Measured Resection Techniques Do Not Align to the Cylindrical Axis in Kinematic Total Knee Arthroplasty

There has been increasing interest with improved functional results in kinematically aligned total knee arthroplasty. Kinematic alignment seeks to replicate the rotational axes of the individual knee. The femoral component can either be aligned to the estimated prearthritic distal and posterior joint lines via a measured-resection technique or by aligning to the cylindrical axis (CA). The CA is calculated using three-dimensional imaging and defined as a line equidistant from the medial and lateral condylar surfaces from 15° to 115° flexion. This study investigates whether these 2 techniques lead to similar alignment angles in the coronal plane.

One hundred three knees undergoing total knee arthroplasty were assessed using a computed tomography-based protocol. The image-based cylindrical axis coronal angle (CAA) was calculated, and the distal condylar coronal angle (DCA) was calculated to simulate a caliper measured resection technique. A computed tomographic planning software program was used to measure the offset from the distal-most extent of the calculated cylinder to the distal-most aspect of the condyles.

The DCA measured 3.3° valgus (standard deviation 2.4°) and the CAA 1.8° valgus (standard deviation 2.1°). The mean difference in offset from CAA radius to DCA from the medial condyle and the lateral condyle was 2.85 mm and 1.51 mm, respectively, increasing valgus predilection.

Caliper measured resection kinematically aligned techniques will position the femoral component in a significantly more valgus position than when aligning to the CA of the knee. This is due to an increased offset of the distal femoral articulation from the most distal aspect of the cylinder on the medial side of the knee.