kinematic alignment technique for tka · adjusted ka tka 2. osteotomy + ka tka prof. vendittoli Ø...
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Kinematic Alignment Technique For TKA
Charles C.J Rivière ISTA 2019 - Keynote
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What have we done so far? Systematic approaches
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Systematic approaches
Ø Poor functional outcomes !
• Dissatisfaction 10 to 20% • Residual symptoms > 50%
o residual pain 33% o stiffness 41% o swelling or tightness 33% o knee ‘normal feeling’ 66% o difficulty with stairs 54%
What have we done so far?
national multi-center survey in USA
<< THR
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Systematic approaches
Ø Poor functional outcomes !
• Lack of precision ?
• Poor implant design ?
What have we done so far?
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Systematic approaches
Ø Poor functional outcomes !
What have we done so far?
• Lack of precision ?
• Poor implant design ?
…Intrinsical limitations ?
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…Intrinsical limitations ?
1. No respect of constitutional knee anatomy: § FT joint § PF joint
2. No respect of physiological knee laxity § FT joint § PF joint
3. Technically demanding
§ Soft tissue balance § Aligning F component with TEA
Systematic techniques:
• Non physiological
• Poor reproducibility
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Solution ? New implants alignment
- OTSR journal
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KA
MA technique “systematic approach”
KA technique “patient specific approach”
F flexion similar
F distal cut perpendicular to femoral mechanical axis parallel to frontal femoral slope after correction of wear
F posterior cut - external rotation/PCL - measured resect° or gap balancing
- neutral rotation/PCL - measured resection tech only
T frontal cut perpendicular mechanical axis of tibia parallel to frontal tibial slope after correction for wear
T slope 2 to 7° posterior slope slope of medial plateau
T rotation towards ATT parallel to axis of lateral plateau
New surgical technique
(2007)
≠ ≠ ≠ ≠ ≠
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KA
MA technique “systematic approach”
KA technique “patient specific approach”
F flexion similar
F distal cut perpendicular to femoral mechanical axis parallel to frontal femoral slope after correction of wear
F posterior cut - external rotation/PCL - measured resect° or gap balancing
- neutral rotation/PCL - measured resection tech only
T frontal cut perpendicular mechanical axis of tibia parallel to frontal tibial slope after correction for wear
T slope 2 to 7° posterior slope slope of medial plateau
T rotation towards ATT parallel to axis of lateral plateau
New surgical technique
(2007)
Makes everyone the same
≠ ≠ ≠ ≠ ≠
Keeps everyone unique
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KA
New surgical technique
(2007)
Cylindrical Axis (trans-condylar)
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KA
New surgical technique
(2007)
Cylindrical Axis (trans-condylar) -True Knee Resurfacing -No Ligaments release
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KA 1. No respect of constitutional knee anatomy § FT joint § PF joint
2. No respect of physiological knee laxity § FT joint § PF joint
3. technically demanding
§ Soft tissue balance § Aligning F component with TEA
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1. Respect of the constitutional knee anatomy: § FT joint § PF joint
2. Respect physiologocal knee laxity
3. Technically simple: § No soft tissue release § Ease for aligning F component with
cylindrical axis
KA
KA technique:
• More physiological
• More reproducible
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses
KA
KA > MA
Luo et al. KSSTA 2019 CORRECTED VERSION
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain:
KA
KA > MA (Odds Ratio 5)
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain: - Patients’ Satisfaction:
KA
KA > MA (Odds Ratio 3)
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain: - Patients’ Satisfaction: - Complication/Survivorship:
KA
KA = MA
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain: - Patients’ Satisfaction: - Complication/Survivorship - Implant migration (RSA)
KA
KA = MA
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain: - Patients’ Satisfaction: - Complication/Survivorship - Implant migration (RSA) - Biomechanics
KA
KA ≥ MA
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain: - Patients’ Satisfaction: - Complication/Survivorship - Implant migration (RSA) - Biomechanics
KA
KA ≥ MA
KA TKA: Reduced edge loading
&
Reduced dynamic adduction moment
Reduced varus trust/lift-off
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Ø Evidence: - Functional performance:
è 6 RCTs & 4 meta-analyses - Anterior Knee Pain: - Patients’ Satisfaction: - Complication/Survivorship - Implant migration (RSA) - Biomechanics
KA
KA ≥ MA
KA TKA: Reduced edge loading
&
Reduced dynamic adduction moment
Reduced varus trust/lift-off
Reduced lever arm
More favourable dynamic HKA
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Negligible influence on
TKA LIFESPAN (obesity does not
hinder good long-term TKA fixation)
ADD° MOMENT à negligible influence
on total JRF
TOTAL JRF applied on TKA
Ø Don’t be scared of restoring constitutional limb alignment
Obesity
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Negligible influence on
TKA LIFESPAN
JRF from ADD° MOMENT
Dictated by unknown DYNAMIC HKA (?)
TOTAL JRF applied on TKA
Ø Don’t be scared of restoring constitutional limb alignment
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1. Adjusted KA TKA
2. Osteotomy + KA TKA
Prof. Vendittoli
Ø Exceptional extreme deformities …..from developmental disease (e.g. Blount, Rickets, Volkman)
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KA TKA is: 1. PHYSIOLOGICAL 2. SIMPLE (! reproducible technique) 3. VERY GOOD OUTCOMES…so far! 4. Probably BIOMECHANICALLY FRIENDLY 5. Probably for EVERYONE (! rKA TKA when severe deformity)
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MA TKA1970-2018
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To learn more…
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Thank You For Your Attention