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Systematic alignments yield balanced knees without additional releases in only 11% of knee arthroplasties: a prospective study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The literature suggests that “forgotten” knees are the most stable knees postoperatively. The main objective of our study was to determine whether a systematic alignment (mechanical, anatomical or kinematic) makes it possible to stabilise the operated joint in extension and in flexion.

Methods

This monocentric prospective cohort study was conducted between May 1st, 2021 and October 31st, 2021. A total of 132 consecutive patients undergoing primary navigated total knee arthroplasty were included, with a mean age of 72.4 years (7.9; 48.8–91.2 years), a mean body mass index (BMI) of 28.6 kg/m2 (4.6; 17.6–41.6) and 71.2% (94/132) women. Mechanical, anatomical and kinematic knee alignments were simulated using Kick software for each patient. The primary outcome was the targeted rate of balanced knees for each type of alignment, based on a three-point score, aiming for a 3/3 score for each knee. Our secondary outcome was to characterise the specific implantation finally achieved by the surgeon.

Results

The targeted balance was reached in 10.6% (14/132), 10.6% (14/132) and 12.9% (17/132) of knees with mechanical, anatomical and kinematic alignment simulations, respectively. None of these simulations provided a superior number of balanced knees (p = 0.87). When simulating a patient-specific implantation, the highest score was reached in 89.1% (115/132) of cases.

Conclusion

Systematic alignment simulations achieved knee balance in only 11% of cases. Patient-specific implantation, favouring knee balancing over alignment, allowed an 89% perfect score rate without having to perform any collateral release.

Level of evidence

Case series. Level 4.

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Data Availability Statement

The data are avialable on request.

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Funding

The researchers did not receive any funding to conduct this study.

Author information

Authors and Affiliations

  1. Service de chirurgie orthopedique et traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, 125 Rue d’Avron, 75020, Paris, France

    Pierre-Alban Bouché, Thomas Aubert, Simon Corsia, Nicolas Gaujac, Vincent Le Strat, Antoine Mouton & Simon Marmor

Authors
  1. Pierre-Alban Bouché
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  2. Thomas Aubert
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  3. Simon Corsia
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  4. Nicolas Gaujac
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  5. Vincent Le Strat
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  6. Antoine Mouton
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  7. Simon Marmor
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Contributions

P-AB: article design, data collection and analysis, article writing. TA: surgeon, article design and proofreading. SC: data collection and article writing. NG: data collection and proofreading. VLS: surgeon and proofreading. AM: surgeon and proofreading. SM: article design, surgeon, data analysis and article writing.

Corresponding author

Correspondence to Pierre-Alban Bouché.

Ethics declarations

Conflict of interest

Some authors are consultant for Depuy, Lape, Corin and Amplitude.

Ethical approval

This study was approved by the Comité de Protection des Personnes Nord-Ouest II (CPP) under the N° ID-RCB: 2021-100252-39.

Informed consent

All patients were informed about the study. All patients have given their consent.

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Bouché, PA., Aubert, T., Corsia, S. et al. Systematic alignments yield balanced knees without additional releases in only 11% of knee arthroplasties: a prospective study. Knee Surg Sports Traumatol Arthrosc 31, 1443–1450 (2023). https://doi.org/10.1007/s00167-022-07252-4

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