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Inverse kinematic alignment accommodates native coronal knee alignment better in comparison to adjusted mechanical alignment and restricted kinematic alignment

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose was to determine the proportion of native non-arthritic knees that fit within the target zones of adjusted mechanical alignment (aMA), restricted kinematic alignment (rKA), and inverse kinematic alignment (iKA), and to estimate adjustments in native coronal alignment to bring outlier knees within the respective target zones. The hypothesis was that the target zone of iKA, compared to the target zones of aMA and rKA, accommodates a higher proportion of native non-arthritic knees.

Methods

The study used measurements obtained from a computed tomography (CT) scan database (SOMA, Stryker) of 972 healthy knees (Caucasian, 586; Asian, 386). Hip knee ankle (HKA) angle, medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were used to estimate the proportions of knees within the patient-specific alignment target zones; and to estimate theoretical adjustments of MPTA, LDFA and soft tissue balance (HKA) to bring outlier knees within target zones. Theoretical adjustments to bring outlier knees within the alignment target zones of aMA, rKA and iKA were calculated by subtracting the native coronal alignment angles (MPTAnative, LDFAnative and HKAnative) from angles on the nearest target zone border (MPTAtarget, LDFAtarget and HKAtarget).

Results

Patients were aged 59.8 ± 15.8 years with a BMI of 25.0 ± 4.4 kg/m2. The HKA angles were between 168° and 186°, MPTA between 78° and 98° and LDFA between 79° and 93°. Of the 972 knees, 81 (8%) were in the aMA target zone, 530 (55%) were in the rKA target zone, and 721 (74%) were in the iKA target zone. Adjustments of MPTA, LDFA and HKA angle to bring outlier knees within the target zones, were, respectively, 90, 91 and 28% for aMA, 45, 28 and 25% for rKA, and 25, 23 and 7% for iKA.

Conclusions

There is considerable variability in native knee coronal alignment that corresponds to different proportions of the restricted patient-specific alignment target zones for TKA. Although extension of the MPTA and LDFA target zones with rKA accommodate native knee alignment better than aMA, up to 25% would require adjustment of native HKA angle. By also extending the HKA angle target zone into varus, iKA accommodates a greater proportion (93%) of native limb alignment.

Level of evidence

IV.

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Data availability

The authors will consider providing access to raw data upon reasonable request.

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Acknowledgements

We thank Mo Saffarini for assistance with study design and manuscript editing.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium

    Philip Winnock de Grave, Thomas Luyckx, Tamaya Van Criekinge, Britt Ollivier & Eduard Van Eecke

  2. Department Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200, Brugge, Belgium

    Philip Winnock de Grave, Tamaya Van Criekinge & Kurt Claeys

  3. Department Orthopaedic Surgery, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium

    Thomas Luyckx, Britt Ollivier & Eduard Van Eecke

  4. ReSurg SA, Nyon, Switzerland

    Jacobus Hendrik Müller

  5. Stryker, 325 Corporate Drive, Mahwah, NJ, 07621, USA

    Sally LiArno & Ahmad Faizan

Authors
  1. Philip Winnock de Grave
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  2. Thomas Luyckx
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Corresponding author

Correspondence to Philip Winnock de Grave.

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Conflict of interest

PWdG reports consultancy for Stryker, Lima and Mathys. TL reports consultancy for Stryker, Lima and Corin. TvC, JHM, BO, EvE and KC have nothing to disclose. SL is employed by Stryker with stocks or stock options, is on the editorial or governing board of Journal of Orthopaedic Research, is on the board or a committee member of Penn State University Center for Biodevices, is on the board or a committee member of Stryker/ORS Women’s Research Fellowship, has a family member that is employed by Onkos Surgical. AF is employed by Stryker with stocks or stock options.

Ethical approval

All scans were obtained per local legal and regulatory requirements which included ethics board approval and informed patient consent. The SOMA database was constituted after local ethical approval and informed patient consent for the use of their data in future studies. The present study was approved by the local institutional review board (IRB#: B1172022000030).

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Winnock de Grave, P., Luyckx, T., Van Criekinge, T. et al. Inverse kinematic alignment accommodates native coronal knee alignment better in comparison to adjusted mechanical alignment and restricted kinematic alignment. Knee Surg Sports Traumatol Arthrosc 31, 3765–3774 (2023). https://doi.org/10.1007/s00167-023-07326-x

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