Edoardo Franceschetti, Giancarlo Giurazza, Stefano Campi, Michael T Hirschmann, Kristian Samuelsson, Andrea Tanzilli, Pietro Gregori, Michele Paciotti, Biagio Zampogna, Rocco Papalia
{"title":"内翻全膝关节置换术中无限制的运动学对齐优于CPAK I型的机械对齐，但在CPAK IV中产生类似的结果：FP-UCBM膝关节研究组的回顾性分析。","authors":"Edoardo Franceschetti, Giancarlo Giurazza, Stefano Campi, Michael T Hirschmann, Kristian Samuelsson, Andrea Tanzilli, Pietro Gregori, Michele Paciotti, Biagio Zampogna, Rocco Papalia","doi":"10.1002/ksa.70084","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes in varus-aligned patients undergoing cruciate-retaining total knee arthroplasty (TKA) with mechanical alignment (MA) versus unrestricted kinematic alignment (KA). The hypothesis was that KA would yield superior outcomes, and that preserving joint line obliquity-regardless of alignment technique-would be associated with better results.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data from 140 KA and 209 MA TKA cases was performed. Inclusion criteria were: end-stage varus osteoarthritis (aHKA < 178°), MA or unrestricted KA TKA and ≥ 1-year follow-up. Exclusion criteria included prior major surgery (osteotomies, fractures) on the affected limb, inadequate preoperative full-length radiographs, or post-operative complications unrelated to alignment strategy. Patients were categorised by CPAK phenotype (I, IV and VII) based on the joint line obliquity. Clinical outcomes at 1-year follow-up were assessed using the Knee Society Score (KSS) pt.1 and 2, Oxford Knee Score (OKS), SF-12, and Forgotten Joint Score (FJS). ANOVA was used to compare results of MA and KA in the overall varus population, and in CPAK subgroups. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>KA led to significantly higher KSS pt.1 (84.6 ± 15.3 vs. 73.9 ± 18.9; p < 0.001) and FJS (90.5 ± 15.3 vs. 80.4 ± 15.8; p < 0.001) than MA. In CPAK I patients, KA outperformed MA in KSS pt.1 (83.5 ± 16.2 vs. 74.9 ± 19.1; p < 0.001) and FJS (89.8 ± 15.5 vs. 80.7 ± 17.8; p < 0.001). No differences were found between KA and MA in CPAK IV patients (p > 0.05). KSS pt.1 (80.1 ± 13.8) and FJS (86.5 ± 18.1) achieved with MA in CPAK IV were significantly higher than in both the overall varus aHKA group and CPAK I patients treated with MA (p < 0.05).</p><p><strong>Conclusions: </strong>Cruciate-retaining unrestricted KA yields better clinical outcomes compared to MA in varus aHKA patients, and in the CPAK I subgroup. In CPAK IV, preserving joint line obliquity leads to similar outcomes with both MA and KA.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0000,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Unrestricted kinematic alignment in varus total knee arthroplasty outperforms mechanical alignment in CPAK I phenotype, but yields comparable outcomes in CPAK IV: A retrospective analysis from the FP-UCBM Knee Study Group.\",\"authors\":\"Edoardo Franceschetti, Giancarlo Giurazza, Stefano Campi, Michael T Hirschmann, Kristian Samuelsson, Andrea Tanzilli, Pietro Gregori, Michele Paciotti, Biagio Zampogna, Rocco Papalia\",\"doi\":\"10.1002/ksa.70084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To compare clinical outcomes in varus-aligned patients undergoing cruciate-retaining total knee arthroplasty (TKA) with mechanical alignment (MA) versus unrestricted kinematic alignment (KA). The hypothesis was that KA would yield superior outcomes, and that preserving joint line obliquity-regardless of alignment technique-would be associated with better results.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data from 140 KA and 209 MA TKA cases was performed. Inclusion criteria were: end-stage varus osteoarthritis (aHKA < 178°), MA or unrestricted KA TKA and ≥ 1-year follow-up. Exclusion criteria included prior major surgery (osteotomies, fractures) on the affected limb, inadequate preoperative full-length radiographs, or post-operative complications unrelated to alignment strategy. Patients were categorised by CPAK phenotype (I, IV and VII) based on the joint line obliquity. Clinical outcomes at 1-year follow-up were assessed using the Knee Society Score (KSS) pt.1 and 2, Oxford Knee Score (OKS), SF-12, and Forgotten Joint Score (FJS). ANOVA was used to compare results of MA and KA in the overall varus population, and in CPAK subgroups. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>KA led to significantly higher KSS pt.1 (84.6 ± 15.3 vs. 73.9 ± 18.9; p < 0.001) and FJS (90.5 ± 15.3 vs. 80.4 ± 15.8; p < 0.001) than MA. In CPAK I patients, KA outperformed MA in KSS pt.1 (83.5 ± 16.2 vs. 74.9 ± 19.1; p < 0.001) and FJS (89.8 ± 15.5 vs. 80.7 ± 17.8; p < 0.001). No differences were found between KA and MA in CPAK IV patients (p > 0.05). KSS pt.1 (80.1 ± 13.8) and FJS (86.5 ± 18.1) achieved with MA in CPAK IV were significantly higher than in both the overall varus aHKA group and CPAK I patients treated with MA (p < 0.05).</p><p><strong>Conclusions: </strong>Cruciate-retaining unrestricted KA yields better clinical outcomes compared to MA in varus aHKA patients, and in the CPAK I subgroup. In CPAK IV, preserving joint line obliquity leads to similar outcomes with both MA and KA.</p><p><strong>Level of evidence: </strong>Level IV.</p>\",\"PeriodicalId\":520702,\"journal\":{\"name\":\"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-10-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/ksa.70084\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/ksa.70084","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Unrestricted kinematic alignment in varus total knee arthroplasty outperforms mechanical alignment in CPAK I phenotype, but yields comparable outcomes in CPAK IV: A retrospective analysis from the FP-UCBM Knee Study Group.
Purpose: To compare clinical outcomes in varus-aligned patients undergoing cruciate-retaining total knee arthroplasty (TKA) with mechanical alignment (MA) versus unrestricted kinematic alignment (KA). The hypothesis was that KA would yield superior outcomes, and that preserving joint line obliquity-regardless of alignment technique-would be associated with better results.
Methods: A retrospective analysis of prospectively collected data from 140 KA and 209 MA TKA cases was performed. Inclusion criteria were: end-stage varus osteoarthritis (aHKA < 178°), MA or unrestricted KA TKA and ≥ 1-year follow-up. Exclusion criteria included prior major surgery (osteotomies, fractures) on the affected limb, inadequate preoperative full-length radiographs, or post-operative complications unrelated to alignment strategy. Patients were categorised by CPAK phenotype (I, IV and VII) based on the joint line obliquity. Clinical outcomes at 1-year follow-up were assessed using the Knee Society Score (KSS) pt.1 and 2, Oxford Knee Score (OKS), SF-12, and Forgotten Joint Score (FJS). ANOVA was used to compare results of MA and KA in the overall varus population, and in CPAK subgroups. Statistical significance was set at p < 0.05.
Results: KA led to significantly higher KSS pt.1 (84.6 ± 15.3 vs. 73.9 ± 18.9; p < 0.001) and FJS (90.5 ± 15.3 vs. 80.4 ± 15.8; p < 0.001) than MA. In CPAK I patients, KA outperformed MA in KSS pt.1 (83.5 ± 16.2 vs. 74.9 ± 19.1; p < 0.001) and FJS (89.8 ± 15.5 vs. 80.7 ± 17.8; p < 0.001). No differences were found between KA and MA in CPAK IV patients (p > 0.05). KSS pt.1 (80.1 ± 13.8) and FJS (86.5 ± 18.1) achieved with MA in CPAK IV were significantly higher than in both the overall varus aHKA group and CPAK I patients treated with MA (p < 0.05).
Conclusions: Cruciate-retaining unrestricted KA yields better clinical outcomes compared to MA in varus aHKA patients, and in the CPAK I subgroup. In CPAK IV, preserving joint line obliquity leads to similar outcomes with both MA and KA.
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