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Kinematic alignment technique for medial OXFORD UKA: An in-silico study - 29/12/18

Doi : 10.1016/j.otsr.2018.11.005 
Charles Rivière a, , Ciara Harman b, Anthony Leong c, Justin Cobb c, Cedric Maillot a
a The MSK Lab-Imperial college London, South West London Elective Orthopaedic Centre, London, United Kingdom 
b South West London Elective Orthopaedic Centre, Dorking road, KT18 7EG Epsom, United Kingdom 
c The MSK Lab-Imperial college London, Charing Cross Campus, Laboratory Block, W6 8RP London, United Kingdom 

Corresponding author at: MSK Lab Imperial College London–SWLEOC, Charring Cross Hospital, Joint replacement, Fulham Palace Rd, W6 8RF London, United Kingdom.MSK Lab Imperial College London–SWLEOC, Charring Cross Hospital, Joint replacementFulham Palace RdLondonW6 8RFUnited Kingdom
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 29 décembre 2018

Abstract

Background

Mobile bearing unicompartmental knee arthroplasty (UKA) Oxford™ components are recommended to be systematically and mechanically aligned (MA) for restoring the constitutional lower-limb alignment. Good long-term clinical outcomes have been generated with the medially implanted MA Oxford™, but some sub-optimal biomechanical-related complications still remain. Kinematic Alignment (KA) is a personalised technique for anatomically and kinematically implanting components (total knee, fixed bearing partial knee, total hip) aimed at creating more physiological prosthetic joint biomechanics. Interestingly, for decades the principles for implanting fixed bearing UKA components were consistent with those promoted by the KA technique, but differently formulated. We initiated this computational study to assess the feasibility of this technique with the Oxford™ components, as we thought this more anatomical implantation may be clinically advantageous.

Hypothesis

We surmised that kinematically aligning the Oxford™ medial UKA would maximise the prosthesis-bone interface through maximising the implants’ size used (question 1), and alter, within an acceptable limit, the components’ orientation (question 2) compared to conventional mechanical alignment.

Methods

A cohort of 40 consecutive medial osteoarthritic knee patients scheduled for UKA had a preoperative CT scan that was segmented to create 3D knee bone models. MA and KA of medial UKA Oxford® components (Zimmer-Biomet, Warsaw, Indiana, USA) were simulated. Component sizing and positioning were compared between the two techniques.

Results

We found no difference in component size, but significantly fewer occurrences of borderline fit with the KA simulation. KA technique oriented the femoral component 3.6° more valgus (from 1° varus to 7° valgus) and the tibial component 2.9° more varus (from 8° varus to 0°) compared to the MA technique. The tibial component slope in KA simulation was 6.4° posterior (from 0 to 12°) compared to a systematic 7° posterior for MA positioning.

Discussion and conclusion

Kinematic alignment of the medial Oxford™ generated a different, albeit still acceptable (Oxford group recommendations), implant orientation, in addition to a likely better shape-fit between components and the supportive bone cut, compared to the MA technique. The potential to improve the implants’ interaction and to restore a more physiological bone loading makes the KA of Oxford™ an attractive, potentially clinically beneficial option. Clinical investigations are needed to assess its true value.

Level of evidence

I, computational study.

Le texte complet de cet article est disponible en PDF.

Keywords : Partial knee replacement, Mobile-bearing, Kinematic alignment, Anatomic positioning


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