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Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Kinematic alignment technique for TKA aims to restore the individual knee anatomy and ligament tension, to restore native knee kinematics. The aim of this study was to compare parameters of kinematics during gait (knee flexion–extension, adduction–abduction, internal–external tibial rotation and walking speed) of TKA patients operated by either kinematic alignment or mechanical alignment technique with a group of healthy controls. The hypothesis was that the kinematic parameters of kinematically aligned TKAs would more closely resemble that of healthy controls than mechanically aligned TKAs.

Methods

This was a retrospective case–control study. Eighteen kinematically aligned TKAs were matched by gender, age, operating surgeon and prosthesis to 18 mechanically aligned TKAs. Post-operative 3D knee kinematics analysis, performed with an optoelectronic knee assessment device (KneeKG®), was compared between mechanical alignment TKA patients, kinematic alignment TKA patients and healthy controls. Radiographic measures and clinical scores were also compared between the two TKA groups.

Results

The kinematic alignment group showed no significant knee kinematic differences compared to healthy knees in sagittal plane range of motion, maximum flexion, abduction–adduction curves or knee external tibial rotation. Conversely, the mechanical alignment group displayed several significant knee kinematic differences to the healthy group: less sagittal plane range of motion (49.1° vs. 54.0°, p = 0.020), decreased maximum flexion (52.3° vs. 57.5°, p = 0.002), increased adduction angle (2.0–7.5° vs. − 2.8–3.0°, p < 0.05), and increased external tibial rotation (by a mean of 2.3 ± 0.7°, p < 0.001). The post-operative KOOS score was significantly higher in the kinematic alignment group compared to the mechanical alignment group (74.2 vs. 60.7, p = 0.034).

Conclusions

The knee kinematics of patients with kinematically aligned TKAs more closely resembled that of normal healthy controls than that of patients with mechanically aligned TKAs. This may be the result of a better restoration of the individual’s knee anatomy and ligament tension. A return to normal gait parameters post-TKA will lead to improved clinical outcomes and greater patient satisfaction.

Level of evidence

III.

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Funding

Research funds were provided by Maisonneuve-Rosemont Hospital Fundation.

Author information

Authors and Affiliations

  1. Department of Surgery, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415, Boulevard de l’Assomption, Montreal, QC, H1T 2M4, Canada

    William Blakeney & Pascal-André Vendittoli

  2. Centre de recherche de l’Hôpital Maisonneuve-Rosemont-Orthopédie, 5415, Boulevard de l’Assomption, Montreal, QC, H1T 2M4, Canada

    Julien Clément, François Desmeules & Pascal-André Vendittoli

  3. School of Rehabilitation, Faculty of Medicine, Université de Montreal, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada

    François Desmeules

  4. Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du CHUM, Tour Viger 900, rue St-Denis, local R11.322, Montreal, QC, H2X 0A9, Canada

    Nicola Hagemeister

  5. École de technologie supérieure, 1100 Notre-Dame Ouest, Montreal, H3C1K3, Canada

    Nicola Hagemeister

  6. The MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, W6 8RP, UK

    Charles Rivière

Authors
  1. William Blakeney
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  2. Julien Clément
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  4. Nicola Hagemeister
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  6. Pascal-André Vendittoli
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Corresponding author

Correspondence to Pascal-André Vendittoli.

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Conflict of interest

None of the author have proprietary, financial, professional or other personal interest of any nature or kind of any product, service and/or company that could be construed as influencing the position presented in the manuscript.

Ethical approval

Ethical approval was obtained from the research and ethics committee (CIUSSS de l’Est-de-l’Île-de-Montréal, Project number 2011-462), and all patients gave informed consent.

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Blakeney, W., Clément, J., Desmeules, F. et al. Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment. Knee Surg Sports Traumatol Arthrosc 27, 1410–1417 (2019). https://doi.org/10.1007/s00167-018-5174-1

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  • DOI: https://doi.org/10.1007/s00167-018-5174-1

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