Modified kinematic alignment better restores plantar pressure distribution than mechanical alignment in total knee arthroplasty: a randomized controlled trial - Details

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Abstract：

Kinematic　alignment　(KA)　in　the　short　to　medium　term　clinical　outcomes　is　superior　to　the　mechanical　alignment　(MA),　but　whether　it　will　improve　patients’　postoperative　gait　is　still　controversial.　Understanding　whether　and　how　KA　influences　postoperative　gait　mechanics　could　provide　insights　into　optimizing　alignment　philosophy　to　improve　functional　outcomes.　To　investigate　the　impact　of　KA　versus　MA　in　total　knee　arthroplasty　(TKA)　on　the　operated　and　contralateral　native　lower　limbs　by　analyzing　plantar　pressure　distribution　during　walking　gait.　This　study　was　designed　as　a　secondary　analysis　from　a　randomized　controlled　trial.　Thirty-seven　patients　were　included,　nineteen　underwent　KA-TKA　and　eighteen　underwent　MA-TKA,　each　with　a　native　knee　in　the　contralateral　limb.　Pressure-sensitive　insoles　were　used　to　collect　plantar　pressure　distribution　of　both　limbs　simultaneously　during　walking　defined　as　medial-lateral　load　ratio　(MLR).　Perioperative　characteristics　including　radiographic　metrics　(Hip-Knee-Ankle　angle　(HKA),　mechanical　lateral　distal　femoral　angle　(mLDFA),　and　mechanical　medial　proximal　tibial　angle　(mMPTA)　and　clinical　outcomes　(Oxford　Knee　Scores　(OKS))　were　compared　between　the　two　groups　pre-operatively　and　2-year　postoperatively.　Significant　differences　were　found　in　postoperative　radiographic　metrics,　with　KA　showing　better　OKS　1　year　postoperatively　(p　=　0.021),　lower　mean　HKA　(p　=　0.009)　and　mMPTA　(p　＜　0.001).　Other　perioperative　characteristics　were　similar　between　groups.　In　the　pedobarographic　analysis,　the　MA　group　demonstrated　greater　medial　pressure　distribution　in　forefoot　compared　to　both　the　KA　group　(p　＜　0.001)　and　the　contralateral　native　knee　(p　=　0.002).　Besides,　the　MA　group　revealed　a　more　lateral　pressure　distribution　in　rearfoot　compared　to　the　KA　group　(p　=　0.007)　and　the　contralateral　native　knee　(p　=　0.001).　While　there　was　no　significant　difference　between　KA　and　native　group　(p　=　0.064　and　p　=　0.802,　respectively).　KA　offered　advantages　over　MA　in　restoring　a　more　physiologic　plantar　pressure　distribution　at　two　years　postoperatively.　These　results　underscore　the　potential　clinical　benefits　of　adopting　KA　techniques　in　TKA　procedures.　©　The　Author(s)　2024.

Keyword：

Biomechanics Kinematically aligned Mechanically aligned Plantar pressure Total knee replacement

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[ 1 ] [Wang G.]Shengli Clinical college of Fujian Medical University, No.134 East Street, Fujian, Fuzhou, China
[ 2 ] [Wang G.]Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 3 ] [Wang G.]Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fujian, Fuzhou, China
[ 4 ] [Wang G.]Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 5 ] [Zhang Y.]College of Mechanical Engineering and Automation, Fuzhou University, Fujian, Fuzhou, China
[ 6 ] [Zhang Y.]Fujian Engineering Research Center of Joint Intelligent Medical Engineering, Fujian, Fuzhou, China
[ 7 ] [Chen L.]Shengli Clinical college of Fujian Medical University, No.134 East Street, Fujian, Fuzhou, China
[ 8 ] [Chen L.]Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 9 ] [Chen L.]Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fujian, Fuzhou, China
[ 10 ] [Chen L.]Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 11 ] [Yu G.]Shengli Clinical college of Fujian Medical University, No.134 East Street, Fujian, Fuzhou, China
[ 12 ] [Yu G.]Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 13 ] [Yu G.]Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fujian, Fuzhou, China
[ 14 ] [Yu G.]Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 15 ] [Luo F.]Shengli Clinical college of Fujian Medical University, No.134 East Street, Fujian, Fuzhou, China
[ 16 ] [Luo F.]Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 17 ] [Luo F.]Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fujian, Fuzhou, China
[ 18 ] [Luo F.]Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 19 ] [Xu J.]Shengli Clinical college of Fujian Medical University, No.134 East Street, Fujian, Fuzhou, China
[ 20 ] [Xu J.]Department of Orthopedic, Fujian Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China
[ 21 ] [Xu J.]Fujian Provincial Clinical Medical Research Center for Spinal Nerve and Joint Diseases, No.134 East Street, Fujian, Fuzhou, China
[ 22 ] [Xu J.]Fuzhou University Affiliated Provincial Hospital, No.134 East Street, Fujian, Fuzhou, China

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