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Does a positioning rod or a patient-specific guide result in more natural femoral flexion in the concept of kinematically aligned total knee arthroplasty?

Abstract：

PURPOSE:Flexion of the femoral component in 5° increments downsizes the femoral component, decreases the proximal reach and surface area of the trochlea, delays the engagement of the patella during flexion, and is associated with a higher risk of patellar-femoral instability after kinematically aligned TKA. The present study evaluated flexion of the femoral component after use of two kinematic alignment instrumentation systems. We determined whether a distal cutting block attached to a positioning rod inserted perpendicular to the distal femoral joint line in the axial plane and 8-10 cm into the distal femur anterior and posterior to the distal cortex of the femur in the sagittal plane or a femoral patient-specific cutting guide sets the femoral component in more natural flexion. METHODS:Flexion of the femoral component was measured with respect to the sagittal femoral anatomic axis of the distal diaphysis and the sagittal femoral axis on rotationally controlled long-leg lateral computer scanograms. Measurements were performed on 53 consecutive patients treated with a kinematically aligned TKA performed with a distal cutting block attached to a positioning rod, and 53 consecutive patients treated with a kinematically aligned TKA performed with a femoral patient-specific cutting guide. RESULTS:The average flexion and variability (±standard deviation) of the femoral component of patients treated with a positioning rod was 1° ± 2° and 7° ± 4° with respect to the anatomic and mechanical axes, respectively, which was 5° less than the average flexion of the femoral component of patients treated with a femoral patient-specific cutting guide of 6° ± 4° and 12° ± 5° (p = 0.0001, p = 0.0001, respectively). CONCLUSIONS:Because a distal cutting block attached to a positioning rod sets the femoral component in 5° less flexion and with less variability than a femoral patient-specific cutting guide, we prefer this instrumentation system when performing kinematically aligned TKA to reduce the risk of patellar-femoral instability. Each surgeon should determine the repeatability of setting the flexion of the femoral component with this instrumentation system.

journal_name

Arch Orthop Trauma Surg

journal_title

Archives of orthopaedic and trauma surgery

authors

Ettinger M,Calliess T,Howell SM

doi

10.1007/s00402-016-2598-2

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

105-110

issue

eissn

0936-8051

issn

1434-3916

pii

10.1007/s00402-016-2598-2

journal_volume

137

pub_type

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Does a positioning rod or a patient-specific guide result in more natural femoral flexion in the concept of kinematically aligned total knee arthroplasty?