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Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques

Knee Surgery, Sports Traumatology, Arthroscopy (2023)Cite this article

Abstract

Purpose

A key part of kinematic alignment (KA) and functional alignment (FA) is to restore the natural femoral joint line, in particular the medial joint line. KA is known to reproduce the femoral joint line accurately; however, direct comparisons with other surgical techniques such as FA are currently lacking. The purpose of this study was to evaluate differences of alignment parameters in KA and FA techniques with a special focus given to the femoral joint line.

Methods

We performed a retrospective radiological analysis of pre- and postoperative long leg radiographs of 221 consecutive patients with varus or neutral leg alignment, who underwent primary total knee arthroplasty (TKA) procedures from 2018 to 2020. Patients were assigned to one of four groups: (1) FA: image-based robotic-assisted TKA, (2) FA: imageless robotic-assisted TKA, (3): restricted KA: 3D cutting block-assisted (patient-specific instruments, PSI) TKA, (4): unrestricted KA: calipered technique. Patients’ radiographs were (re)-analyzed for overall limb alignment, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), as well as medial and lateral femoral joint line alteration. Statistical significance was determined using unpaired t testing (FA vs. KA group) and one-way ANOVA (subgroup analyses).

Results

Comparisons of KA vs. FA, as well as individual subgroups of KA and FA did not show any differences in the accuracy of medial joint line reconstruction (< 2 mm, p = 0.384, p = 0.744, respectively) and LDFA alteration (< 2°, p = 0.997, 0.921, respectively). Correction of MPTA (3.4° vs. 2.2°) and lateral femoral joint line (2.1 mm vs. 1.5 mm) was higher for FA and FA subgroups compared to KA and KA subgroups (both p < 0.001).

Conclusion

Kinematic and functional alignments showed a comparable accuracy in reconstruction of the medial femoral joint line and femoral joint line orientation. Increased correction of MPTA and lateral femoral joint line was recorded with FA techniques.

Level of evidence

III.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

aHKA:

Arithmetic hip-to-knee angle

AT:

Adductor tubercle

ATJL:

Adductor tubercle joint line distance

BCS:

Bi-cruciate stabilized

CT:

Computed tomography

FA:

Functional alignment

HKA:

Hip-to-knee angle

JL:

Joint line

JLO:

Joint line obliquity

KA:

Kinematic alignment

LDFA:

Lateral distal femoral angle

lJL:

Lateral femoral joint line

mJL:

Medial femoral joint line

MPTA:

Medial proximal tibial angle

OLA:

Overall limb alignment

PSI:

Patient-specific instruments

PS:

Posterior stabilized

rTKA:

Robotic-assisted total knee arthroplasty

SD:

Standard deviation

TKA:

Total knee arthroplasty

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Acknowledgements

We thank Felix KF Kommoss for English language editing of the current manuscript.

Funding

This research received no external funding.

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Author notes

  1. Peter Savov & Max Ettinger

    Present address: Department of Orthopaedic and Trauma Surgery, Pius Hospital, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany

    Lars-Rene Tuecking, Peter Savov, Mats Zander, Henning Windhagen & Max Ettinger

  2. Department of Orthopaedic Surgery, St.Vincenz Hospital Brakel, Danziger Str. 17, 33034, Brakel, Germany

    Dragan Jeremic

Authors
  1. Lars-Rene Tuecking
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Contributions

Conceptualization, L-RT, PS, HW and ME; data curation, MZ, L-RT, PS; formal analysis, L-RT, HW and ME; investigation, MZ, L-RT, PS; methodology, L-RT, MZ, PS, HW and ME; project administration, HW and ME; supervision, ME; visualization, PS; writing—original draft, L-RT; writing—review and editing, PS, DJ, HW and ME.

Corresponding author

Correspondence to Lars-Rene Tuecking.

Ethics declarations

Conflict of interest

LT, PS, ME and HW are paid educational consultants for Stryker. LT, PS and ME are paid educational consultants for Smith & Nephew. HW is a paid consultant for Medacta. No funding was received for this study. MZ and DJ have no conflict of interest.

Ethical approval

This study was approved by the local ethics committee (8403_BO_S_2019).

Informed consent

Informed consent was not needed due to the use of only anonymized data (radiographs) in this retrospective study.

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Tuecking, LR., Savov, P., Zander, M. et al. Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques. Knee Surg Sports Traumatol Arthrosc (2023). https://doi.org/10.1007/s00167-023-07360-9

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  • DOI: https://doi.org/10.1007/s00167-023-07360-9

Keywords

  • Kinematic alignment
  • Functional alignment
  • Robotic TKA
  • RA-TKA
  • PSI
  • Unrestricted KA
  • Joint line
  • Accuracy
  • Total knee arthroplasty