A randomised controlled trial of kinematically and mechanically aligned total knee replacements

Bone and Joint Journal - Tập 96-B Số 7 - Trang 907-913 - 2014
H. Gene Dossett1, Nicolette Estrada2, George J Swartz3, George W. LeFevre3, Bertram G Kwasman3
1Phoenix Veterans Affairs Health Care System, P.O. Box 27410, Scottsdale, Arizona, 85255, USA.
2Veterans Affairs Salt Lake City Health Care System, 500 Foothill, Drive, Salt Lake City, Utah 84104, USA.
3Phoenix Veterans Affairs Health Care System, 650 E. Indian School Road Phoenix Arizona, 85012, USA.

Tóm tắt

We have previously reported the short-term radiological results of a randomised controlled trial comparing kinematically aligned total knee replacement (TKR) and mechanically aligned TKR, along with early pain and function scores. In this study we report the two-year clinical results from this trial. A total of 88 patients (88 knees) were randomly allocated to undergo either kinematically aligned TKR using patient-specific guides, or mechanically aligned TKR using conventional instruments. They were analysed on an intention-to-treat basis. The patients and the clinical evaluator were blinded to the method of alignment.At a minimum of two years, all outcomes were better for the kinematically aligned group, as determined by the mean Oxford knee score (40 (15 to 48) versus 33 (13 to 48); p = 0.005), the mean Western Ontario McMaster Universities Arthritis index (WOMAC) (15 (0 to 63) versus 26 (0 to 73); p = 0.005), mean combined Knee Society score (160 (93 to 200) versus 137 (64 to 200); p= 0.005) and mean flexion of 121° (100 to 150) versus 113° (80 to 130) (p = 0.002). The odds ratio of having a pain-free knee at two years with the kinematically aligned technique (Oxford and WOMAC pain scores) was 3.2 (p = 0.020) and 4.9 (p = 0.001), respectively, compared with the mechanically aligned technique. Patients in the kinematically aligned group walked a mean of 50 feet further in hospital prior to discharge compared with the mechanically aligned group (p = 0.044).In this study, the use of a kinematic alignment technique performed with patient-specific guides provided better pain relief and restored better function and range of movement than the mechanical alignment technique performed with conventional instruments.Cite this article: Bone Joint J 2014;96-B:907–13.

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Bone and Joint Journal

Tập 96-B Số 7

907-913

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