AUGUST 2022 | The Surgical Technologist | 349 ORIGINAL RESEARCH published: 26 August 2021 doi: 10.3389/fsurg.2021.721379 Frontiers in Surgery | www.frontiersin.org 1 August 2021 | Volume 8 | Article 721379 Edited by: Sujit Kumar Tripathy, All India Institute of Medical Sciences Bhubaneswar, India Reviewed by: Prabhudevprasad Purudappa, VA Boston Healthcare System, United States Arne Kienzle, Brigham and Women’s Hospital and Harvard Medical School, United States *Correspondence: Pascal-André Vendittoli [email protected] Specialty section: This article was submitted to Orthopedic Surgery, a section of the journal Frontiers in Surgery Received: 06 June 2021 Accepted: 28 July 2021 Published: 26 August 2021 Citation: Kostretzis L, Roby GB, Martinov S, Kiss M-O, Barry J and Vendittoli P-A (2021) Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results. Front. Surg. 8:721379. doi: 10.3389/fsurg.2021.721379 Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results Lazaros Kostretzis1, Gabriel Bouchard Roby1, Sagi Martinov1, Marc-Olivier Kiss1,2, Janie Barry1 and Pascal-André Vendittoli 1,2,3* 1 Département de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada, 2 Clinique Orthopédique Duval, Laval, QC, Canada, 3 Personalized Arthroplasty Society, Atlanta, GA, United States Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique. Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up. Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8◦ varus (from 5◦ varus to 4◦ valgus), mean mechanical distal femoral angle was 1.7◦ valgus (from 2◦ varus to 5◦ valgus), and mean mechanical tibia proximal angle was 2.2◦ varus (from 5◦ varus to 1◦ valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified. Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term. Level of evidence: IV Keywords: revision, knee, arthroplasty, technique, patient reported outcome measures, restricted kinematic alignment, mechanical alignment, kinematic alignment doi: 10.3389/fsurg.2021.721379 Frontiers in Surgery | www.frontiersin.org 1 August 2021 | Volume 8 | Article 721379 Edited by: Sujit Kumar Tripathy, All India Institute of Medical Sciences Bhubaneswar, India Reviewed by: Prabhudevprasad Purudappa, VA Boston Healthcare System, United States Arne Kienzle, Brigham and Women’s Hospital and Harvard Medical School, United States *Correspondence: Pascal-André Vendittoli [email protected] Specialty section: This article was submitted to Orthopedic Surgery, a section of the journal Frontiers in Surgery Received: 06 June 2021 Accepted: 28 July 2021 Published: 26 August 2021 Citation: Kostretzis L, Roby GB, Martinov S, Kiss M-O, Barry J and Vendittoli P-A (2021) Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results. Front. Surg. 8:721379. doi: 10.3389/fsurg.2021.721379 Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results Lazaros Kostretzis1, Gabriel Bouchard Roby1, Sagi Martinov1, Marc-Olivier Kiss1,2, Janie Barry1 and Pascal-And é Vendittoli 1,2,3* 1 Département de Chirurgie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada, 2 Clinique Orthopédique Duval, Laval, QC, Canada, 3 Personalized Arthroplasty Society, Atlanta, GA, United States Purpose: Kinematic lignment (KA) f r primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) pro ocol and to report (1) rerevision rate and adv rse ev n s, (2) patient-reported outcome measures (PROMs), and (3) radi logical signs of implant ysfunction rel ted to this t chnique. Methods: The rKA prot col was used in 43 selected TKA revisions cases suita le for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and ra iographic evaluation to identify signs of implant dysfuncti n were documented at l st follow-up. R sults: Aft r a mean f llow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the f mur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior tabilized tibial insert was us d, while 12 (28%) cases required a semi-co rained insert. The mean WOMAC sc re wa 34.4 (0–80, ±21.7). Mean postoperative arithm tic hip-kne -ankle angle (HKA) was 0.8◦ var s (from 5◦ varus to 4◦ valgus), mean m chanical distal femoral angle was 1.7◦ valgus (from 2◦ varus to 5◦ valgus), and me mechanical tibia proximal angle was 2.2◦ varus (from 5◦ varus to 1◦ valg s). No radiological evi e c of as ptic loosening or peripro thetic radiolucencies w re iden ified. C nclusion: Although current revision TKA implants are ot ideal for revision TKA performed with rKA, they are an app aling alternative to MA, esp cially in cases of early, non-wear-related, un uccessful MA TKAs. rKA TKA revision using short-cem nted stems in conjunction ith meticulous preoperative planning is safe in the mid-term. Level of evidence: IV Keywords: revision, knee, arthroplasty, technique, patient reported outcome measures, restricted kinematic alig ment, mech nical alignment, kinematic alignment
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