Issue link: https://beckershealthcare.uberflip.com/i/1524731
16 EXECUTIVE BRIEFING EXECUTIVE BRIEFING 1 Kinematic Alignment – The Cost-Effective Strategy for Achieving Superior Outcomes We've all heard the data; total knee arthroplasty (TKA) is one of the fastest-growing procedures, by 2030 TKA will increase by 189% to approximately 1.28 million procedures 1 . These are opportunistic tailwinds for surgeons, not just more patients requiring TKA, but rapid growth in surgeon ownership models in Ambulatory Surgery Centers (ASCs), and improvements in technology and surgical devices. Healthcare efficiency has become a major driver, requiring surgeons to carefully evaluate and refine every aspect of their practice. We also all know that TKA is a successful procedure that significantly improves postoperative pain scores. Yet over the past 40 years, unfortunately, a distinct subset of patients have been dissatisfied with their outcome after surgery 2,3 . The leading complaints tend to relate to feeling tight, instability, anterior pain, and patellofemoral issues 4 . The one common denominator for most surgeons performing TKA is that nearly all utilize the mechanical alignment (MA) technique. Perhaps MA is a root cause for dissatisfaction, especially when all objective measurements, including x-ray standards, stable exam, achieving neutral cuts, etc., indicate a successful procedure. Industry has attempted to respond with so-called novel devices to help improve patient outcomes. A leading trend has been the push toward robotically assisted surgery to improve the accuracy of component positioning. These technologies, while fascinating, incur heavy costs with disposables, exorbitant facility contracts, and longer surgical times. Despite increased cost, robotically assisted TKA has not shown improved outcomes 5,6,7 . Perhaps a different direction is the calipered Kinetic Alignment (KA) technique, which is one of the fastest-growing and most-discussed in TKA. It is simple, straightforward to implement, and does not require expensive robotics. In fact, the technique is more accurate than robotic TKA 8 . The overall premise of KA is to match the patient's prearthritic anatomy through femoral and tibial resurfacing to allow the patient to have their native kinematics and gait restored, all while eliminating the pain they experienced before surgery. The benefits of Kinematic Alignment are immense and could have major implications for eliminating the dissatisfaction previously seen in TKA globally: 1. Studies repeatedly demonstrate higher forgotten joint scores and other PROMs versus mechanical alignment 9,10,11 2. It is cost-effective, reproducible, and simple to implement in practice 3. Mid-term and long-term data demonstrate similar survivorship to prior conventional techniques 12,13 I personally came to KA after decades of practicing Mechanical Alignment. I switched from an MA technique with an ultra-congruent conventional knee system to calipered KA with the GMK Sphere medial ball-in-socket knee system. Evaluating my first 327 KA TKA, I saw improved KOOS-jr scores, more patients reaching minimally clinically important difference (MCID), a higher percentage of patients achieving the patient-acceptable symptom state (PASS), a lower manipulation rate, and improved patient satisfaction. We published the early results, including our learning curve with the technique 14 . When Medacta launched the GMK SpheriKA, the world's first knee system specifically optimized for KA, I began implanting these instead of the GMK Sphere. Since switching, I've seen even further improvements. especially evident in difficult-to-satisfy patients, who I have noticed are typically females with CPAK III phenotype (CPAK classification system 15 ). Becker's Executive Briefing, Sponsored by Medacta USA Written by: Keith R. Berend, MD; Stephen M. Howell, MD Keith Berend, MD JIS Orthopedics New Albany, OH