Inverse Kinematic Alignment for Total Knee Arthroplasty The Concept, Clinical Outcomes and Biomechanical Outcomes

Knee arthroplasty is a frequently performed surgical procedure for the treatment of end stage knee osteoarthritis. Postoperative function and patient satisfaction are becoming increasingly relevant in knee arthroplasty. Despite adequate preoperative planning and improved surgical techniques and rehabilitation protocols, only 75%-85% of patients seem satisfied after mechanically aligned total knee arthroplasty (TKA). Unicompartmental knee arthroplasty (UKA) is an alternative to TKA in isolated end-stage medial femorotibial osteoarthritis. In comparison to TKA, UKA is a less invasive procedure based upon a resurfacing procedure of the arthritic femoral condyle. UKA enables physiological restoration of the knee kinematics, resulting in better postoperative function, generally observed to outperform TKA. Nevertheless, despite the excellent functional outcomes, the long-term survival and the demanding surgical technique remain obscure.

This project may further solve the abovementioned shortcomings in the world of knee arthroplasty. At first, the survival rates and clinical outcomes of a large cohort of UKA patients will be investigated in depth. Secondly, the surgical procedure for optimal UKA procedure will be extensively explained by a surgical video technique, describing each individual surgical step and delineating technical pearls.  Thirdly, a new patient specific alignment technique 'inverse kinematic alignment' (iKA) for TKA will be described and its surgical advantages compared to conventional mechanical alignment (MA) or kinematic alignment (KA) will be discussed in detail. At last, besides these surgical benefits, also the clinical and biomechanical outcomes of patients with an iKA TKA will be investigated extensively and compared to the outcomes of patients with conventional MA TKA. 

This project may build bridges between orthopaedic surgery and rehabilitation sciences. By investigating clinical and biomechanical outcomes of knee arthroplasty patients in relation to specific surgical updated procedures (UKA and alignment strategies in TKA), new insights into surgical procedures will be created with a direct link to daily clinical outcome of the patient. Next, the investigated biomechanical variables may deliver some necessary information to create specific rehabilitation programmes adapted to the surgical procedure.