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No Difference in 10-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A
John P Gibbons1, Nina Zeng1, Ali Bayan1
1Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand.
Clinical Orthopaedics and Related Research
|August 15, 2024
Summary
Ten-year follow-up of total knee replacement (TKA) shows no significant difference in patient-reported outcomes or survivorship between mechanical alignment and kinematic alignment. Mechanical alignment remains the reference standard due to unknown long-term impacts of kinematic alignment.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Clinical trial research
Background:
- Debate persists regarding the optimal component alignment philosophy in total knee arthroplasty (TKA).
- Limited long-term functional and radiographic data exist for randomized comparisons of kinematic alignment versus mechanical alignment.
Purpose of the Study:
- To compare 10-year functional outcomes (PROM scores) and survivorship (revision, reoperation, radiographic loosening) between mechanical alignment and kinematic alignment in TKA.
- To evaluate patient-reported outcome measures (PROMs) including Knee Society Score, Oxford Knee Score, WOMAC, Forgotten Joint Score, and EuroQol 5-Dimension score.
- To assess survivorship free from revision or reoperation for any cause and survivorship free from radiographic loosening.
Main Methods:
- A single-center, multisurgeon randomized controlled trial (RCT) involving 99 patients undergoing primary TKA for osteoarthritis.
- Patients were randomized to mechanical alignment (n=50) using computer navigation or kinematic alignment (n=49) using patient-specific cutting blocks.
- Follow-up at 10 years included assessment of PROMs and radiographic evaluation for aseptic loosening; Kaplan-Meier analysis was used for survivorship.
Main Results:
- No significant differences were observed in any patient-reported outcome scores (PROMs) at 10 years between the two alignment groups.
- Ten-year survivorship free from revision did not differ significantly (96% mechanical vs. 91% kinematic; p=0.38).
- No difference was found in survivorship free from radiographic loosening (0% mechanical vs. 3% kinematic; p=0.52).
Conclusions:
- This 10-year follow-up RCT found no functional or radiographic differences between mechanical alignment and kinematic alignment TKA.
- The anticipated functional benefits of kinematic alignment were not demonstrated.
- Mechanical alignment remains the reference standard for TKA due to unknown long-term effects of kinematic alignment on implant position.
