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Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the study was to compare clinical and radiological results between kinematic alignment (KA) and mechanical alignment (MA) with a posterior-stabilized (PS) total knee arthroplasty (TKA) with a post-cam mechanism at a minimum follow-up of 3 years. The authors hypothesized a higher risk of aseptic loosening when performing KA using PS TKA.

Methods

A retrospective monocentric single surgeon case control study was performed comparing 100 matched patients who had TKA performed using a MA philosophy to 50 patients receiving TKA with a KA technique between January 2016 and October 2017. All patients had the same knee prosthesis (GMK primary posterior-stabilized, Medacta®, Switzerland). Patient specific cutting blocks were used in both groups and a restricted KA (rKA) was aimed in the KA group. A hybrid cementation technique was performed. The new Knee Society Score (KSS) and radiological assessment were collected preoperatively and at the final follow-up. Comparisons between groups were done with the T test or Fisher exact test. Global survival curves were estimated with Kaplan–Meier model. Significance was set at p < 0.05.

Results

Mean follow-up was 42.9 months ± 3.6 (range 37.6–46.7) and 53.3 months ± 4.1 (range 45.5–59.8) for rKA and MA groups. Postoperatively, no significant differences were found for clinical scores between both groups. Radiological assessment found similar postoperative Hip–Knee–Ankle angle for rKA and MA groups (178° versus 179° respectively, NS). At last follow-up, a significant higher survivorship was found for the MA group compared to the rKA group (97 versus 84%; p < 0.001) for aseptic loosening revision as the endpoint.

Conclusion

An increased risk of tibial implant loosening was found with rKA compared to MA using a posterior-stabilized TKA with a post-cam system at short-term follow-up. Caution should be taken when choosing the TKA design while performing rKA.

Level of evidence

Retrospective case–control study, Level IV.

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Funding

No funding for this study.

Author information

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, 69004, Lyon, France

    Elliot Sappey-Marinier, Cécile Batailler, Axel Schmidt, Elvire Servien & Sébastien Lustig

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

    Elliot Sappey-Marinier, Cécile Batailler & Sébastien Lustig

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

    Jobe Shatrov

  4. University of Notre Dame Australia, Sydney, Australia

    Jobe Shatrov

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

    Jobe Shatrov

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

    Elvire Servien

  7. Centre Orthopédique Fleming, 30 Avenue Alexandre Fleming, 38300, Bourgoin-Jallieu, France

    Emmanuel Marchetti

Authors
  1. Elliot Sappey-Marinier
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  2. Jobe Shatrov
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  3. Cécile Batailler
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  4. Axel Schmidt
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  5. Elvire Servien
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  7. Sébastien Lustig
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Corresponding author

Correspondence to Elliot 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. Dr Emmanuel Marchetti has perfomed consultancy work for Medacta and receives royalties from Medacta. The other authors declare that they have no conflicts of interest.

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study received institutional review board approval (number 2019-A02567-49), and all participants gave valid consent to participate.

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Sappey-Marinier, E., Shatrov, J., Batailler, C. et al. Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case–control study. Knee Surg Sports Traumatol Arthrosc 30, 2838–2845 (2022). https://doi.org/10.1007/s00167-021-06714-5

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