Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results
Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-08-01
|
Series: | Frontiers in Surgery |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.721379/full |
id |
doaj-842917a71c8240d380dcee45888af783 |
---|---|
record_format |
Article |
spelling |
doaj-842917a71c8240d380dcee45888af7832021-08-31T12:20:13ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-08-01810.3389/fsurg.2021.721379721379Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial ResultsLazaros Kostretzis0Gabriel Bouchard Roby1Sagi Martinov2Marc-Olivier Kiss3Marc-Olivier Kiss4Janie Barry5Pascal-André Vendittoli6Pascal-André Vendittoli7Pascal-André Vendittoli8Département de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, CanadaDépartement de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, CanadaDépartement de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, CanadaDépartement de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, CanadaClinique Orthopédique Duval, Laval, QC, CanadaDépartement de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, CanadaDépartement de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, CanadaClinique Orthopédique Duval, Laval, QC, CanadaPersonalized Arthroplasty Society, Atlanta, GA, United StatesPurpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique.Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up.Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified.Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term.Level of evidence: IVhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.721379/fullrevisionkneearthroplastytechniquepatient reported outcome measuresrestricted kinematic alignment |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lazaros Kostretzis Gabriel Bouchard Roby Sagi Martinov Marc-Olivier Kiss Marc-Olivier Kiss Janie Barry Pascal-André Vendittoli Pascal-André Vendittoli Pascal-André Vendittoli |
spellingShingle |
Lazaros Kostretzis Gabriel Bouchard Roby Sagi Martinov Marc-Olivier Kiss Marc-Olivier Kiss Janie Barry Pascal-André Vendittoli Pascal-André Vendittoli Pascal-André Vendittoli Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results Frontiers in Surgery revision knee arthroplasty technique patient reported outcome measures restricted kinematic alignment |
author_facet |
Lazaros Kostretzis Gabriel Bouchard Roby Sagi Martinov Marc-Olivier Kiss Marc-Olivier Kiss Janie Barry Pascal-André Vendittoli Pascal-André Vendittoli Pascal-André Vendittoli |
author_sort |
Lazaros Kostretzis |
title |
Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_short |
Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_full |
Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_fullStr |
Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_full_unstemmed |
Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results |
title_sort |
revision total knee arthroplasty with the use of restricted kinematic alignment protocol: surgical technique and initial results |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Surgery |
issn |
2296-875X |
publishDate |
2021-08-01 |
description |
Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique.Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up.Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified.Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term.Level of evidence: IV |
topic |
revision knee arthroplasty technique patient reported outcome measures restricted kinematic alignment |
url |
https://www.frontiersin.org/articles/10.3389/fsurg.2021.721379/full |
work_keys_str_mv |
AT lazaroskostretzis revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT gabrielbouchardroby revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT sagimartinov revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT marcolivierkiss revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT marcolivierkiss revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT janiebarry revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT pascalandrevendittoli revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT pascalandrevendittoli revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults AT pascalandrevendittoli revisiontotalkneearthroplastywiththeuseofrestrictedkinematicalignmentprotocolsurgicaltechniqueandinitialresults |
_version_ |
1721183528491679744 |