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Kinematic alignment of medial UKA is safe: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Owing to the improved understanding of knee kinematics and the successful introduction of the kinematic alignment (KA) technique for implanting total knee arthroplasty (TKA), it was recently understood that the “Cartier angle technique” corresponds to a kinematic implantation of the uni-compartmental knee arthroplasty (UKA) components. When compared to the universally spread mechanical alignment (MA) technique for implanting UKA, the KA method generates a more anatomic prosthetic knee that may be clinically advantageous. The aims of this study are to determine if KA UKAs are associated with acceptable functional performance and patient satisfaction (question 1), rates of residual pain and tibia plateau fracture (question 2), and rates of reoperation and revision (question 3), and to define the component orientation and limb alignment as measured on radiograph (question 4), and the stress shielding related bone loss in the proximal tibia (question 5) with KA UKA, and where possible to compare with MA UKA.

Study hypothesis

KA UKA generates good clinical outcomes, similar or superior to the ones of MA UKA.

Method

Systematic review of literature databases were primarily searched using Healthcare Databases Advanced Search (HDAS). Two primary searches were conducted using the electronic databases MEDLINE, EMBASE, and PubMed, and a secondary search was conducted using review articles and bibliography of obtained papers in order to ascertain more material.

Results

Nine eligible non-comparative prospective (3) or retrospective (6) cohort studies, which cumulated 593 KA UKAs with follow-up between 3.2 and 12 years, fulfilled the inclusion criteria for this systematic review. The findings demonstrated high Knee Society Score (KSS) (from 87 to 95) and function scores (from 81 to above 91) in addition to patient satisfaction scores of 88%. There was no revision for tibia plateau fracture, 0.8% (5 cases) for unexplained pain tibia, 2.0% (12 cases) for component loosening, and 5.6% (33 cases) for any causes of aseptic failures reported for KA UKA. The prosthetic lower limb and tibia implant alignments were both found to be in slight varus (means between 3 and 5°), and the postoperative joint line and tibia component was shown to be parallel to the floor when standing. The KA UKA components migration, as measured on radiostereometry, was acceptable.

Discussion/conclusion

The KA technique is an alternative, personalised, more physiological method for implanting UKA, which could be clinically advantageous when compared to the MA technique. The literature supports the good mid- to long-term clinical safety and good efficacy of KA UKA; however, comparison between KA and MA techniques for UKA was not performed due to limited literature. Further investigations are needed to better define the clinical impact of KA UKA, and the acceptable limits for KA of the UKA tibial component.

Level of evidence

Level 4; systematic review of level 4 studies.

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Funding

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Author information

Authors and Affiliations

  1. MSK Lab-Imperial College London, White City Campus, London, W12 0BZ, UK

    Charles Rivière & Justin Cobb

  2. The Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK

    Charles Rivière

  3. Centre de L’Arthrose-Clinique de Sport, 4 Rue Georges Negrevergne, 33700, Mérignac, France

    Charles Rivière & Loic Villet

  4. Personalized Arthroplasty Society, London, UK

    Charles Rivière, Loic Villet, Philippe Cartier, Sébastien Lustig, Pascal-André Vendittoli & Justin Cobb

  5. South West London Elective Orthopaedic Centre, Dorking Rd, Epsom, KT18 7EG, UK

    Sivan Sivaloganathan

  6. Centre Albert Trillat, Groupement Hospitalier Nord, Université Lyon 1, Villeurbanne, France

    Sébastien Lustig

  7. Département de Chirurgie, Université de Montréal, Hôpital Maisonneuve-Rosemont, 5415 Boul L’Assomption, Montréal, Québec, H1T 2M4, Canada

    Pascal-André Vendittoli

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  1. Charles Rivière
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Contributions

(1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted, (4) Statistics: Charles Rivière: 1–2–3–4; Sivan Sivaloganathan: 2–3; Loic Villet: 2–3; Philippe Cartier: 2–3; Sébastien Lustig: 2–3; Pascal André Vendittoli: 2–3; Justin Cobb: 2–3.

Corresponding author

Correspondence to Charles Rivière.

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Conflict of interest

Charles Rivière declares being a consultant for Medacta, Pascal André Vendittoli declares being a consultant for Microport, Medacta, Stryker, Ethicon and Johnson & Johnson, Justin Cobb declares being a consultant for Biomet-Zimmer, Mathortho, and to receive fees from Microport. Sebastien Lustig declares being a consultant for Strytker and to receive institutional support form Amplitude and Corin. Other authors have no conflict of interest.

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Rivière, C., Sivaloganathan, S., Villet, L. et al. Kinematic alignment of medial UKA is safe: a systematic review. Knee Surg Sports Traumatol Arthrosc 30, 1082–1094 (2022). https://doi.org/10.1007/s00167-021-06462-6

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  • DOI: https://doi.org/10.1007/s00167-021-06462-6

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