Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2021

01-10-2021 | KNEE

Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty

Authors: Michele D’Amato, Nienke M. Kosse, Ate B. Wymenga

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2021

Login to get access

Abstract

Purpose

The objectives of this study were to examine the relation between clinical outcomes 1 year postoperatively, in a cohort of mechanically aligned total knee arthroplasties (TKA), and (1) the degrees of alignment change of the tibial, femoral and the hip–knee–ankle (HKA) angle; (2) the change of phenotype; (3) the postoperative knee joint line orientation to the floor.

Methods

Pre-operative and postoperative long-leg X-rays of 90 patients were used to determine the coronal alignment. The absolute difference between the pre-operative and postoperative measurements was determined and the outcomes were categorized in whether or not a change in phenotype had occurred. Finally, the orientation of the knee joint line relative to the floor (tibial joint line angle—TJLA) was measured. Clinical outcomes were determined with the KOOS and KSS at 1-year follow-up.

Results

The clinical outcomes (1) did not correlate with the absolute difference of the alignment measured; (2) did not show a difference between patients with or without a change in phenotype; and (3) were higher (KOOS ADL, Sport and QoL) in patients with a medial open TJLA.

Conclusion

This study showed no correlation between clinical outcomes and joint line restoration of the femur, tibia or HKA in patients after TKA. Leaving the prosthesis with some degrees of under correction on the coronal plane maintaining the phenotype, was not associated to better clinical results compared to TKA overcorrection. Nevertheless, the results showed that patients with a medial open TJLA had better clinical outcomes than patients with a lateral open TJLA.

Level of evidence

III.
Appendix
Available only for authorised users
Literature
1.
Abdel MP, Oussedik S, Parratte S, Lustig S, Haddad FS (2014) Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Jt J 96-B:857–862CrossRef
2.
Bauwens K, Matthes G, Wich M, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement. A meta-analysis. J Bone Jt Surg Am 89:261–269CrossRef
3.
Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat Award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop 470:45–53CrossRef
4.
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327:307–310CrossRef
5.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop 468:57–63CrossRef
6.
Choi Y-J, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28:1–15CrossRef
7.
Choong PF, Dowsey MM, Stoney JD (2009) Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 24:560–569CrossRef
8.
Cooke TDV, Sled EA, Scudamore RA (2007) Frontal plane knee alignment: a call for standardized measurement. J Rheumatol 34:1796–1801PubMed
9.
Courtney PM, Lee GC (2017) Early outcomes of kinematic alignment in primary total knee arthroplasty: a meta-analysis of the literature. J Arthroplasty 32:2028–2032CrossRef
10.
Eckhoff DG, Bach JM, Spitzer VM, Reining KD, Bagur MM, Baldini TH, Flannery NMP (2005) Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Jt Surg Am 87:71–80
11.
Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A (2014) What is the optimal alignment of the tibial and femoral components in knee arthroplasty? Acta Orthop 85:480–487CrossRef
12.
de Groot IB, Favejee MM, Reijman M, Verhaar JAN, Terwee CB (2008) The dutch version of the knee injury and osteoarthritis outcome score: a validation study. Health Qual Life Outcomes 6:1–11CrossRef
13.
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860CrossRef
14.
Heesterbeek PJC (2020) CORR Insights® no difference in 5-year clinical or radiographic outcomes between kinematic and mechanical alignment in TKA: a randomized controlled trial. Clin Orthop 478:1280–1282CrossRef
15.
Hess S, Moser LB, Amsler F, Behrend H, Hirschmann MT (2019) Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:1368–1377CrossRef
16.
Hirschmann MT, Hess S, Behrend H, Amsler F, Leclercq V, Moser LB (2019) Phenotyping of hip–knee–ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability. Knee Surg Sports Traumatol Arthrosc 27:1378–1384CrossRef
17.
Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclercq V, Hess S (2019) Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc 27:1385–1393CrossRef
18.
Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML (2013) Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Knee. Clin Orthop 471:1000–1007CrossRef
19.
Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21:2271–2280CrossRef
20.
Hutt J, Massé V, Lavigne M, Vendittoli PA (2016) Functional joint line obliquity after kinematic total knee arthroplasty. Int Orthop 40:29–34CrossRef
21.
Innocenti B, Bellemans J, Catani F (2016) Deviations from optimal alignment in TKA: is there a biomechanical difference between femoral or tibial component alignment? J Arthroplasty 31:295–301CrossRef
22.
Insall JN, Dorr LD, Scott RD, Norman W (1989) Rationale of the knee society clinical rating system. Clin Orthop 248:13–14
23.
Jeffery RS, Morris RW, Denham A (1991) Coronal alignment after total knee replacement. J Bone Jt Surg Br 73:709–714CrossRef
24.
Ji H-M, Han J, Jin DS, Seo H, Won Y-Y (2016) Kinematically aligned TKA can align knee joint line to horizontal. Knee Surg Sports Traumatol Arthrosc 24:2436–2441CrossRef
25.
Kosse NM, Heesterbeek PJC, Schimmel JJP, van Hellemondt GG, Wymenga AB, Defoort KC (2017) Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 26:1792–1799CrossRef
26.
Li Y, Wang S, Wang Y, Yang M (2018) Does kinematic alignment improve short-term functional outcomes after total knee arthroplasty compared with mechanical alignment? A systematic review and meta-analysis. J Knee Surg 31:78–86CrossRef
27.
Luo Z, Zhou K, Peng L, Shang Q, Pei F, Zhou Z (2019) Similar results with kinematic and mechanical alignment applied in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 28:1720–1735CrossRef
28.
Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R (2017) Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Jt J 99-B:640–646CrossRef
29.
Matziolis G, Adam J, Perka C (2010) Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 130:1487–1491CrossRef
30.
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. three-dimensional evaluation of implant alignment and rotation. J Bone Jt Surg Am 89:236–243CrossRef
31.
Murakami K, Hamai S, Okazaki K, Ikebe S, Higaki H, Shimoto T, Nakashima Y (2018) Preoperative tibial mechanical axis orientation and articular surface design influence on the coronal joint line orientation relative to the ground during gait after total knee arthroplasties. Knee Surg Sports Traumatol Arthrosc 26:3368–3376CrossRef
32.
Nam D, Nunley RM, Barrack RL (2014) Patient dissatisfaction following total knee replacement: a growing concern? Bone Joint J 96-B:96–100CrossRef
33.
Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K (2018) Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 26:1629–1635CrossRef
34.
Ritter MA, Faris PM, Keating M, Meding JB (1994) Postoperative alignment of total knee replacement: its effect on survival. Clin Orthop 299:153–156
35.
Schimmel JJP, Defoort KC, Heesterbeek PJC, Wymenga AB, Jacobs WCH, van Hellemondt GG (2014) Bicruciate substituting design does not improve maximal flexion in total knee arthroplasty a randomized controlled trial. J Bone Jt Surg Am 96(10):e81CrossRef
36.
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428CrossRef
37.
Slevin O, Amsler F, Hirschmann MT (2017) No correlation between coronal alignment of total knee arthroplasty and clinical outcomes: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc 25:3892–3900CrossRef
38.
Slevin O, Hirschmann A, Schiapparelli FF, Amsler F, Huegli RW, Hirschmann MT (2018) Neutral alignment leads to higher knee society scores after total knee arthroplasty in preoperatively non-varus patients: a prospective clinical study using 3D-CT. Knee Surg Sports Traumatol Arthrosc 26:1602–1609CrossRef
39.
Vanlommel L, Vanlommel J, Claes S, Bellemans J (2013) Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 21:2325–2330CrossRef
40.
Victor JMK, Bassens D, Bellemans J, Gürsu S, Dhollander AAM, Verdonk PCM (2014) Constitutional varus does not affect joint line orientation in the coronal plane knee. Clin Orthop 472:98–104CrossRef
Metadata
Title
Restoration of pre-operative joint line orientation and alignment does not affect KSS and KOOS 1 year after total knee arthroplasty
Authors
Michele D’Amato
Nienke M. Kosse
Ate B. Wymenga
Publication date
01-10-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06097-z

Other articles of this Issue 10/2021

Knee Surgery, Sports Traumatology, Arthroscopy 10/2021 Go to the issue

KNEE

Effect of medial collateral ligament release and osteophyte resection on medial laxity in total knee arthroplasty

KNEE

Unicompartmental knee arthroplasty has higher revisions than total knee arthroplasty at long term follow-up: a registry study on 6453 prostheses

KNEE

Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

KNEE

Active heel-slide exercise therapy facilitates the functional and proprioceptive enhancement following total knee arthroplasty compared to continuous passive motion

KNEE

Prioritising of hip and knee arthroplasty procedures during the COVID-19 pandemic: the European Hip Society and the European Knee Associates Survey of Members

KNEE

Machine-learning algorithm that can improve the diagnostic accuracy of septic arthritis of the knee