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Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to report Knee Society Scores (KSS) at 12-month follow-up in a series of 266 knees that received custom TKA. The hypothesis was that custom TKA combined with personalised alignment would yield improvements greater than substantial clinical benefits (SCB) of KSS Knee and Function.

Methods

From a consecutive series of 905 patients (918 knees) that received primary TKAs, 261 (29%) patients (266 knees) received computed tomography (CT)-based posterior-stabilised cemented custom TKA. Knees were aligned aiming to preserve or restore constitutional alignment within predetermined limits of 85°–95° for femoral mechanical angle (FMA) and tibial mechanical angle (TMA), and 175°–183° for hip knee ankle (HKA) angle. The KSS Knee and Function were collected preoperatively and 12 months postoperatively, to determine if patients achieved SCB. Uni- and multivariable analyses were performed to determine associations between KSS scores (Knee and Function) and patient demographics as well as pre- and postoperative radiographic alignments.

Results

Of the initial cohort of 261 patients, 4 (1.8%) were reoperated for patellar resurfacing, 1 (0.4%) for lavage to treat infection, and 1 (0.4%) had arthroscopy to treat a stiff knee with < 90° range of motion. Complete clinical records were available for 227 patients (232 knees, 87%) that comprised 102 men (5 bilateral) and 125 women. At 12-month follow-up, mean improvements in KSS Knee and Function scores were, respectively, 61.0 ± 13.0 and 42.7 ± 16.7, which exceeded the SCB of KSS. Comparison of knees inside versus outside the target zone revealed no differences in KSS Knee (94.1 ± 9.1 versus 94.3 ± 9.0, n.s.) and Function (96.1 ± 9.2 versus 96.3 ± 8.9, n.s.). Multivariable analysis revealed worse KSS Knee in knees with preoperative FMA > 95° (β = − 6.21; p = 0.023), but no association between KSS Function and patient demographics or pre- and postoperative radiographic alignments.

Conclusions

Custom TKA combined with personalised alignment yielded improvements that exceeded substantial clinical benefits of KSS Knee and Function scores. These findings demonstrate the feasibility of custom TKA with ‘personalised alignment’ and encourage further investigations using comparative studies at longer follow-up.

Level of evidence

IV, case series.

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Acknowledgements

The authors are grateful to Mo Saffarini and Andreas Dobbelaere for assistance with study design and interpretation of findings.

Funding

The authors are grateful to “GCS Ramsay Santé pour l’Enseignement et la Recherche” for funding the statistical analysis and manuscript preparation for this study.

Author information

Authors and Affiliations

  1. Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France

    Salvatore Ratano, Jeremy Daxhelet, Lucas Beckers, Louka Bondoux, Tarik Aït-Si-Selmi & Michel P. Bonnin

  2. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Jacobus H. Müller

  3. KniePraxis, Straubing, Germany

    Carsten O. Tibesku

Authors
  1. Salvatore Ratano
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  2. Jacobus H. Müller
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  3. Jeremy Daxhelet
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  4. Lucas Beckers
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  5. Louka Bondoux
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  6. Carsten O. Tibesku
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  7. Tarik Aït-Si-Selmi
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  8. Michel P. Bonnin
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Corresponding author

Correspondence to Jacobus H. Müller.

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Conflict of interest

SR has nothing to declare. JHM has nothing to declare. JD has nothing to declare. LB has nothing to declare. LB has nothing to declare. COT reports personal fees from Symbios and Smith & Nephew. TASS reports personal fees from DePuy-Synthes and from Symbios. MPB reports personal fees from DePuy Synthes, Wright Medical, Integra and Symbios

Ethical approval

All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board approved the study in advance (IRB reference number: COS-RGDS-2021-03-004-BONNIN-M; Ramsay Santé Comité d’Ethique; +33 (0)1 87 86 22 97; Dr Sylviane Olschwang).

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Ratano, S., Müller, J.H., Daxhelet, J. et al. Custom TKA combined with personalised coronal alignment yield improvements that exceed KSS substantial clinical benefits. Knee Surg Sports Traumatol Arthrosc 30, 2958–2965 (2022). https://doi.org/10.1007/s00167-022-06867-x

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  • DOI: https://doi.org/10.1007/s00167-022-06867-x

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