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Tibial joint line orientation has no effect on joint awareness after mechanically aligned total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Joint line orientation (JLO) plays an important role in total knee arthroplasty (TKA), but its influence on patient-reported outcomes (PROs) is unclear. The purpose of this study was to examine JLO impact as measured by the forgotten joint score (FJS-12). The hypothesis was that restoring the joint line (JL) parallel to the floor would influence joint awareness favorably, i.e., allow the patient to forget about the joint in daily living.

Methods

All computer-navigated primary TKAs using a cemented, cruciate-retaining (CR) design implanted between January 2018 and September 2019 were reviewed in this retrospective single-center analysis. Primary endpoints were: clinical [range of motion (ROM)], and patient-reported (FJS-12) and radiographical outcomes [tibia joint line angle (TJLA), hip knee axis (HKA), mechanical medial proximal tibia angle (mMPTA) as well as mechanical lateral distal femoral angle (mLDFA)].

Results

Seventy-six patients (mean age: 70.3 ± 9.7 years, mean BMI: 29.7 ± 5.2 kg/m2) were included. Postoperative ROM averaged 118.7 ± 9.6°. The mean FJS-12 improved from 16.4 ± 15.3 (preoperatively) to 89.4 ± 16.9 (1-year follow-up; p < 0.001). Clinical outcomes and PROs did not correlate with JLO (p = n.s.). Cluster analysis using six measures revealed that a medially opened TJLA was associated with significantly better postoperative FJS-12.

Conclusion

Tibial JLO was found to have no effect on PROs. Considering the JLO in the coronal plane alone probably has questionable clinical relevance. Lower limb alignment should be assessed in all three planes and correlated with the clinical outcome.

Level of clinical evidence

Level IV.

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Abbreviations

CR:

Cruciate retaining

FJS-12:

Forgotten joint score-12

HKA:

Hip knee ankle axis

ICC:

Interclass correlation coefficient

JL:

Joint line

JLO:

Joint line orientation

KA:

Kinematic alignment

MA:

Mechanical alignment

MCID:

Minimal clinically important difference

mLDFA:

Mechanical lateral distal femoral angle

mMPTA:

Mechanical medial proximal tibial angle

PRO:

Patient-reported outcome

ROM:

Range of motion

TJLA:

Tibia joint line angle

TKA:

Total knee arthroplasty

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Funding

No direct support for this project was received.

Author information

Author notes

  1. Anna-Katharina Calek and Andreas Ladurner have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland

    Anna-Katharina Calek, Andreas Ladurner, Lukas Jud, Vilijam Zdravkovic & Henrik Behrend

Authors
  1. Anna-Katharina Calek
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  2. Andreas Ladurner
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  3. Lukas Jud
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  4. Vilijam Zdravkovic
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  5. Henrik Behrend
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Contributions

AKC and HB were involved in conceptualization and design of the study. AKC, VZ, and LJ were involved in analysis and interpretation of the data. AKC and AL were drafting the manuscript. AL, LJ, and HB were involved in manuscript revision. All authors edited, read, and approved the final manuscript.

Corresponding author

Correspondence to Henrik Behrend.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Approval was obtained from the local ethical committee (Ethikkommission Nordwest- und Zentralschweiz, ID 2020-02361). All procedures performed were in accordance with the ethical standards of the institutional and/or the national research committees and with the 1964 Declaration of Helsinki and its later amendments or with comparable ethical standards.

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Informed consent was obtained from all participants of the study.

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Not applicable.

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Calek, AK., Ladurner, A., Jud, L. et al. Tibial joint line orientation has no effect on joint awareness after mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 389–396 (2022). https://doi.org/10.1007/s00167-021-06696-4

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  • DOI: https://doi.org/10.1007/s00167-021-06696-4

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