Comparison of Functional Recovery Between Restricted Inverse Kinematic Alignment and Adjusted Mechanical Alignment With Robotic-assisted Unilateral Total Knee Arthroplasty.
NCT ID: NCT06835621
Last Updated: 2025-02-19
Study Results
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Basic Information
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NOT_YET_RECRUITING
NA
80 participants
INTERVENTIONAL
2025-03-31
2028-08-31
Brief Summary
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In unilateral robotic-assisted total knee arthroplasty, dose Restricted iKA technique provide better postoperative performance-based outcome compared to aMA technique?
Researchers will compare restricted iKA and aMA technique to determine which technique offers better acceleration in functional recovery and patient satisfaction.
Participants will:
After randomization, participants will allocate to either restricted iKA or aMA technique for unilateral robotic-assisted total knee arthroplasty.
Attend follow-up visits for assessments of 2-minute walk test (Primary outcome), Time up and go test (TUG), VAS for pain, ROM and complete patient-reported functional outcome questionnaires regarding knee function and satisfaction at regular intervals.
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Detailed Description
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In 2006, Howell introduced kinematic alignment TKA (KA TKA) as an alternative, with the goal of restoring the patient's natural kinematic axis and reducing the incidence of pain related to TKA rather than focusing on equal medial and lateral joint line gap and neutral mechanical axis like in mechanical alignment technique. KA TKA is considered a more personalized approach because it aims to replicate the knee's pre-arthritic alignment and movement, believing that each patient's knee has a unique alignment. This approach has gained increasing interest in recent years, with studies reporting good short- to mid-term clinical outcomes. However, the KA technique is more complex because we cannot always know the pre-arthritic alignment of individual patients and measuring soft tissue tension remains imprecise.
Later, Dr. Pascal-André Vendittoli proposed the restricted kinematic alignment TKA (rKA TKA) technique to restore natural knee movement while avoiding excessive correction of coronal alignment by maintain the HKA axis within ± 3 degrees (safe zone). By maintaining some of the constitutional deformity, this technique reduces the need for excessive soft tissue or ligament releases. In 2020 Winnock et al, introduced the Inversed kinematic technique (iKA) or tibia-referenced technique by resurfacing the tibia with equal medial and lateral resections maintaining the native tibial joint line obliquity before distal femoral bone. When combines these KA principles with robotic-assisted TKA, enhancing the accuracy of soft tissue balancing and the overall effectiveness of the procedure.
In 2020, McEwen et al. compared the use of robotic-assisted KA with MA in the same patients who underwent bilateral knee surgery using different techniques. They found that clinical outcomes, including range of motion and knee scores, were not significantly different at any time point. However, Elbuluk conducted a similar comparison, specifically robotic-assisted (MAKO) KA versus MA, and found that the KA group had less pain and better knee scores, including a higher Forgotten Joint Score. Later, Abhari conducted a study comparing robotic-assisted (MAKO) restricted KA with non-robotic MA TKA and found that the robotic-assisted (MAKO) restricted KA group had superior clinical outcomes and knee scores, including the Forgotten Joint Score, KOOS, WOMAC, Knee Society Score, as well as greater patient satisfaction. However, there are still limited prospective RCTs that study differences in outcomes, especially performance-based outcomes between restricted inverse kinematic alignment (restricted iKA) versus adjusted mechanical alignment (aMA). Therefore, the researchers aim to conduct a study comparing the efficiency of performance-based outcomes as a primary focus, including patient-reported outcome questionnaires, ROM, VAS for postoperative pain, postoperative morphine consumption within 24 hours, postoperative lower limb alignment (HKA axis), operative time, blood loss, and complications. The goal is to further advance the development of knee replacement surgery.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
TRIPLE
Study Groups
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Group 1
Restricted inverse kinematic alignment
Restricted inverse kinematic alignment Total Knee Arthroplasty
Restricted inverse kinematic alignment (restricted iKA) total knee arthroplasty is an alignment technique of total knee replacement surgery, aim to maintain the native coronal alignment within a HKA angle safe zone of 177° to 183°. This technique aims to 'resurface' the femur maintaining the native femoral joint line obliquity, with the flexion and extension gaps balanced by adjusting the tibial resection first. It is considered a more personalized approach because it aims to replicate the knee's pre-arthritic alignment and movement, believing that each patient's knee has a unique alignment.
Group 2
Adjusted mechanical alignment
Adjusted Mechanical alignment Total Knee Arthroplasty
The adjusted Mechanical Alignment (aMA) technique is an adaptation of the conventional MA technique but with undercorrection of constitutional coronal deformity, within a limit of ± 3°. The femoral resection is adjusted to preserve mild constitutional deformity and/or reduce more severe deformity while leaving the tibial component mechanically aligned. The tibial component was positioned with the aim to be perpendicular (90°) to the mechanical tibial axis.
Interventions
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Restricted inverse kinematic alignment Total Knee Arthroplasty
Restricted inverse kinematic alignment (restricted iKA) total knee arthroplasty is an alignment technique of total knee replacement surgery, aim to maintain the native coronal alignment within a HKA angle safe zone of 177° to 183°. This technique aims to 'resurface' the femur maintaining the native femoral joint line obliquity, with the flexion and extension gaps balanced by adjusting the tibial resection first. It is considered a more personalized approach because it aims to replicate the knee's pre-arthritic alignment and movement, believing that each patient's knee has a unique alignment.
Adjusted Mechanical alignment Total Knee Arthroplasty
The adjusted Mechanical Alignment (aMA) technique is an adaptation of the conventional MA technique but with undercorrection of constitutional coronal deformity, within a limit of ± 3°. The femoral resection is adjusted to preserve mild constitutional deformity and/or reduce more severe deformity while leaving the tibial component mechanically aligned. The tibial component was positioned with the aim to be perpendicular (90°) to the mechanical tibial axis.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Diagnosed with primary OA knee and indicated for unilateral total knee arthroplasty with MAKO robotic-assisted knee replacement system
* ASA classification I-II
Exclusion Criteria
* KL grading \> 3 on contralateral knee
* Unable or difficulty for walking due to comorbidities
* BMI \> 40 kg/m2
* Previous knee surgery
* Infection around the knee
50 Years
80 Years
ALL
No
Sponsors
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Thammasat University
OTHER
Responsible Party
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Krit Boontanapibul
Associate Professor
Locations
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Faculty of Medicine, Thammasat University
Klongluang, Changwat Pathum Thani, Thailand
Faculty of Medicine, Thammasat University
Klongluang, Changwat Pathum Thani, Thailand
Countries
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Central Contacts
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Facility Contacts
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References
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Elbuluk AM, Jerabek SA, Suhardi VJ, Sculco PK, Ast MP, Vigdorchik JM. Head-to-Head Comparison of Kinematic Alignment Versus Mechanical Alignment for Total Knee Arthroplasty. J Arthroplasty. 2022 Aug;37(8S):S849-S851. doi: 10.1016/j.arth.2022.01.052. Epub 2022 Jan 31.
McEwen PJ, Dlaska CE, Jovanovic IA, Doma K, Brandon BJ. Computer-Assisted Kinematic and Mechanical Axis Total Knee Arthroplasty: A Prospective Randomized Controlled Trial of Bilateral Simultaneous Surgery. J Arthroplasty. 2020 Feb;35(2):443-450. doi: 10.1016/j.arth.2019.08.064. Epub 2019 Sep 5.
Van Essen J, Stevens J, Dowsey MM, Choong PF, Babazadeh S. Kinematic alignment results in clinically similar outcomes to mechanical alignment: Systematic review and meta-analysis. Knee. 2023 Jan;40:24-41. doi: 10.1016/j.knee.2022.11.001. Epub 2022 Nov 17.
Blakeney WG, Vendittoli PA. Restricted Kinematic Alignment: The Ideal Compromise? 2020 Jul 1. In: Riviere C, Vendittoli PA, editors. Personalized Hip and Knee Joint Replacement [Internet]. Cham (CH): Springer; 2020. Chapter 17. Available from http://www.ncbi.nlm.nih.gov/books/NBK565760/
Howell SM, Shelton TJ, Hull ML. Implant Survival and Function Ten Years After Kinematically Aligned Total Knee Arthroplasty. J Arthroplasty. 2018 Dec;33(12):3678-3684. doi: 10.1016/j.arth.2018.07.020. Epub 2018 Jul 31.
Vanlommel L, Vanlommel J, Claes S, Bellemans J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc. 2013 Oct;21(10):2325-30. doi: 10.1007/s00167-013-2481-4. Epub 2013 Apr 4.
Winnock de Grave P, Luyckx T, Claeys K, Tampere T, Kellens J, Muller J, Gunst P. Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):488-499. doi: 10.1007/s00167-020-06165-4. Epub 2020 Jul 31.
Yang Y, Wang Y, Chen Y, Wang J, Lu B, Zhu W, Zhu J, Zhu C, Zhang X. Tracing the evolution of robotic-assisted total knee arthroplasty: a bibliometric analysis of the top 100 highly cited articles. J Robot Surg. 2023 Dec;17(6):2973-2985. doi: 10.1007/s11701-023-01742-4. Epub 2023 Oct 26.
Vendittoli PA, Martinov S, Blakeney WG. Restricted Kinematic Alignment, the Fundamentals, and Clinical Applications. Front Surg. 2021 Jul 20;8:697020. doi: 10.3389/fsurg.2021.697020. eCollection 2021.
Hirschmann MT, Becker R, Tandogan R, Vendittoli PA, Howell S. Alignment in TKA: what has been clear is not anymore! Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2037-2039. doi: 10.1007/s00167-019-05558-4. Epub 2019 Jun 12. No abstract available.
Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Joint J. 2014 Jul;96-B(7):907-13. doi: 10.1302/0301-620X.96B7.32812.
Roth JD, Howell SM, Hull ML. Native Knee Laxities at 0 degrees , 45 degrees , and 90 degrees of Flexion and Their Relationship to the Goal of the Gap-Balancing Alignment Method of Total Knee Arthroplasty. J Bone Joint Surg Am. 2015 Oct 21;97(20):1678-84. doi: 10.2106/JBJS.N.01256.
Brar AS, Howell SM, Hull ML, Mahfouz MR. Does Kinematic Alignment and Flexion of a Femoral Component Designed for Mechanical Alignment Reduce the Proximal and Lateral Reach of the Trochlea? J Arthroplasty. 2016 Aug;31(8):1808-13. doi: 10.1016/j.arth.2016.01.040. Epub 2016 Feb 4.
Hiranaka T, Suda Y, Saitoh A, Tanaka A, Arimoto A, Koide M, Fujishiro T, Okamoto K. Current concept of kinematic alignment total knee arthroplasty and its derivatives. Bone Jt Open. 2022 May;3(5):390-397. doi: 10.1302/2633-1462.35.BJO-2022-0021.R2.
Nisar S, Palan J, Riviere C, Emerton M, Pandit H. Kinematic alignment in total knee arthroplasty. EFORT Open Rev. 2020 Aug 1;5(7):380-390. doi: 10.1302/2058-5241.5.200010. eCollection 2020 Jul.
Other Identifiers
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MTU-EC-OT-0-240/67
Identifier Type: -
Identifier Source: org_study_id
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