Kinematic alignment in total knee arthroplasty leads to a better restoration of patellar kinematics compared to mechanic alignment.

Abstract

The influence of different implantation techniques in TKA on tibiofemoral kinematics was analysed in few investigations so far. However, the influence on patellar kinematics remain unclear. The aim of the present investigation was to compare patellar kinematics of the natural knee with those of knees after both kinematically and mechanically aligned TKAs. Patellar kinematics of ten cadaveric knees before and after TKAs implanted using both a kinematic and mechanic alignment technique were investigated and compared using a commercial optical computer navigation system. There was a statistically significant difference between natural patellar kinematics and both implantation techniques analysing mediolateral shift. Patellar lateral tilt showed significant better results in the kinematically compared to the mechanically aligned TKAs. In terms of patella rotation, the patella of both mechanically and kinematically aligned TKAs showed significant higher values for external rotation compared to the natural knee. Regarding epicondylar distance again a significant better restoration of natural kinematics could be found in the kinematically aligned TKAs. Kinematically aligned TKAs showed a better overall restoration of patellar kinematics compared to a conventional mechanical alignment technique. In terms of clinical usefulness, the present study highlights the potential benefit for clinical outcome using a kinematically aligned implantation technique in TKA to achieve a better restoration of natural patellofemoral kinematics.