A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-18 DOI:10.1002/ksa.12648

Luca Andriollo, Christos Koutserimpas, Pietro Gregori, Elvire Servien, Cécile Batailler, Sébastien Lustig

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引用次数: 0

Abstract

Purpose: Alignment strategies in total knee arthroplasty (TKA) have predominantly emphasized coronal alignment in extension, with minimal focus on dynamic alignment during flexion. This study aims to identify the predictors of the intraoperative robotic hip-knee-ankle angle at 90° of flexion (rHKA-90F) and assess its clinical significance in postoperative outcomes, proposing that rHKA-90F may be a critical factor in enhancing functional results in TKA.

Methods: A retrospective analysis was conducted on 180 patients with varus deformity undergoing robotic-assisted TKA under the functional alignment principles. Clinical outcomes were assessed using the Knee Society Score (KSS), Forgotten Joint Score (FJS-12) and Kujala Anterior Knee Pain Scale (AKPS) score. Predictors for final rHKA-90F and its intraoperative changes were identified using multiple linear regression models. Initial and intraoperative robotic measurements were also analyzed.

Results: Significant predictors of the final rHKA-90F included femoral rotation, tibial varus/valgus alignment, initial rHKA-90F and the final robotic axis in extensions. Patients with a final rHKA-90F ≥ 5° of varus demonstrated superior KSS function and KSS knee compared to those with a final rHKA-90F between 0° and 4° of varus. Furthermore, patients with intraoperative changes of rHKA-90F > 2.5° neutralization (varus reduction or with a valgus value) achieved better FJS and AKPS score.

Conclusions: This study highlights the clinical relevance of rHKA-90F as an intraoperative tool in robotic knee arthroplasty, emphasizing the need to balance the correction of varus deformity with the maintenance of slight varus alignment in flexion. Personalized alignment strategies tailored to patient-specific anatomy and kinematics are crucial to optimizing outcomes. There is still a need for future research on the long-term effects of dynamic alignment.

Level of evidence: Level III.

查看原文本刊更多论文

机器人全膝关节置换术时代的新参数：屈曲90°冠状位对齐影响临床结果。

目的：全膝关节置换术（TKA）中的对齐策略主要强调伸展时的冠状对齐，屈曲时的动态对齐。本研究旨在确定术中机器人髋关节-膝关节-踝关节90°屈曲角（rHKA-90F）的预测因素，并评估其对术后预后的临床意义，提出rHKA-90F可能是增强TKA功能结果的关键因素。方法：回顾性分析180例内翻畸形患者在功能对准原则下进行机器人辅助TKA的临床资料。临床结果采用膝关节社会评分（KSS）、遗忘关节评分（FJS-12）和Kujala膝关节前痛量表（AKPS）评分进行评估。使用多元线性回归模型确定最终rHKA-90F及其术中变化的预测因子。还分析了初始和术中机器人测量值。结果：最终rHKA-90F的重要预测因素包括股骨旋转、胫骨内翻/外翻对准、初始rHKA-90F和最终机器人轴伸展。最终rHKA-90F≥5°内翻的患者与最终rHKA-90F在0°至4°内翻的患者相比，表现出更好的KSS功能和KSS膝关节。此外，术中rhka - 90f> 2.5°中和改变（内翻复位或外翻值）的患者获得更好的FJS和AKPS评分。结论：本研究强调了rHKA-90F作为机器人膝关节置换术中工具的临床意义，强调需要平衡内翻畸形的矫正与屈曲时轻微内翻对齐的维持。个性化对齐策略量身定制的患者特定的解剖和运动学是优化结果的关键。动态对准的长期效应还需要进一步的研究。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).