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. 2022 Aug;30(8):2838-2845.
doi: 10.1007/s00167-021-06714-5. Epub 2021 Aug 23.

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case-control study

Elliot Sappey-Marinier  1   2 , Jobe Shatrov  3   4   5 , Cécile Batailler  6   7 , Axel Schmidt  6 , Elvire Servien  6   8 , Emmanuel Marchetti  9 , Sébastien Lustig  6   7
Affiliations

Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case-control study

Elliot Sappey-Marinier et al. Knee Surg Sports Traumatol Arthrosc. 2022 Aug.

Abstract

Purpose: The purpose of the study was to compare clinical and radiological results between kinematic alignment (KA) and mechanical alignment (MA) with a posterior-stabilized (PS) total knee arthroplasty (TKA) with a post-cam mechanism at a minimum follow-up of 3 years. The authors hypothesized a higher risk of aseptic loosening when performing KA using PS TKA.

Methods: A retrospective monocentric single surgeon case control study was performed comparing 100 matched patients who had TKA performed using a MA philosophy to 50 patients receiving TKA with a KA technique between January 2016 and October 2017. All patients had the same knee prosthesis (GMK primary posterior-stabilized, Medacta®, Switzerland). Patient specific cutting blocks were used in both groups and a restricted KA (rKA) was aimed in the KA group. A hybrid cementation technique was performed. The new Knee Society Score (KSS) and radiological assessment were collected preoperatively and at the final follow-up. Comparisons between groups were done with the T test or Fisher exact test. Global survival curves were estimated with Kaplan-Meier model. Significance was set at p < 0.05.

Results: Mean follow-up was 42.9 months ± 3.6 (range 37.6-46.7) and 53.3 months ± 4.1 (range 45.5-59.8) for rKA and MA groups. Postoperatively, no significant differences were found for clinical scores between both groups. Radiological assessment found similar postoperative Hip-Knee-Ankle angle for rKA and MA groups (178° versus 179° respectively, NS). At last follow-up, a significant higher survivorship was found for the MA group compared to the rKA group (97 versus 84%; p < 0.001) for aseptic loosening revision as the endpoint.

Conclusion: An increased risk of tibial implant loosening was found with rKA compared to MA using a posterior-stabilized TKA with a post-cam system at short-term follow-up. Caution should be taken when choosing the TKA design while performing rKA.

Level of evidence: Retrospective case-control study, Level IV.

Keywords: Knee arthroplasty; Knee replacement; Mechanical alignment; Posterior-stabilized; Restricted kinematic alignment; Tibial loosening.

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References

    1. Abdel MP, Ollivier M, Parratte S, Trousdale RT, Berry DJ, Pagnano MW (2018) Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise follow-up at 20 years. J Bone Jt Surg Am 100:472–478 - DOI
    1. Almaawi AM, Hutt JRB, Masse V, Lavigne M, Vendittoli P-A (2017) The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty. J Arthroplasty 32:2133–2140 - DOI
    1. Australian National Joint Registry The Australia National Joint Registry Report: 2020. ‘Primary Total Knee Replacement’. Adelaide, Australia. https://aoanjrr.sahmri.com/documents/10180/689619/Hip+Knee+Shoulder+Arth...
    1. Batailler C, Malemo Y, Demey G, Kenney R, Lustig S, Servien E (2020) Cemented vs uncemented femoral components: a randomized, controlled trial at 10 years minimum follow-up. J Arthroplasty 35:2090–2096 - DOI
    1. Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470:45–53 - DOI

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