ISSN: 2577-297X
Authors: Hornero-Vazquez, M* , Del Pozo-Martin, R , Estevez-Espejo, J , Marois, B , Cagnin, A , Fuentes, A , Utz, M and Larrainzar-Garijo, R
Introduction: Dynamic knee alignment is a key determinant in the planning and success of total knee arthroplasty. Although intraoperative navigation enables assessment of the dynamic phenotype under unloaded conditions, its correspondence with weight-bearing knee function during gait remains unclear. Objective: To evaluate the relationship between dynamic phenotypes obtained passively intraoperatively under unloaded conditions and those measured under active load during gait. Methods: A prospective study was performed on 28 patients undergoing navigated total knee arthroplasty. The dynamic phenotype of each knee was classified into nine categories according to coronal alignment at extension and throughout flexion. Two variables were defined: (1) full-range dynamic phenotype and (2) midflexion dynamic phenotype corresponding to the functional range during gait. Concordance between loaded and unloaded conditions was assessed using Cohen’s kappa coefficient and percentage of agreement. Results: Agreement between unloaded and loaded phenotypes was 57% for full-range and 68% for midflexion. Varus knees showed higher correlation in midflexion, whereas valgus knees demonstrated differences between passive and weight-bearing conditions. Conclusion: Intraoperative passive assessment remains a valuable guide to the knee’s dynamic phenotype, especially in midflexion, yet a functional assessment under loading can express alternative phenotypes that are not always evident in unloaded conditions. Both computer-assisted surgical systemsand preoperative gait analyses provide valuable information for surgical decision-making and may be combined to optimize the characterization of each patient’s dynamic phenotype.
Keywords: Dynamic Phenotypes; Navigated TKA; Knee Kinematics; Weigh-Bearing Alignment
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