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Kinematic alignment in total knee arthroplasty leads to a better restoration of patellar kinematics compared to mechanic alignment

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The influence of different implantation techniques in TKA on tibiofemoral kinematics was analysed in few investigations so far. However, the influence on patellar kinematics remain unclear. The aim of the present investigation was to compare patellar kinematics of the natural knee with those of knees after both kinematically and mechanically aligned TKAs.

Methods

Patellar kinematics of ten cadaveric knees before and after TKAs implanted using both a kinematic and mechanic alignment technique were investigated and compared using a commercial optical computer navigation system.

Results

There was a statistically significant difference between natural patellar kinematics and both implantation techniques analysing mediolateral shift. Patellar lateral tilt showed significant better results in the kinematically compared to the mechanically aligned TKAs. In terms of patella rotation, the patella of both mechanically and kinematically aligned TKAs showed significant higher values for external rotation compared to the natural knee. Regarding epicondylar distance again a significant better restoration of natural kinematics could be found in the kinematically aligned TKAs.

Conclusion

Kinematically aligned TKAs showed a better overall restoration of patellar kinematics compared to a conventional mechanical alignment technique. In terms of clinical usefulness, the present study highlights the potential benefit for clinical outcome using a kinematically aligned implantation technique in TKA to achieve a better restoration of natural patellofemoral kinematics.

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Acknowledgements

We would like to thank Depuy, Germany and Brainlab, Germany for their technical and logistical support for this study. Furthermore, we would like to thank the Institute of Anatomy at the Medical University of Graz/Austria to provide the specimen for this investigation.

Funding

For this study no external funding was used.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany

    Armin Keshmiri, Günther Maderbacher, Clemens Baier, Achim Benditz, Joachim Grifka & Felix Greimel

Authors
  1. Armin Keshmiri
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  2. Günther Maderbacher
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  3. Clemens Baier
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  4. Achim Benditz
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  5. Joachim Grifka
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  6. Felix Greimel
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Corresponding author

Correspondence to Armin Keshmiri.

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Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest regarding the submitted article.

Ethical approval

According to the local ethical committee at the Medical University of Regensburg/Germany, IRB approval was not necessary.

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Keshmiri, A., Maderbacher, G., Baier, C. et al. Kinematic alignment in total knee arthroplasty leads to a better restoration of patellar kinematics compared to mechanic alignment. Knee Surg Sports Traumatol Arthrosc 27, 1529–1534 (2019). https://doi.org/10.1007/s00167-018-5284-9

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  • DOI: https://doi.org/10.1007/s00167-018-5284-9

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