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The coronal alignment technique impacts deviation from native knee anatomy after total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to analyze and quantify the changes in native coronal alignment of a population of TKA patients according to different alignment goals.

Methods

Five hundred and twenty TKAs were analyzed. The following angles were measured using an image-free navigation system prior to prosthetic implantation: medial femorotibial mechanical angle without stress and with maximum manual stress to reduce the deformity, medial distal femoral mechanical angle, medial proximal tibial mechanical angle. The native angles were derived from the osteoarthritic knee angles using a validated correction technique, and the overall, femoral and tibial coronal phenotypes were defined.

Five different coronal alignment techniques were simulated: mechanical (MA), restricted mechanical (RMA), anatomical (AA), kinematic (KA) and restricted kinematic (RKA). The overall, femoral and tibial coronal phenotypes were compared before and after TKA. The primary endpoint was the binary criterion of whether or not TKA restored the natural overall phenotype. Secondary endpoints were the binary criteria of whether or not the natural femoral and tibial phenotypes were restored by TKA. The rates of restored and non restored phenotypes were compared with a Chi-square test at a 0.05 level of significance, with post hoc tests between all pairs of techniques at a 0.01 level of significance.

Results

The overall phenotype was restored significantly differently by the five alignment techniques: 15% for MA, 23% for RMA, 2% for AA, 100% for KA and 79% for RKA (p < 0.001). There was a significant difference between each of the technique pairs (p < 0.01 to p < 0.001), except for the mechanical alignment-restricted mechanical alignment pair. The femoral phenotype was restored significantly differently by the five alignment techniques: 37% for MA, 58% for RMA, 19% for AA, 100% for KA and 85% for RKA (p < 0.001). The tibial phenotype was restored significantly differently by the five alignment techniques: 36% for MA, 36% for RMA, 17% for AA, 100% for KA and 88% for RKA (p < 0.001). There was a significant difference between each pair of techniques for both femoral and tibial phenotypes (p < 0.01 to p < 0.001).

Conclusion

Except for the kinematic alignment technique, the various alignment techniques induce significant changes in the pre-arthritic anatomy of the TKA patient. The surgeon must be aware of these modifications. The clinical relevance of this alteration still needs to be defined.

Level of evidence

III.

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Abbreviations

TKA:

Total knee arthroplasty

MDFMA:

Medial distal femoral mechanical angle

MPTMA:

Medial proximal tibial mechanical angle

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Acknowledgements

The authors would like to thank Mrs Archambault for proofreading the article and correcting the English language.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Locomax Unit, University Hospital, 1 avenue Molière, 67200, Strasbourg, France

    Jean-Yves Jenny & Florent Baldairon

Authors
  1. Jean-Yves Jenny
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  2. Florent Baldairon
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Contributions

JYJ conceived the study, analyzed the data and wrote the manuscript. FB collected the data and reviewed the manuscript.

Corresponding author

Correspondence to Jean-Yves Jenny.

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Conflict of interest

The authors declare that they have nothing to disclose in relationship with this manuscript.

Ethical approval

This study was conducted after approval by our hospital's ethics committee (# CE-2021-32).

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Informed consent was obtained from all patients.

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Jenny, JY., Baldairon, F. The coronal alignment technique impacts deviation from native knee anatomy after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 1427–1432 (2023). https://doi.org/10.1007/s00167-022-07157-2

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  • DOI: https://doi.org/10.1007/s00167-022-07157-2

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