Systematic alignments yield balanced knees without additional releases in only 11% of knee arthroplasties: a...

The literature suggests that "forgotten" knees are the most stable knees postoperatively. The main objective of our study was to determine whether a systematic alignment (mechanical, anatomical or kinematic) makes it possible to stabilise the operated joint in extension and in flexion.

This monocentric prospective cohort study was conducted between May 1st, 2021 and October 31st, 2021. A total of 132 consecutive patients undergoing primary navigated total knee arthroplasty were included, with a mean age of 72.4 years (7.9; 48.8-91.2 years), a mean body mass index (BMI) of 28.6 kg/m² (4.6; 17.6-41.6) and 71.2% (94/132) women. Mechanical, anatomical and kinematic knee alignments were simulated using Kick software for each patient. The primary outcome was the targeted rate of balanced knees for each type of alignment, based on a three-point score, aiming for a 3/3 score for each knee. Our secondary outcome was to characterise the specific implantation finally achieved by the surgeon.

The targeted balance was reached in 10.6% (14/132), 10.6% (14/132) and 12.9% (17/132) of knees with mechanical, anatomical and kinematic alignment simulations, respectively. None of these simulations provided a superior number of balanced knees (p = 0.87). When simulating a patient-specific implantation, the highest score was reached in 89.1% (115/132) of cases.

Systematic alignment simulations achieved knee balance in only 11% of cases. Patient-specific implantation, favouring knee balancing over alignment, allowed an 89% perfect score rate without having to perform any collateral release.

Case series. Level 4.