Does inverse kinematic alignment coupled with robot-assisted TKA optimize patellofemoral clinical and radiological results?

Introduction: With a satisfaction rate of 80%, Total Knee Arthroplasty (TKA) surgery has seen significant improvements in recent decades. The 20% of poor results may be explained by the alignment technique used for implant placement, which can influence patellofemoral kinematics. The objective of this study was to demonstrate that the use of inverse kinematic alignment makes it possible to obtain satisfactory clinical and radiological patellar scores in robotic TKA.Hypothesis: The inverse kinematic alignment technique coupled with robotic surgery makes it possible to restore the native kinematics of the patella.Materials and methods: This prospective study including 100 TKAs with a primary TKA performed using the Stryker Mako™ robotic surgery system, and the inverse kinematic alignment technique. Patients who underwent patella resurfacing were excluded. Clinical and radiological scores were recorded preoperatively and 1 year postoperatively.Results: At one year, the specific patellar clinical scores were excellent with an average Kujala score of 85.69 and an average HSS Patellar score 88.15. The average patellar lateralization index was 0.15 and the average patellar tilt was 5.1°, showing no significant difference compared to pre-operation (p=0.45 and p=0.18). The average external rotation of the femoral implant was 0.47±0.6°[-1.9; 2.1].Discussion: The patellofemoral clinical results were excellent. The use of the robotic arm coupled with this alignment technique makes it possible to obtain a controlled external rotation of the femoral implant as well as an optimized orientation of the tibial component, favoring good restitution of the alignment of the extensor apparatus. This study did not demonstrate any radiological correction of patellar tilt and lateralization.Conclusion: The combined use of robotic surgery with the inverse kinematic alignment technique seems effective on specific clinical results of the patellofemoral joint.Level of evidence: II; Prospective cohort.