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True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done...

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Autores principales: Huber, Kim, Christen, Bernhard, Calliess, Sarah, Calliess, Tilman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307604/
https://www.ncbi.nlm.nih.gov/pubmed/34357129
http://dx.doi.org/10.3390/jpm11070662
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author Huber, Kim
Christen, Bernhard
Calliess, Sarah
Calliess, Tilman
author_facet Huber, Kim
Christen, Bernhard
Calliess, Sarah
Calliess, Tilman
author_sort Huber, Kim
collection PubMed
description Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.
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spelling pubmed-83076042021-07-25 True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance Huber, Kim Christen, Bernhard Calliess, Sarah Calliess, Tilman J Pers Med Article Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase. MDPI 2021-07-15 /pmc/articles/PMC8307604/ /pubmed/34357129 http://dx.doi.org/10.3390/jpm11070662 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Huber, Kim
Christen, Bernhard
Calliess, Sarah
Calliess, Tilman
True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance
title True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance
title_full True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance
title_fullStr True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance
title_full_unstemmed True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance
title_short True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance
title_sort true kinematic alignment is applicable in 44% of patients applying restrictive indication criteria—a retrospective analysis of 111 tka using robotic assistance
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307604/
https://www.ncbi.nlm.nih.gov/pubmed/34357129
http://dx.doi.org/10.3390/jpm11070662
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