Cargando…
Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results
Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428977/ https://www.ncbi.nlm.nih.gov/pubmed/34513916 http://dx.doi.org/10.3389/fsurg.2021.721379 |
_version_ | 1783750476097912832 |
---|---|
author | Kostretzis, Lazaros Roby, Gabriel Bouchard Martinov, Sagi Kiss, Marc-Olivier Barry, Janie Vendittoli, Pascal-André |
author_facet | Kostretzis, Lazaros Roby, Gabriel Bouchard Martinov, Sagi Kiss, Marc-Olivier Barry, Janie Vendittoli, Pascal-André |
author_sort | Kostretzis, Lazaros |
collection | PubMed |
description | Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique. Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up. Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified. Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term. Level of evidence: IV |
format | Online Article Text |
id | pubmed-8428977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84289772021-09-10 Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results Kostretzis, Lazaros Roby, Gabriel Bouchard Martinov, Sagi Kiss, Marc-Olivier Barry, Janie Vendittoli, Pascal-André Front Surg Surgery Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique. Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up. Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified. Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term. Level of evidence: IV Frontiers Media S.A. 2021-08-26 /pmc/articles/PMC8428977/ /pubmed/34513916 http://dx.doi.org/10.3389/fsurg.2021.721379 Text en Copyright © 2021 Kostretzis, Roby, Martinov, Kiss, Barry and Vendittoli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Surgery Kostretzis, Lazaros Roby, Gabriel Bouchard Martinov, Sagi Kiss, Marc-Olivier Barry, Janie Vendittoli, Pascal-André Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title | Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_full | Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_fullStr | Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_full_unstemmed | Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_short | Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_sort | revision total knee arthroplasty with the use of restricted kinematic alignment protocol: surgical technique and initial results |
topic | Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428977/ https://www.ncbi.nlm.nih.gov/pubmed/34513916 http://dx.doi.org/10.3389/fsurg.2021.721379 |
work_keys_str_mv | AT kostretzislazaros revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT robygabrielbouchard revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT martinovsagi revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT kissmarcolivier revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT barryjanie revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT vendittolipascalandre revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults |