Does Calipered Kinematically Aligned TKA Restore Native Left to Right Symmetry of the Lower Limb and Improve Function?

BACKGROUND: Kinematically aligned total knee arthroplasty (KA TKA) strives to restore the native left to right symmetry of the lower limb; however, the reproducibility of achieving this target is unknown. The present study determined the proportion of patients with left to right symmetry and the improvement in patient-reported function after calipered KA TKA.

METHODS: A review of 562 postoperative scanograms identified 102 patients (53 women) with a KA TKA in one limb, no other skeletal abnormalities in either limb, and symmetrical rotation between limbs on the scanogram. All patients were treated with primary TKA that used caliper measurement of the thicknesses of the femoral bone and tibial bone resections to kinematically align the components. The hip-knee-ankle (HKA) angle, distal lateral femoral angle (DLFA), and proximal medial tibial angle (PMTA) were measured. Patient-reported Oxford Knee Score (OKS) measured preoperative and postoperative functions.

RESULTS: The proportion of patients with a difference in the HKA angle, DLFA, and PMTA between limbs within ±3°, >3° varus, and <-3° valgus was 95%, 2%, and 3%, respectively, for the HKA angle; 97%, 1%, and 2%, respectively, for the DLFA; and 97%, 2%, and 1%, respectively, for the PMTA. The mean OKS improved from 20 preoperatively to 44 points (range 18-48 points) at 15 months postoperatively.

CONCLUSION: Calipered KA TKA restored native left to right symmetry of the HKA angle, DLFA, and PMTA in nearly all patients with negligible risk of varus alignment of the tibial component with respect to the native tibial joint line. The mean postoperative OKS indicated clinically important improvement in patient-reported function.