed consultancy work for Medacta, Heraeus, Corin, Amplitude, Groupe Lépine, Depuy Synthes, Smith & Nephew, Stryker. Prof. Sébastien Lustig receives institutional research support from Corin and Amplitude. Prof. Sébastien Lustig is a board member of KSSTA, Maitrise Orthopédique and JBJS american. The other authors declare that they have no conflicts of interest.

Ethical approval

The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 under the number 135–5265. 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.

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Sappey-Marinier, E., Meynard, P., Shatrov, J. et al. Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs. Knee Surg Sports Traumatol Arthrosc 30, 2915–2921 (2022). https://doi.org/10.1007/s00167-021-06832-0

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