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Kinematic aligned femoral rotation leads to greater patella tilt but similar clinical outcomes when compared to traditional femoral component rotation in total knee arthroplasty. A propensity score matched study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

External rotation of femoral component in total knee arthroplasty (TKA) with reference to the posterior condyles is recommended in mechanical alignment (MA) to ensure optimum patella tracking. In kinematic knee alignment (KA) technique, femoral component is more internally rotated as the femoral resection is based on flexion–extension axis. This study aims to investigate the clinical and radiological outcomes of the patellofemoral joint in patients who underwent TKA using KA versus mechanical alignment.

Methods

A review of prospectively collected registry data of 378 consecutive cruciate retaining primary TKAs (P.F.C.® Total Knee System, DePuy Synthes, Massachusetts, United States) was performed. Propensity scoring was performed matching patients who received KA TKA (n = 93) to MA TKA (n = 93). Oxford Knee Score (OKS), Knee Society Score (KSS), Short-Form 36 (SF-36), range of motion as well as radiographs assessing patella tilt were compared at 6 months and 2 years after surgery. All patients received the same implant and had their patella resurfaced.

Results

OKS, KSS, physical component of SF-36 and satisfaction rates were comparable at both 6 months and 2 years after surgery. There was moderate association between preoperative and postoperative patella tilt in KA TKA (Cramer’s V = 0.260, p < 0.05). Postoperatively, KA group had a greater number of patients with lateral patella tilt compared to the mechanical group (12 [12.9%] vs 1 [1.1%], p < 0.001). Patella tilts, however, resolved two years after surgery.

Conclusion

The relative internal rotation of the femoral component in KA TKA results in greater incidence of lateral patella tilt postoperatively. Nevertheless, patella tilt resolution was noted at 2 years.

Level of evidence

Level III Evidence—Retrospective Cohort Study.

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Funding

There was no financial conflict of interest with regards to this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore

    Don Thong Siang Koh, Yew Lok Woo, Andy Khye Soon Yew & Seng-Jin Yeo

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  1. Don Thong Siang Koh
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  2. Yew Lok Woo
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Correspondence to Don Thong Siang Koh.

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Conflict of interest

Authors Don Thong Siang Koh, Yew Lok Woo, Andy Khye Soon Yew and Seng-Jin Yeo declare that they have no conflict of interest.

Ethical approval

 This study was approved by the institution’s ethics committee (SingHealth CIRB: 2015/2632) and carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Koh, D.T.S., Woo, Y.L., Yew, A.K.S. et al. Kinematic aligned femoral rotation leads to greater patella tilt but similar clinical outcomes when compared to traditional femoral component rotation in total knee arthroplasty. A propensity score matched study. Knee Surg Sports Traumatol Arthrosc 29, 1059–1066 (2021). https://doi.org/10.1007/s00167-020-06081-7

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