What does this research mean for the field?

Ultrasound-guided center of femoral head identification significantly improves postoperative hip-knee-ankle alignment accuracy in kinematic alignment-based total knee replacement. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To assess the impact of ultrasound guidance on the accuracy of hip-knee-ankle alignment in kinematic alignment-based total knee replacements.

March 1, 2026Open Access

A Retrospective Comparative Study of Ultrasound-guided Extramedullary Kinematic Alignmentin Total Knee Replacement

Puntos clave

To assess the impact of ultrasound guidance on the accuracy of hip-knee-ankle alignment in kinematic alignment-based total knee replacements.
Retrospective analysis of 217 patients undergoing primary total knee replacement.
Comparison of postoperative hip-knee-ankle angles between an ultrasound-guided group and a calipered group.
Utilized radiographic measurements and statistical analysis for comparison.
91.6% of patients in the ultrasound-guided group achieved postoperative HKA within the safe range compared to 81.1% in the calipered group.
The ultrasound technique reduced the risk of varus crossover to valgus by 59%.

Resumen

Background/Aim: Accurate hip-knee-ankle (HKA) alignment plays a crucial role in the success of total knee replacement (TKR). Kinematic alignment (KA) aims to restore the patient’s natural joint anatomy to improve postoperative function and satisfaction. Ultrasound, a noninvasive and real-time imaging technique, can identify the center of the femoral head (COFH) and enhance surgical alignment accuracy. This study aimed to evaluate whether ultrasound-guided COFH identification improves postoperative HKA alignment accuracy in KA-based TKR. Patients and Methods: A retrospective analysis of 217 patients who underwent primary TKR at Show Chwan Memorial Hospital (2020-2022) was performed. Patients were divided into a calipered group (without ultrasound) and an ultrasound-guided group. Postoperative alignment and HKA angles were compared between the groups using radiographic measurements and statistical analysis. Results: The ultrasound-guided group demonstrated significantly improved alignment, with 91.6% of patients achieving postoperative HKA within the safe range (−4° valgus to +5° varus) compared to 81.1% in the calipered group (p=0.029). Moreover, the ultrasound-guided technique reduced the risk of postoperative varus cross-over to valgus by 59%. Conclusion: Ultrasound-guided COFH identification significantly enhances the accuracy of KA-based TKR, particularly in neutral-type osteoarthritis knees. This noninvasive and real-time approach serves as a valuable adjunct for improving alignment precision and clinical outcomes.

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