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Good clinical results using a modified kinematic alignment technique with a cruciate sacrificing medially stabilised total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Background

This study aims to evaluate the clinical and radiological outcomes of a modified technique of Kinematically Aligned Total Knee Arthroplasty (KA TKA) using a cruciate sacrificing (CS) medially stabilised prosthesis at a minimum 24-months follow-up.

Methods

59 patients with a varus HKA angle who underwent a TKA from May, 2016 to April, 2017 were retrospectively enrolled. Radiological and clinical evaluations were assessed after 40 days, 6 months and at a minimum follow-up of 24 months. Long leg standing X-rays were performed pre-operatively and the Hip–Knee–Ankle (HKA) angle, the mechanical Lateral Distal Femoral Angle (mLDFA), the mechanical Medial Proximal Tibial Angle (mMPTA) and the Knee Joint Line Obliquity Angle (KJLOA) were analysed. At a minimum follow-up of 24 months, the patients were evaluated subjectively based on the Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) and the Oxford Knee Score (OKS). The post-operative range of motion (ROM) was measured. To reduce flexion instability, an original technique was used, with more posterior positioning of the femoral component, called the “virtuous mistake”. Results were compared to the data reported in the literature in patients treated with standard kinematic alignment (KA) technique.

Results

No difference was found between the mean pre-operative and post-operative angles regarding mLDFA (p value = 0.410) and mMTPA (p value = 0.242). A difference of 0.8° in HKA angle between males and females was found, with more varus results in males. At a minimum follow-up of 24 months, the WOMAC was 87 (SD 4.3), the OKS was 41 (SD 2.4), and the flexion was 124°, which was similar to the data reported in literature with standard KA. There were not any cases of aseptic failures.

Conclusions

The modified KA TKA surgical technique proposed in this study can achieve good clinical results at minimum 24 months of follow-up, reproducing accurately native mLDFA and mMPTA.

Level of evidence

Level III, therapeutic study.

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Acknowledgements

The authors would like to thank professor Stephen Howell for his intuitions, his ability to standardize them and to transmit them with force, passion and dedication. We are convinced that his work will be recognized in the future as a paramount contribution in the epochal shift of the positioning of knee implants. We would also like to thank Dr. Cristina Fumagalli for her indispensable help in the statistical processing of the data of the current study. Dr. Michele Malavolta would like to thank the few people who believed in him when he first in Italy, in 2015, introduced the concept of kinematic alignment and started to implement it.

Funding

None.

Author information

Authors and Affiliations

  1. Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, Verona, Italy

    M. Malavolta & S. Mezzari

  2. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy

    R. Compagnoni, F. Calanna & P. Randelli

  3. Knee Surgery Department, Koelliker Private Hospital, Turin, Italy

    A. Pastrone

  4. Department of Biomedical Sciences for Health, Laboratory of Applied Biomechanics, Università Degli Studi di Milano, Milan, Italy

    R. Compagnoni & P. Randelli

  5. Orthopaedics and Trauma Department, Piero Pederzoli Private Hospital, Via Monte Baldo, 24 Peschiera del Garda, 37019, Verona, Italy

    M. Malavolta

Authors
  1. M. Malavolta
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  2. R. Compagnoni
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  3. S. Mezzari
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  4. F. Calanna
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  6. P. Randelli
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Corresponding author

Correspondence to M. Malavolta.

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Conflict of interest

One of the authors is a paid consultant for the following companies and suppliers: AIM, IBSA (Giava and First Class), ARTHREX, HERAEUS, J&J, LIMA, MEDACTA, MENARINI, MICROPORT, OIC, OLYMPU, SMITH& NEPHEW, ZIMMERBIOMET. One of the authors is part of board of the following medical/orthopaedic publication editorials: Editorial Board of KSSTA and Orthopaedic Today, Journal of Orthopaedic and traumatology, Orthopaedic Journal of Sport Medicine. One of the authors is second past president of SIAGASCOT.

Ethical approval

The study protocol was approved by the Regional Ethical Committee (authorization Azienda Ospedaliera Universitaria Integrata Verona—Borgo Trento, Verona (n°23718 Verona 24.4.2019) and was registered on ClinicalTrials.gov (Clinical Trials.gov ID: NCT039726741; April 24, 2019).

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Malavolta, M., Compagnoni, R., Mezzari, S. et al. Good clinical results using a modified kinematic alignment technique with a cruciate sacrificing medially stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 30, 500–506 (2022). https://doi.org/10.1007/s00167-020-06196-x

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