Evidence map›Paper›PMID 25823516›Full record

ArticleInternational orthopaedics2015

Does varus alignment adversely affect implant survival and function six years after kinematically aligned total knee arthroplasty?

Stephen M Howell, Stelios Papadopoulos, Kyle Kuznik, Lillian R Ghaly, Maury L Hull

Abstract read
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In one paragraph

Article in International orthopaedics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 94 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
94citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

94 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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  6. Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2017
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  8. Shorter survival rate in varus-aligned knees after total knee arthroplasty.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2016
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  12. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2017
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34 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Stephen M HowellBiomedical Engineering Graduate Group, University of California, Davis, Davis, CA, 95616, USA. sebhowell@mac.com.
Stelios PapadopoulosBiomedical Engineering Graduate Group, University of California, Davis, Davis, CA, 95616, USA.
Kyle KuznikBiomedical Engineering Graduate Group, University of California, Davis, Davis, CA, 95616, USA.
Lillian R GhalyBiomedical Engineering Graduate Group, University of California, Davis, Davis, CA, 95616, USA.
Maury L HullBiomedical Engineering Graduate Group, University of California, Davis, Davis, CA, 95616, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWe report the six year implant survivorship, tibial component alignment and knee and limb function measured by the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index ((WOMAC) score after kinematically aligned total knee arthroplasty (TKA) and tested the hypothesis that varus alignment of the tibial component, knee, or limb does not adversely affect implant survival and function.

methodsWe prospectively followed 214 consecutive patients (219 knees) treated with a kinematically aligned TKA in 2007. Kaplan-Meier survival analysis and revision rate per 100 component years determined implant failure. The Oxford Knee Score (0 worst, 48 best) and WOMAC score (0 worst, 100 best) were used to measure function. We categorised tibial component alignment as in-range (≤ 0°) or varus (>0°), knee alignment as in-range (between -2.5° and -7.4°), varus (>-2.5°), or valgus (<-7.4°), and limb alignment as in-range (0° ± 3°), varus (>3°) or valgus (<-3°).

resultsAt a mean of 6.3 years (range, 5.8-7.2), implant survivorship was 97.5 % and revision-rate per 100 component years 0.40. Three implants had been revised (deep infection one, loose tibial component one and patella instability [1); two loose patella components were pending revision and considered failures. The average Oxford Knee Score was 43 and WOMAC 91. Function of tibial components (80 %), knees (31 %) and limbs (7 %) that were aligned in varus was similar to patients aligned in-range.

conclusionsAt a mean of 6.3 years after kinematically aligned TKA, varus alignment of the tibial component, knee and limb did not adversely affect implant survival or function, which supports the consideration of kinematic alignment as an alternative to mechanical alignment for performing primary TKA. Level of evidence, III; therapeutic study.

Indexed as

AdultAgedAged, 80 and overArthroplasty, Replacement, KneeBiomechanical PhenomenaFemaleGenu VarumHumansKaplan-Meier EstimateKnee JointKnee ProsthesisMaleMiddle AgedPatellaProspective StudiesReoperationAlignmentArthroplastyKinematicKneeSurvival

Identifiers

PMID25823516

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.