Abstract
BackgroundA mismatch between the femoral component and trochlear resection surface is observed in kinematically aligned total knee arthroplasty (KA-TKA) when conventional prostheses are employed. This mismatch is mainly manifested in the undercoverage of the lateral trochlear resection surface. The aim of the present study was to assess the relationship between the mismatch and the alignment parameters of the tibiofemoral joint.MethodsForty-five patients (52 knees) who underwent KA-TKA in our hospital were included. Patient-specific instrumentation was used in 16 patients (16 knees), and conventional instruments with calipers and other special tools were employed in the other 29 patients (36 knees). The widths of the exposed resection bone surface at the middle (MIDexposure) and distal (DISexposure) levels on the lateral trochlea were measured as dependent variables, whereas the hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and transepicondylar axis angle (TEAA) were measured as independent variables. Correlation analysis and subsequent linear regression were conducted among the dependent variables and various alignment parameters of the tibiofemoral joint.ResultsThe incidence of undercoverage of the lateral trochlear resection surface was 86.5 % with MIDexposure and DISexposure values of 2.3 (0–6 mm) and 2.0 (0–5 mm), respectively. The widths of the two levels of exposed bone resection were significantly correlated with mLDFA and HKAA but were not related to TEAA.ConclusionsThe undercoverage of the trochlear resection surface in KA-TKA is mainly correlated with the degree of valgus of the distal femoral joint line. The current study suggests that this correlation should be considered in the development of KA-specific prostheses.
Highlights
A mismatch between the femoral component and trochlear resection surface is observed in kinematically aligned total knee arthroplasty (KA-Total knee arthroplasty (TKA)) when conventional prostheses are employed
We found that undercoverage of the lateral trochlear resection surface in kinematically aligned total knee arthroplasty (KA-TKA) is more common than that in MATKA
The reliability test (ICC, two-way mixed effects, random, fixed effects) of the two sets of transepicondylar axis angle (TEAA) measurements was performed in 16 patients who received PSIKA, and the intraclass correlation coefficient (ICC) was 0.792 (0.501–0.922), indicating that the two measurement approaches had good consistency
Summary
A mismatch between the femoral component and trochlear resection surface is observed in kinematically aligned total knee arthroplasty (KA-TKA) when conventional prostheses are employed. This mismatch is mainly manifested in the undercoverage of the lateral trochlear resection surface. The aim of the present study was to assess the relationship between the mismatch and the alignment parameters of the tibiofemoral joint. Kinematical alignment (KA) is dedicated to restoring the anatomical geometry of the tibiofemoral joint and the laxity of the joint to that which it would have been before the onset of arthritis [7] and abandoning the “neutral” alignment of the MA. KA has attracted widespread attention in recent years [8,9,10]
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