Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology,International Orthopaedics

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Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology
International Orthopaedics ( IF 2.0 ) Pub Date : 2022-09-16 , DOI: 10.1007/s00264-022-05570-3
Jobe Shatrov _{1,

2} , Benoit Coulin ₁ , Cécile Batailler ₁ , Elvire Servien ₁ , Bill Walter _{3,

4} , Sebastien Lustig ₁

Affiliation

Purpose

The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove.

Methods

One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial–lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°–40°) and deep flexion (70°–80°).

Results

Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion.

Conclusion

Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.

中文翻译：

对线理念影响全膝关节置换术中的滑车再造：一项使用基于图像的机器人技术的比较研究

目的

运动学对齐 (KA) 在全膝关节置换术 (TKA) 中持续恢复滑车解剖结构的能力尚不清楚，尽管重建体质解剖学是其使用的基本原理。本研究的目的是评估 TKA 中的排列选择是否影响恢复天然滑车沟的能力。

方法

122 名连续使用 MAKO 基于图像的机器人平台接受机器人辅助 TKA 的患者根据运动学、机械和功能对齐原则放置了模拟股骨组件。比较各组间的种植体位置和滑车修复情况。通过三个一致点相对于天然凹槽的移位（内侧-外侧）和深度评估修复；完全伸展 (0°)、中度屈曲 (30°–40°) 和深度屈曲 (70°–80°)。

结果

分析了 366 个对齐选项。组间股骨排列有显着差异。在 KA 中，13.1% 和 3.3% 的 FA 计划在安全冠状边界之外。与 KA 和 FA 相比，MA 对滑车沟的平移最多（完全伸展，MA 7.84 ± 1.99 mm 横向于天然沟，KA 6.40 ± 2.43 mm 和 FA 6.88 ± 1.74 mm，p ≤ 0.001 ）。在完全伸展时，FA 在所有三个屈曲位置中最接近地恢复了滑车沟深度。