ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
Kinematic alignment matches functional alignment for the extension gap: a consecutive analysis of 749 primary varus osteoarthritic knees with stress radiographs.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Proximal Tibial Resection Alone Leads to a Significant Increase in Flexion Gap Size in Tibia-First Robotic-Assisted Posterior-Stabilized Total Knee Arthroplasty.Clinics in orthopedic surgery · 2026Observational
- Lateral deviation of the prosthetic trochlear angle relative to the quadriceps vector in mechanically aligned total knee arthroplasty: a radiological and clinical analysis.BMC musculoskeletal disorders · 2026Article
- Optimizing uni-compartmental knee arthroplasty: the impact of preoperative planning and arithmetic hip-knee-ankle angle.BMC musculoskeletal disorders · 2025Article
- Functional Alignment Achieved a More Balanced Knee After Robotic Arm-Assisted Total Knee Arthroplasty than Modified Kinematic Alignment.Journal of clinical medicine · 2025Article
- Article
- Gender-specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Predicting valgus malalignment after mobile-bearing UKA using a new method: the arithmetic HKA of the arthritic knee.Archives of orthopaedic and trauma surgery · 2023Article
- Arithmetic hip knee angle measurement on long leg radiograph versus computed tomography-inter-observer and intra-observer reliability.Arthroplasty (London, England) · 2023Article
- The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
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8 authors.
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Abstract
purposeThe alignment goal in total knee arthroplasty (TKA) remains debated. Two major strategies have emerged based on recreating the native knee: kinematic and functional alignment (KA and FA). Recently a new Coronal Plane Alignment of the Knee (CPAK) classification for KA, based on bony landmarks, was described considering joint line obliquity and the arithmetic HipKneeAnkle angle (aHKA). Valgus corrected HKA medial angle (vcHKA) was measured on distractive valgus preoperative radiographs compensating for cartilage wear and ligament balance in varus osteoarthritis. The purpose of this study was to determine if aHKA accounts for differences in medial laxity for the extension gap by comparing vcHKA to aHKA. The hypothesis was that no significant difference would be observed between the two measurements.
methodsThis is a retrospective analysis of 749 knees in consecutive patients presenting to a single-centre with primary medial osteoarthritis. Patients underwent standardized weight bearing long-leg and valgus stress radiographs. Tibial mechanical angle (TMA), femoral mechanical angle (FMA) and vcHKA were measured using digital software. aHKA and vcHKA were compared to determine differences due to soft tissue balancing.
resultsThe mean FMA was 91.3 ± 2.2° (range 82°-97°), the mean TMA was 85.7 ± 2.5° (range 75°-98°), the mean aHKA was 177.0 ± 3.0° (range 164°-185°) and the mean vcHKA was 176.6 ± 3.1° (range 165°-192°). No significant difference was observed between aHKA and vcHKA (p = 0.06). A significant correlation was found between vcHKA and TMA (ρ = 0.3; p < 0.001) and between vcHKA and FMA (ρ = 0.41; p < 0.001).
conclusionThis study showed that vcHKA was similar to aHKA confirming that aHKA accounts for ligamentous medial laxity. Therefore, kinematic alignment based on the CPAK classification matches the pre-arthritic coronal alignment of the knee for the extension gap. LEVEL OF EVIDENCE: IV.
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