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A robotic-assisted simulation of kinematic alignment in TKA leads to excessive valgus and internal rotation in valgus knees

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Strategies to further improve patient satisfaction after total knee arthroplasty include the introduction of new alignment philosophies and more precise instruments such as navigation and robotics. The aim of this study was to investigate the effect of a combination of image-based robotic assistance and the use of modern alignment strategies on the resulting joint line obliquity as well as femoral component rotation and to compare this between varus, neutral and valgus knees.

Methods

This retrospective study included 200 patients who received a robotic-assisted total knee arthroplasty (MAKO®, Stryker) using functional alignment between 2018 and 2020. The patients were divided into a varus (103 patients), neutral (57 patients) and valgus (40 patients) group. The intraoperatively recorded bone cuts and resulting joint line obliquity were identified and compared to values obtained with a robotic computer simulation of kinematic alignment.

Results

The mean femoral coronal alignment of the varus, neutral and valgus group, respectively, equalled 0.5° (± 1.1°), 1.1° (± 0.8°) and 1.6° (± 0.7°) of valgus with functional alignment and 2.1° (± 2.1°), 4.1° (± 1.7°) and 6.2° (± 1.7°) of valgus with kinematic alignment. The mean femoral axial alignment of the valgus group resulted in 0.8° (± 2.0°) of internal rotation with functional alignment and 3.9° (± 2.8°) of internal rotation with kinematic alignment. Overall, 186 knees (93%) could be balanced while respecting certain safe zones by using functional alignment as opposed to 54 knees (27% and none in the valgus group) when applying kinematic alignment. Kinematic alignment led to a combination of femoral component valgus and internal rotation of more than 3° in 22 valgus knees (55%), 10 neutral knees (18%) and 3 varus knees (3%) compared to none in each group when applying functional alignment with safe zones.

Conclusions

Robotic-assisted kinematic alignment leads to a combination of excessive valgus and internal rotation of the femoral component in valgus and to a lesser extent also in neutral knees when compared with functional alignment.

Level of evidence

IV.

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Acknowledgements

The authors thank Wim Coucke for his contribution to the statistical analysis of this study.

Funding

None.

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium

    Britt Ollivier & Hilde Vandenneucker

  2. Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    Hilde Vandenneucker

  3. Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium

    Hannes Vermue

  4. Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium

    Thomas Luyckx

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  1. Britt Ollivier
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  2. Hilde Vandenneucker
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  3. Hannes Vermue
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  4. Thomas Luyckx
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Contributions

The contribution of each author meets the requirements for authorship as defined by the ICMJE guidelines.

Corresponding author

Correspondence to Britt Ollivier.

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Conflict of interest

One of the authors receives consulting fees from Stryker (TL). The other authors certify that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.

Ethical approval

Ethical approval for this study was obtained from the hospital’s ethics committee (AZ Delta Roeselare).

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None was required at it concerns a retrospective, anonymized study.

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Ollivier, B., Vandenneucker, H., Vermue, H. et al. A robotic-assisted simulation of kinematic alignment in TKA leads to excessive valgus and internal rotation in valgus knees. Knee Surg Sports Traumatol Arthrosc 31, 4747–4754 (2023). https://doi.org/10.1007/s00167-023-07504-x

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