Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction
Purpose The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aim...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2023-09, Vol.31 (9), p.3861-3870 |
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| creator | Hazratwala, Kaushik Gouk, Conor Wilkinson, Matthew P. R. O’Callaghan, William B. |
| description | Purpose
The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA.
Methods
This paper reports a single surgeon’s outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported.
Results
Mean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion,
r
= 0.926 and 0.856,
p
|
| doi_str_mv | 10.1007/s00167-023-07327-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10435654</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2786812388</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-ff0498aa6df352301eac20141919a4a9bb12861793e2678ba64174c5bb0e2d063</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi1ERQ-FF2CBLLFhQYpvsZMVqipuUtVuYG1NHCdx8YmD7ZyjvgJPjdtTymXBamY03_wz9o_QC0pOKSHqbSKESlURxiuiOFPV_hHaUMF5pbhQj9GGtIJVjNTyGD1N6ZqQkor2CTrmsqWKiWaDflzCzo2QbY-HdTbZhRk8Bu_GeWvnjHPIpf42W4sh5imGxUPKNxjM5OzOJhytd9B5-6ZkSwz9alypMMx9Ycwai3TppNXnhPcuT3hy44QXyO5WPpWYBrjb-wwdDeCTfX4fT9DXD--_nH-qLq4-fj4_u6iMUHWuhoGItgGQ_cBrxgm1YBihgra0BQFt11HWSKpabplUTQdSUCVM3XXEsp5IfoLeHXSXtdva3pQ7Ini9RLeFeKMDOP13Z3aTHsNOUyJ4LWtRFF7fK8TwfbUp661LxnoPsw1r0kw1sqGMN01BX_2DXoc1lj8uVFMzqoiUbaHYgTIxpBTt8HANJfrWa33wWhev9Z3Xel-GXv75joeRX-YWgB-AVFrzaOPv3f-R_QkpKbkV</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2852170669</pqid></control><display><type>article</type><title>Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction</title><source>Springer Nature</source><source>Wiley Blackwell Single Titles</source><creator>Hazratwala, Kaushik ; Gouk, Conor ; Wilkinson, Matthew P. R. ; O’Callaghan, William B.</creator><creatorcontrib>Hazratwala, Kaushik ; Gouk, Conor ; Wilkinson, Matthew P. R. ; O’Callaghan, William B.</creatorcontrib><description>Purpose
The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA.
Methods
This paper reports a single surgeon’s outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported.
Results
Mean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion,
r
= 0.926 and 0.856,
p
< 0.001. No statistical outcome difference was detected between the types of prostheses. 14.5% of patients required soft tissue release, with the lateral release (50%) and posterior capsule (29%) being the most common.
Conclusion
CAS FA TKA in this cohort proved to be a predictable, reliable, and reproducible technique with acceptable short-term revision rates and high PROMs. FA can account for extremes in individual patient bony morphology and achieve desired gap and kinematic targets with soft tissue releases required in only 14.5% of patients.
Level of evidence
IV (retrospective case series review).</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-023-07327-w</identifier><identifier>PMID: 36917248</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alignment ; Arthroplasty (knee) ; Complications ; Joint replacement surgery ; Kinematics ; Knee ; Medicine ; Medicine & Public Health ; Orthopaedic implants ; Orthopedics ; Patient satisfaction ; Phenotypes ; Prostheses ; Prosthetics ; Revisions ; Soft tissues ; Sports Medicine ; Tissues</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-09, Vol.31 (9), p.3861-3870</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-ff0498aa6df352301eac20141919a4a9bb12861793e2678ba64174c5bb0e2d063</citedby><cites>FETCH-LOGICAL-c475t-ff0498aa6df352301eac20141919a4a9bb12861793e2678ba64174c5bb0e2d063</cites><orcidid>0000-0002-0649-9231</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-023-07327-w$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-023-07327-w$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36917248$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hazratwala, Kaushik</creatorcontrib><creatorcontrib>Gouk, Conor</creatorcontrib><creatorcontrib>Wilkinson, Matthew P. R.</creatorcontrib><creatorcontrib>O’Callaghan, William B.</creatorcontrib><title>Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA.
Methods
This paper reports a single surgeon’s outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported.
Results
Mean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion,
r
= 0.926 and 0.856,
p
< 0.001. No statistical outcome difference was detected between the types of prostheses. 14.5% of patients required soft tissue release, with the lateral release (50%) and posterior capsule (29%) being the most common.
Conclusion
CAS FA TKA in this cohort proved to be a predictable, reliable, and reproducible technique with acceptable short-term revision rates and high PROMs. FA can account for extremes in individual patient bony morphology and achieve desired gap and kinematic targets with soft tissue releases required in only 14.5% of patients.
Level of evidence
IV (retrospective case series review).</description><subject>Alignment</subject><subject>Arthroplasty (knee)</subject><subject>Complications</subject><subject>Joint replacement surgery</subject><subject>Kinematics</subject><subject>Knee</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopaedic implants</subject><subject>Orthopedics</subject><subject>Patient satisfaction</subject><subject>Phenotypes</subject><subject>Prostheses</subject><subject>Prosthetics</subject><subject>Revisions</subject><subject>Soft tissues</subject><subject>Sports Medicine</subject><subject>Tissues</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi1ERQ-FF2CBLLFhQYpvsZMVqipuUtVuYG1NHCdx8YmD7ZyjvgJPjdtTymXBamY03_wz9o_QC0pOKSHqbSKESlURxiuiOFPV_hHaUMF5pbhQj9GGtIJVjNTyGD1N6ZqQkor2CTrmsqWKiWaDflzCzo2QbY-HdTbZhRk8Bu_GeWvnjHPIpf42W4sh5imGxUPKNxjM5OzOJhytd9B5-6ZkSwz9alypMMx9Ycwai3TppNXnhPcuT3hy44QXyO5WPpWYBrjb-wwdDeCTfX4fT9DXD--_nH-qLq4-fj4_u6iMUHWuhoGItgGQ_cBrxgm1YBihgra0BQFt11HWSKpabplUTQdSUCVM3XXEsp5IfoLeHXSXtdva3pQ7Ini9RLeFeKMDOP13Z3aTHsNOUyJ4LWtRFF7fK8TwfbUp661LxnoPsw1r0kw1sqGMN01BX_2DXoc1lj8uVFMzqoiUbaHYgTIxpBTt8HANJfrWa33wWhev9Z3Xel-GXv75joeRX-YWgB-AVFrzaOPv3f-R_QkpKbkV</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Hazratwala, Kaushik</creator><creator>Gouk, Conor</creator><creator>Wilkinson, Matthew P. 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R.</au><au>O’Callaghan, William B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>31</volume><issue>9</issue><spage>3861</spage><epage>3870</epage><pages>3861-3870</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
The decision on which technique to perform a total knee arthroplasty (TKA) has become more complicated over the last decade. Perceived limitations of mechanical alignment (MA) and kinematic alignment (KA) have led to the development of the functional alignment (FA) philosophy. This study aims to report the 2-year results of an initial patient cohort in terms of revision rate, PROMs and complications for Computer Aided Surgery (CAS) Navigated FA TKA.
Methods
This paper reports a single surgeon’s outcomes of 165 consecutive CAS FA TKAs. The final follow-up was 24 months. Pre-operative and post-operative patient-reported outcome measures, WOMAC and KSS, and intra-operative CAS data, including alignment, kinematic curves, and gaps, are reported. Stress kinematic curves were analysed for correlation with CAS final alignment and CAS final alignment with radiographic long-leg alignment. Pre- and post-operative CPAK and knee phenotypes were recorded. Three different types of prostheses from two manufacturers were used, and outcomes were compared. Soft tissue releases, revision and complication data are also reported.
Results
Mean pre-operative WOMAC was 48.8 and 1.2 at the time of the final follow-up. KSS was 48.8 and 93.7, respectively. Pre- and post-operative range of motion was 118.6° and 120.1°, respectively. Pre-operative and final kinematic curve prediction had an accuracy of 91.8%. CAS data pre-operative stress alignment and final alignment strongly correlate in extension and flexion,
r
= 0.926 and 0.856,
p
< 0.001. No statistical outcome difference was detected between the types of prostheses. 14.5% of patients required soft tissue release, with the lateral release (50%) and posterior capsule (29%) being the most common.
Conclusion
CAS FA TKA in this cohort proved to be a predictable, reliable, and reproducible technique with acceptable short-term revision rates and high PROMs. FA can account for extremes in individual patient bony morphology and achieve desired gap and kinematic targets with soft tissue releases required in only 14.5% of patients.
Level of evidence
IV (retrospective case series review).</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36917248</pmid><doi>10.1007/s00167-023-07327-w</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-0649-9231</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-09, Vol.31 (9), p.3861-3870 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10435654 |
| source | Springer Nature; Wiley Blackwell Single Titles |
| subjects | Alignment Arthroplasty (knee) Complications Joint replacement surgery Kinematics Knee Medicine Medicine & Public Health Orthopaedic implants Orthopedics Patient satisfaction Phenotypes Prostheses Prosthetics Revisions Soft tissues Sports Medicine Tissues |
| title | Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction |
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