Abstract
Purpose
The joint line of the native knee is horizontal to the floor and perpendicular to the vertical weight-bearing axis of the patient in a bipedal stance. The purposes of this study were as follows: (1) to find out the distribution of the native joint line in a population of normal patients with normal knees; (2) to compare the native joint line orientation between patients receiving conventional mechanically aligned total knee arthroplasty (TKA), navigated mechanically aligned TKA, and kinematically aligned TKA; and (3) to determine which of the three TKA methods aligns the postoperative knee joint perpendicular to the weight-bearing axis of the limb in bipedal stance.
Methods
To determine the joint line orientation of a native knee, 50 full-length standing hip-to-ankle digital radiographs were obtained in 50 young, healthy individuals. The angle between knee joint line and the line parallel to the floor was measured and defined as joint line orientation angle (JLOA). JLOA was also measured prior to and after conventional mechanically aligned TKA (65 knees), mechanically aligned TKA using imageless navigation (65 knees), and kinematically aligned TKA (65 knees). The proportion of the knees similar to the native joint line was calculated for each group.
Results
The mean JLOA in healthy individuals was parallel to the floor (0.2° ± 1.1°). The pre-operative JLOA of all treatment groups slanted down to the lateral side. Postoperative JLOA slanted down to the lateral side in conventional mechanically aligned TKA (−3.3° ± 2.2°) and in navigation mechanically aligned TKA (−2.6° ± 1.8°), while it was horizontal to the floor in kinematically aligned TKA (0.6° ± 1.7°). Only 6.9 % of the conventional mechanically aligned TKA and 16.9 % of the navigation mechanically aligned TKA were within one SD of the mean JLOA of the native knee, while the proportion was significantly higher (50.8 %) in kinematically aligned TKA. The portion was statistically greater in mechanically aligned TKA group than the other two.
Conclusion
Postoperative joint line orientation after kinematically aligned TKA was more similar to that of native knees than that of mechanically aligned TKA and horizontal to the floor. Kinematically aligned TKA can restore pre-arthritic knee joint line orientation, while mechanically aligned TKA is inefficient in achieving the purpose even if navigation TKA is employed.
Level of evidence
III.
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References
Bellemans J (2011) Neutral mechanical alignment: a requirement for successful TKA: opposes. Orthopedics 34:e507–e509
Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93:1217–1222
Cooke TD, Pichora D, Siu D, Scudamore RA, Bryant JT (1989) Surgical implications of varus deformity of the knee with obliquity of joint surfaces. J Bone Joint Surg Br 71:560–565
Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG (2014) A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Joint J 96-B:907–913
Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43
Fujimoto E, Sasashige Y, Tomita T, Kashiwagi K, Inoue A, Sawa M, Ota Y (2015) Different femorotibial contact on the weight-bearing: midflexion between normal and varus aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 23:1720–1728
Howell SM, Hodapp EE, Vernace J, Hull ML, Meade T (2013) Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients. Knee Surg Sports Traumatol Arthrosc 21:2281–2287
Howell SM, Papadopoulos S, Kuznik KT, Ghaly LR, Hull ML (2015) Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty? Int Orthop. doi:10.1007/s00264-015-2743-5
Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21:2271–2280
Hutt J, Masse V, Lavigne M, Vendittoli PA (2015) Functional joint line obliquity after kinematic total knee arthroplasty. Int Orthop. doi:10.1007/s00264-015-2733-7
Ishikawa M, Kuriyama S, Ito H, Furu M, Nakamura S, Matsuda S (2015) Kinematic alignment produces near-normal knee motion but increases contact stress after total knee arthroplasty: a case study on a single implant design. Knee. doi:10.1016/j.knee.2015.02.019
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714
Kastner N, Sternbauer S, Friesenbichler J, Vielgut I, Wolf M, Glehr M, Leithner A, Sadoghi P (2014) Impact of the tibial slope on range of motion after low-contact-stress, mobile-bearing, total knee arthroplasty. Int Orthop 38:291–295
Lovejoy CO (2007) The natural history of human gait and posture. Part 3. The knee. Gait Posture 25:325–341
Matziolis G, Adam J, Perka C (2010) Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 130:1487–1491
Miller EJ, Pagnano MW, Kaufman KR (2014) Tibiofemoral alignment in posterior stabilized total knee arthroplasty: static alignment does not predict dynamic tibial plateau loading. J Orthop Res 32:1068–1074
Morgan SS, Bonshahi A, Pradhan N, Gregory A, Gambhir A, Porter ML (2008) The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty. Int Orthop 32:639–642
Nam D, Lin KM, Howell SM, Hull ML (2014) Femoral bone and cartilage wear is predictable at 0 degrees and 90 degrees in the osteoarthritic knee treated with total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:2975–2981
Oh KJ, Park WM, Kim K, Kim YH (2014) Quantification of soft tissue balance in total knee arthroplasty using finite element analysis. Comput Methods Biomech Biomed Eng 17:1630–1634
Pang HN, Jamieson P, Teeter MG, McCalden RW, Naudie DD, MacDonald SJ (2014) Retrieval analysis of posterior stabilized polyethylene tibial inserts and its clinical relevance. J Arthroplasty 29:365–368
Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92:2143–2149
Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA (2011) The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 93:1588–1596
Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 93:153–156
Shi X, Shen B, Kang P, Yang J, Zhou Z, Pei F (2013) The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2696–2703
Victor JM, Bassens D, Bellemans J, Gursu S, Dhollander AA, Verdonk PC (2014) Constitutional varus does not affect joint line orientation in the coronal plane. Clin Orthop Relat Res 472:98–104
Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38:349–355
Yoo JH, Choi IH, Cho TJ, Chung CY, Yoo WJ (2008) Development of tibiofemoral angle in Korean children. J Korean Med Sci 23:714–717
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Ji, HM., Han, J., Jin, D.S. et al. Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 24, 2436–2441 (2016). https://doi.org/10.1007/s00167-016-3995-3
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DOI: https://doi.org/10.1007/s00167-016-3995-3