Artikel
Does the individual phenotype impact the outcome following mechanical aligned total knee arthroplasty for valgus osteoarthritis?
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Autoren
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Friedrich Boettner
- Hospital for Special Surgery, New York, United States
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Martin Faschingbauer
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
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Marco Brenneis
- Hospital for Special Surgery, New York, United States
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Cosima Boettner
- Hospital for Special Surgery, New York, United States
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Kilian List
- Orthopädische Klinik König-Ludwig Haus, Würzburg, Germany
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Maximilan Kasparek
- Evangelisches Krankenhaus Wien, Abteilung für Orthopädie, Wien, Austria
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Laura Streck
- Hospital for Special Surgery, New York, United States
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
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Objectives: There is an ongoing discussion about favorable alignment targets in total knee arthroplasty (TKA). While mechanical alignment has been the standard in TKA for years, kinematic alignment restoring the individual phenotype of the knee has been advocated more recently.
Methods: This study retrospectively evaluated 158 knees in 135 patients who underwent TKA with a mechanical alignment target and standardized soft tissue release for valgus osteoarthritis. Pre- and postoperative hip knee angle, lateral distal femur angle, and medial proximal tibial angle/tibial plate angle (pre-/postoperative) were measured on standing hip to ankle radiographs. The knees were grouped according to their native knee phenotype based on the coronal plane alignment of the knee (CPAK) classification as published by MacDessi et al. Pre- and postoperative range of motion and patient related outcome measures (WOMAC, UCLA, SF-12, pain) were assessed. Outcomes were compared between the CPAK groups.
Results and conclusion: 6 different CPAK groups were detected: 70.3% of patients were in group III, 12.1% group VI, 9.5% group IX, 3.8% group II,, 3.2% group V, and 0.6% group I. The pre- to postoperative improvements were significant for WOMAC, pain, UCLA, SF-12 total and physical score as well as ROM (p<0.001 respectively). There were no differences in the outcome parameters for mechanically aligned TKA between the different phenotypes. Thus suggesting that mechanical alignment is an appropriate target for all phenotypes analyzed in this study. Furthermore, the extend of change between the native and postoperative overall alignment (deviation between arithmetic hip knee angle and postoperative hip knee angle) did not correlate with postoperative WOMAC (p=0.835) or range of motion (p=0.400).
The individual knee phenotype in patients with valgus osteoarthritis does not influence the outcome of mechanical aligned TKA operated with a standardized soft tissue release. This technique remains the gold standard for TKA in valgus osteoarthritis.
