William Blakeney1, Julien Clément2, François Desmeules2,3, Nicola Hagemeister4,5, Charles Rivière6, Pascal-André Vendittoli7,8. 1. Department of Surgery, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415, Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada. 2. Centre de recherche de l'Hôpital Maisonneuve-Rosemont-Orthopédie, 5415, Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada. 3. School of Rehabilitation, Faculty of Medicine, Université de Montreal, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada. 4. Laboratoire de recherche en imagerie et orthopédie, Centre de recherche du CHUM, Tour Viger 900, rue St-Denis, local R11.322, Montreal, QC, H2X 0A9, Canada. 5. École de technologie supérieure, 1100 Notre-Dame Ouest, Montreal, H3C1K3, Canada. 6. The MSK Lab, Imperial College London, Charing Cross Campus, Hammersmith, London, W6 8RP, UK. 7. Department of Surgery, Université de Montréal, Hôpital Maisonneuve Rosemont, 5415, Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada. pa.vendittoli@me.com. 8. Centre de recherche de l'Hôpital Maisonneuve-Rosemont-Orthopédie, 5415, Boulevard de l'Assomption, Montreal, QC, H1T 2M4, Canada. pa.vendittoli@me.com.
Abstract
PURPOSE: Kinematic alignment technique for TKA aims to restore the individual knee anatomy and ligament tension, to restore native knee kinematics. The aim of this study was to compare parameters of kinematics during gait (knee flexion-extension, adduction-abduction, internal-external tibial rotation and walking speed) of TKA patients operated by either kinematic alignment or mechanical alignment technique with a group of healthy controls. The hypothesis was that the kinematic parameters of kinematically aligned TKAs would more closely resemble that of healthy controls than mechanically aligned TKAs. METHODS: This was a retrospective case-control study. Eighteen kinematically aligned TKAs were matched by gender, age, operating surgeon and prosthesis to 18 mechanically aligned TKAs. Post-operative 3D knee kinematics analysis, performed with an optoelectronic knee assessment device (KneeKG®), was compared between mechanical alignment TKA patients, kinematic alignment TKA patients and healthy controls. Radiographic measures and clinical scores were also compared between the two TKA groups. RESULTS: The kinematic alignment group showed no significant knee kinematic differences compared to healthy knees in sagittal plane range of motion, maximum flexion, abduction-adduction curves or knee external tibial rotation. Conversely, the mechanical alignment group displayed several significant knee kinematic differences to the healthy group: less sagittal plane range of motion (49.1° vs. 54.0°, p = 0.020), decreased maximum flexion (52.3° vs. 57.5°, p = 0.002), increased adduction angle (2.0-7.5° vs. - 2.8-3.0°, p < 0.05), and increased external tibial rotation (by a mean of 2.3 ± 0.7°, p < 0.001). The post-operative KOOS score was significantly higher in the kinematic alignment group compared to the mechanical alignment group (74.2 vs. 60.7, p = 0.034). CONCLUSIONS: The knee kinematics of patients with kinematically aligned TKAs more closely resembled that of normal healthy controls than that of patients with mechanically aligned TKAs. This may be the result of a better restoration of the individual's knee anatomy and ligament tension. A return to normal gait parameters post-TKA will lead to improved clinical outcomes and greater patient satisfaction. LEVEL OF EVIDENCE: III.
PURPOSE: Kinematic alignment technique for TKA aims to restore the individual knee anatomy and ligament tension, to restore native knee kinematics. The aim of this study was to compare parameters of kinematics during gait (knee flexion-extension, adduction-abduction, internal-external tibial rotation and walking speed) of TKA patients operated by either kinematic alignment or mechanical alignment technique with a group of healthy controls. The hypothesis was that the kinematic parameters of kinematically aligned TKAs would more closely resemble that of healthy controls than mechanically aligned TKAs. METHODS: This was a retrospective case-control study. Eighteen kinematically aligned TKAs were matched by gender, age, operating surgeon and prosthesis to 18 mechanically aligned TKAs. Post-operative 3D knee kinematics analysis, performed with an optoelectronic knee assessment device (KneeKG®), was compared between mechanical alignment TKA patients, kinematic alignment TKA patients and healthy controls. Radiographic measures and clinical scores were also compared between the two TKA groups. RESULTS: The kinematic alignment group showed no significant knee kinematic differences compared to healthy knees in sagittal plane range of motion, maximum flexion, abduction-adduction curves or knee external tibial rotation. Conversely, the mechanical alignment group displayed several significant knee kinematic differences to the healthy group: less sagittal plane range of motion (49.1° vs. 54.0°, p = 0.020), decreased maximum flexion (52.3° vs. 57.5°, p = 0.002), increased adduction angle (2.0-7.5° vs. - 2.8-3.0°, p < 0.05), and increased external tibial rotation (by a mean of 2.3 ± 0.7°, p < 0.001). The post-operative KOOS score was significantly higher in the kinematic alignment group compared to the mechanical alignment group (74.2 vs. 60.7, p = 0.034). CONCLUSIONS: The knee kinematics of patients with kinematically aligned TKAs more closely resembled that of normal healthy controls than that of patients with mechanically aligned TKAs. This may be the result of a better restoration of the individual's knee anatomy and ligament tension. A return to normal gait parameters post-TKA will lead to improved clinical outcomes and greater patient satisfaction. LEVEL OF EVIDENCE: III.
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