Abstract
PurposeWhile kinematic alignment (KA) total knee arthroplasty (TKA) with cemented implants has been shown to provide equivalent or better results than mechanical alignment, its combination with cementless fixation has not yet been documented. The purpose of this study is to report (1) revision rate and causes, (2) clinical results based on patient report outcome measures (PROMs), and (3) radiological signs of implant dysfunction in patients with an uncemented TKA implanted with restricted KA (rKA), after a minimum follow-up of 2 years.MethodsThis study included the first 100 consecutive uncemented cruciate retaining TKAs implanted between November 2015 and February 2018 by a single surgeon following rKA principles. At last follow-up, all adverse events and PROMs assessed by WOMAC, KOOS, and FJS scores were documented. Radiographic evaluation was performed to identify signs of implant loosening.ResultsAfter a mean follow-up of 49 months (32, 60), no implant revision was performed for aseptic loosening. Three revisions were performed: one for malalignment, one for a deep infection, and one for instability. The mean WOMAC score was 20.1 (0–79, 21.3), the mean KOOS score was 71.5 (19.0–96.6, 19.8), and the mean FJS score was 65.9 (0–100, 29.6). No radiological evidence of implant aseptic loosening or osteolysis was identified.ConclusionThis study shows that in 99% of our cases, rKA combined with the tested cementless TKA implant allowed for adequate secondary fixation and good functional outcomes in the short term. Favourable mid- to long-term implant survivorship is anticipated.Level of evidenceIII.
Highlights
Total knee arthroplasty (TKA) is the most common joint replacement procedure performed in the world [8]
TKA failure leading to revision is most often the result of aseptic loosening, which occurs at a higher rate in younger patients [9, 29, 33] and in morbidly obese patients [29, 40, 42]
After a mean post-operative time of 49 months (32–60), 1 patient (2 knees) was deceased from causes unrelated to his TKA and no patient was lost to follow-up
Summary
Total knee arthroplasty (TKA) is the most common joint replacement procedure performed in the world [8]. Providing a forgotten TKA remains a challenge, despite important improvements in implant designs, fixation methods, and precision of implantation [8, 16]. This leads to the question whether traditional and systematic mechanical alignment (MA) is the ideal method [17, 36], given that coronal knee alignment varies significantly in both non-arthritic [32] and arthritic populations [2]. The concept of kinematic alignment (KA) has gained momentum in the last few years because it uses personalized bone resections to recreate the individual pre-arthritic knee anatomy, phenotype, and ligament laxity [2, 35]
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