In Kinematically Aligned Total Knee Arthroplasty,Failure to Recreate Native Tibial Alignment Is Associated With Early Revision |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA;2. Department of Political Science, Temple University, Philadelphia, PA;3. Drexel University College of Medicine, Philadelphia, PA;1. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA;2. Department of Political Science, Temple University, Philadelphia, PA;3. Drexel University College of Medicine, Philadelphia, PA;1. Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand;2. Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Victoria, Australia;1. Barbara Zucker School of Medicine at Hofstra/Northwell at Plainview Hospital, Plainview, New York;2. University of Queensland, Ochsner, Brisbane, Queensland, Australia;3. Virginia Commonwealth University, Richmond, VA;4. Hospital for Special Surgery, New York, NY;1. Orthopaedic Surgery Department, NYU Langone Health, New York, NY;2. Department of Internal Medicine, NYU Langone Health, New York, NY;1. Department of Surgical Services, John D. Dingell VA Medical Center, Detroit, MI;2. Department of Anesthesiology, Detroit Medical Center/Wayne State University, Detroit, MI;1. Department of Rheumatology, Japanese Red Cross Tottori Hospital, Tottori, Japan;2. Department of Orthopedic Surgery, Japanese Red Cross Tottori Hospital, Tottori, Japan;3. Department of Rehabilitation, Japanese Red Cross Tottori Hospital, Tottori, Japan |
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| Abstract: | BackgroundThe goal of kinematically aligned (KA) total knee arthroplasty (TKA) is to restore native knee anatomy. However, there are concerns about patellofemoral tracking problems with this technique that lead to early revision. We measured the differences between preoperative anatomic alignment and postoperative component alignment in a consecutive series of KA TKA and evaluated the association between alignment changes and the likelihood of early revision.MethodsThe charts of 219 patients who underwent 275 KA TKA procedures were reviewed. Preoperative anatomic alignment and postoperative tibial and femoral component alignment were measured radiographically. The difference in component alignment compared with preoperative anatomic alignment was compared between patients who underwent aseptic revision and those who did not at a minimum of 12 months of follow-up. Receiver operating characteristic curves were created for statistically significant variables, and the Youden index was used to determine optimal alignment thresholds with regard to likelihood of revision surgery.ResultsChange in tibial component alignment compared with native alignment was greater (P = .005) in the revision group (5.0° ± 3.7° of increased varus compared with preoperative anatomic tibial angle) than in the nonrevision group (1.3° ± 4.2° of increased varus). The Youden index indicated that increasing tibial varus by >2.2° or more is associated with increased likelihood of revision. Preoperative anatomic alignment and change in femoral alignment and overall joint alignment (ie, Q angle) were not associated with increased likelihood of revision.ConclusionSmall increases in tibial component varus compared with native alignment are associated with early aseptic revision in patients undergoing KA TKA. |
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| Keywords: | kinematic alignment total knee arthroplasty patellofemoral instability early revision component alignment |
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