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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2023

Open Access 02-12-2022 | Osteoarthrosis | Knee

Mismatch between trochlear coronal alignment of arthritic knees and currently available prosthesis: a morphological analysis of 4116 knees and 45 implant designs

Authors: Sergio Barroso Rosa, Kaushik Hazratwala, Matthew P. R. Wilkinson

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2023

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Abstract

Purpose

In up to a fifth of total knee replacements (TKR), surgeons are not capable of achieving good clinical and functional results. Despite comprehensive diagnostic workup, an underlying cause is not always identified in these patients. The purpose of this study is to compare native and prosthetic trochlear anatomies, to evaluate a potential source of morphologic mismatch and theoretically, of poor clinical outcomes.

Methods

Native trochlear angles of 4116 knee CTs from 360 Knee Systems database of arthritic pre-operative TKR patients were evaluated. A semi-automated tridimensional analysis was performed to define the native trochlear angle in the coronal plane (NTA) among other 142 parameters. An active search was conducted to identify currently available TKR models; prosthetic trochlear orientation in the coronal plane (PTA) was extracted from the technical data provided by manufacturers.

Results

The mean native trochlear angle (NTA) was 1.6° ± 6.6° (valgus) with a range from − 23.8° (varus) to 30.3°(valgus). A valgus NTA was present in 60.6% of the knees and 39.4% of them had a varus NTA. 89 TKR models were identified; trochlear details were available for 45 of them, of which 93% were designed with a valgus orientation of the prosthetic trochlear angle (PTA) and 6.9% showed a neutral (0°) PTA. Varus alignment of PTA was not present in any system. Angular numeric values for PTA were available for 34 models; these ranged from 0° to 15° of valgus, with a median value of 6.18° (SD ± 2.88°).

Conclusion

This study shows a significant mismatch between native and prosthetic trochlear angles. A relevant proportion of the studied knees (41.45%) fall out of the trochlear angle range of currently available implants; representing a potential source for biomechanical imbalance. While further research is warranted to fully understand the clinical implications of the present study, manufacturers may need to take these findings into account for future implant designs.

Level of evidence

Level III, retrospective cohort study.
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Metadata
Title
Mismatch between trochlear coronal alignment of arthritic knees and currently available prosthesis: a morphological analysis of 4116 knees and 45 implant designs
Authors
Sergio Barroso Rosa
Kaushik Hazratwala
Matthew P. R. Wilkinson
Publication date
02-12-2022
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07251-5

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