ArticleCureus2025
Effect of Converting Kinematic Aligned Total Knee Arthroplasty to Mechanical Axis Revision Total Knee Arthroplasty on Gap Measurements.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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6 authors.
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Abstract
backgroundImplants and fixation in revision total knee arthroplasty (rTKA) are based on intramedullary referencing and mechanical axis (MA) restoration. Alternative alignment strategies to primary MA total knee arthroplasty (TKA) are increasing in popularity and often place implants in positions of joint line obliquity. The deviation in implant position could result in significant bony defects when being revised to MA-based revision reconstructions. The purpose of this study was to analyze the medial and lateral, as well as flexion and extension gaps, following a standardized workflow to revise a kinematically aligned total knee arthroplasty (KA TKA) to an MA rTKA.
methodsSeven cadaveric lower extremities that previously underwent caliper-verified KA TKA were converted to MA rTKA utilizing a series of sequential soft tissue releases followed by a tibial osteotomy set perpendicular to the tibial mechanical axis. Gap measurements following each step were recorded using a digital gap-balancing device.
resultsAfter conversion from KA TKA to MA rTKA, statistically significant increases were observed in the medial extension, medial flexion, lateral extension, and lateral flexion spaces of 1.6 mm (p=0.033), 3. 6mm (p<0.001), 5.6 mm (p<0.001) and 6.9 mm (p<0.001), respectively. Release of the posterior cruciate ligament (PCL) resulted in isolated flexion space opening by 2.4 mm (p=0.002) and 2.3 mm (p=0.022), respectively, for the medial and lateral flexion gaps.
conclusionSoft tissue releases seen in rTKA have minimal effect on the medial laxity in extension. In specimens with only mild deviation from neutral alignment and joint line obliquity, the conversion from caliper-verified KA TKA to MA rTKA still resulted in large increases in the lateral-sided gaps, especially in the flexion space. This may create issues with current implant offerings, and surgeons should anticipate substantial augmentation or joint line adjustments when revising implants that were placed with intentional joint line obliquity.
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