Kinematic alignment more closely restores the groove location and the sulcus angle of the native trochlea than mechanical alignment: implications for prosthetic design

PURPOSE: Kinematic alignment (KA) and mechanical alignment (MA) position the prosthetic trochlea that guides patellar tracking differently. The present study determined whether KA or MA more closely restores the groove location and sulcus angle of the prosthetic trochlea to the native trochlea for three femoral component designs. METHODS: Ten 3D femur-cartilage models were created by combining computer tomographic (CT) and laser scans of native human cadaveric femurs. Three femoral component designs were positioned using KA and MA. Measurements of the prosthetic and native trochlea were made along the arc length of the native trochlear groove. The alignment technique with the smaller absolute difference between prosthetic and native for the medial-lateral and radial locations of the groove and sulcus angle of the trochlea more closely restored the native trochlea. RESULTS: For three femoral component designs, KA more closely restored to native the mean medial-lateral location (p = 0.0033 to < 0.0001) and mean radial location (p = 0.0150 to < 0.0001) than MA. For two femoral component designs, KA more closely restored to native the mean sulcus angle (p = 0.0326 to 0.0006) than MA. However, the differences in the mean sulcus angles between KA and MA were less than 2° for all three designs. CONCLUSION: KA more closely restored the native trochlea, which explains why the reported risk of patellofemoral complications for KA is not higher than MA according to five randomized clinical trials. Small design modifications of the medial-lateral and radial locations and sulcus angle are strategies for restoring the native trochlea. Such modifications might further reduce the risk of patellofemoral complications. LEVEL OF EVIDENCE: II.