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Restoration of constitutional alignment optimizes outcomes of computer navigated total knee arthroplasty: a prospective randomized controlled trial

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Abstract

Purpose

The value of computer navigation in total knee arthroplasty (TKA) for arthritic knees continues to be debated. The purpose of this study was to evaluate the value of navigated TKA associated with updated alignment philosophy.

Methods

This prospective randomized controlled trial enrolled 38 consecutive patients (76 knees) and were randomly assigned to both groups. The demographic data and perioperative data were recorded. The coronal plane alignment of the knee (CPAK) classification was used to classify knee alignment phenotypes. Radiographic outcomes were measured and subgroup analysis was further performed. Clinical outcomes were evaluated using patient-reported outcome measures (PROMs). Surgery-related complications were recorded.

Results

The distribution of CPAK phenotypes following constitutional aligned TKA was equivalent to the native cohort, whereas the mechanical aligned TKA dramatically altered the phenotype distribution from type I and type II to type V and type IV. Final implant positioning was different between groups, with constitutional aligned TKA having larger cTCA (P = .004), joint line obliquity (P = .006), joint line distance (P = .033) and smaller sFCA (P = .013). Subgroup analysis showed higher actual accuracy of component positioning was achieved in navigated TKA, especially in knees with deformity of > 10° (P < .05). Patients reported higher HSS score at three months postoperatively in constitutional aligned group (P = .002). One patient in navigated group suffered femoral pin site fracture caused by a minor trauma.

Conclusion

Computer navigated TKA allows for restoration of constitutional alignment and minimizes soft tissue release, which when compared to mechanical alignment may be associated with superior early outcomes.

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Data availability

Not applicable.

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Funding

This work is supported by grants from the National Natural Science Foundation of China (No. 82072498).

Author information

Author notes

  1. Kai Zheng, Yijun Wang and Tianhao Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China

    Kai Zheng, Yijun Wang, Feng Zhu, Lianfang Zhang, Rongqun Li, Jun Zhou, Dechun Geng & Yaozeng Xu

  2. Department of Orthopedics, Wuxi Ninth People’s Hospital Affiliated to Soochow University, Wuxi, China

    Tianhao Wang

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  1. Kai Zheng
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Contributions

Conceptualization: YX, KZ; data curation: KZ, YW, TW; formal analysis: KZ, YW, FZ, LZ; writing—original draft: KZ, TW, RL; writing—review and editing: YX, JZ, DG; supervision: YX.

Corresponding author

Correspondence to Yaozeng Xu.

Ethics declarations

Ethics approval

This study was approved by the local Ethics Committee of the First Affiliated Hospital of Soochow University (2020–079-1). The study has been registered in Chinese Clinical Trial Registry (ChiCTR2000033499).

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Written informed consent was obtained from the patients for publication of related clinical data and images.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Zheng, K., Wang, Y., Wang, T. et al. Restoration of constitutional alignment optimizes outcomes of computer navigated total knee arthroplasty: a prospective randomized controlled trial. International Orthopaedics (SICOT) 48, 971–981 (2024). https://doi.org/10.1007/s00264-024-06093-9

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