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Restricted kinematic alignment achieves similar relative lateral laxity and greater joint line obliquity compared to gap balancing TKA

Abstract

Purpose

The purpose of this study was to compare ligament balance and laxity profiles achieved throughout flexion in restricted kinematic alignment (rKA) and gap balancing (GB). rKA and GB both aim to improve soft tissue balance and reduce ligament releases in total knee arthroplasty (TKA).

Methods

One surgeon performed 68 rKA, another performed 73 GB TKAs using the same CR implant and robotic system. rKA limited femoral valgus and tibial varus to 6°, with tibial recuts performed to achieve balance. GB limited tibial varus and femoral valgus to 2°, with femoral resections adjusted to achieve mediolateral balance throughout flexion using predictive-gap planning software. Final joint laxity was measured using a robotic ligament tensioner. Statistical analyses were performed to compare differences in mediolateral balance and joint laxity throughout flexion. Further analyses compared alignment, joint line elevation and orientation (JLO), and frequency of ligament releases and bone recuts.

Results

Both techniques reported greater lateral laxity throughout flexion, with GB reporting improved mediolateral balance from 10° to 45° flexion. GB resected 1.7 mm more distal femur (p ≤ 0.001) and had greater overall laxity than rKA throughout flexion (p ≤ 0.01). rKA increased JLO by 2.5° and 3° on the femur and tibia (p ≤ 0.001). Pre-operative and post-operative coronal alignment were similar across both techniques. rKA had a higher tibial recut rate: 26.5% vs 1.4%, p < 0.001.

Conclusions

rKA and GB both report lateral laxity but with different JLO and elevation. Use of a predictive-gap GB workflow resulted in greater mediolateral gap symmetry with fewer recuts.

Level of evidence

III, retrospective cohort study.

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Funding

This study was funded by Corin Ltd.

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Authors and Affiliations

Authors

Contributions

AO was involved with conception and design of the study, was the lead for data analysis and interpretation, as well as the lead manuscript drafter and reviser. EW was involved with conception and design of the study, data interpretation, as well manuscript revisions. CP was involved with conception and design of the study, data interpretation, as well manuscript revisions. JP was involved with conception and design of the study, data collection, data interpretation, as well manuscript revisions. SC was involved with conception and design of the study, data collection, data interpretation, as well manuscript revisions.

Corresponding author

Correspondence to Alexander D. Orsi.

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Conflict of interest

The author(s) declare that they have no conflict of interest.

Ethical approval

Ethics approval was obtained from an independent Institutional Review Board (CorinRegistry, Bellberry Ltd Approval No. 2020-08-764-A-1).

Informed consent

Informed consent was not obtained as this project was a retrospective analysis using deidentified data.

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Orsi, A.D., Wakelin, E.A., Plaskos, C. et al. Restricted kinematic alignment achieves similar relative lateral laxity and greater joint line obliquity compared to gap balancing TKA. Knee Surg Sports Traumatol Arthrosc 30, 2922–2930 (2022). https://doi.org/10.1007/s00167-022-06863-1

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  • DOI: https://doi.org/10.1007/s00167-022-06863-1

Keywords

  • Gap balancing
  • Restricted kinematic alignment
  • Total knee arthroplasty
  • Computer assisted
  • Robotic assisted