Association between limb alignment and patient-reported outcomes after total knee arthroplasty using an implant that rep
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(2018) 13:320
RESEARCH ARTICLE
Open Access
Association between limb alignment and patient-reported outcomes after total knee arthroplasty using an implant that reproduces anatomical geometry Arata Nakajima1*, Masato Sonobe1, Yorikazu Akatsu1, Yasuchika Aoki2,3, Hiroshi Takahashi1, Toru Suguro4 and Koichi Nakagawa1
Abstract Background: A kinematically aligned (KA) total knee arthroplasty (TKA) is expected to improve patient satisfaction, but its effect remains controversial. We investigated differences in patient-reported outcomes (PROs) between KA and non-KA TKAs using an implant that reproduces anatomical geometry. Methods: TKAs for varus deformity were performed in consecutive 129 patients (149 knees) via a measured resection technique with conventional instruments. The femorotibial angle (FTA), hip-knee-ankle angle (HKAA), and the angle between the joint line and the line perpendicular to the mechanical axis (AJLMA) were measured postoperatively (mean 13.6 months), and an AJLMA of ≥ 2° was defined as kinematic alignment. Patients were assigned to two or three alignment categories in each measurement method, and the Knee Society Scores (KSS) and Japanese Knee Injury and Osteoarthritis Outcome Scores (J-KOOS) was compared among the groups. Results: For patients assessed by FTA, an ADL-related J-KOOS subscale (J-KOOS-A) showed a significant difference between valgus and varus outliers (p < 0.05). When assessed by HKAA, neither the KSS nor J-KOOS subscales were significantly different among groups. When assessed by AJLMA, J-KOOS-A was significantly different between groups, and a group for AJLMA of ≥ 2° had higher scores than a group for AJLMA of < 2° (95% CI 0.323–7.763; p < 0.05). Conclusions: Patients with an AJLMA of ≥ 2° reported significantly higher patient’s satisfaction regarding ADL. This suggests the importance of restoration of the physiological joint line which can be achieved via KA TKAs. Keywords: Total knee arthroplasty (TKA), Anatomical geometry, Limb alignment, Kinematic alignment, Patient-reported outcomes (PROs)
Background Postoperative restoration of a neutral limb alignment to preserve knee function and longevity has been the primary goal of conventional total knee arthroplasty (TKA) over the past two decades [1, 2]. Conventional TKAs have relieved patients’ symptoms of pain and corrected deformities, resulting in improvements in the activities of daily living (ADL). However, in general, patients’ satisfaction with TKAs is not as favorable as it is for total hip * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba 285-8741, Japan Full list of author information is available at the end of the article
arthroplasties [3–5], generating the need for improved surgical techniques and new technological developments. Recently, kinematically aligned (KA) TKAs were introduced by Bellemans [6]. With KA TKAs, the femoral and tibial components are implanted with mild varus limb alignment, relativ
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