Individualized surgery in primary total knee arthroplasty

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Abstract

Total knee arthroplasty (TKA) is a satisfactory procedure for end-stage knee joint pathology. However, there is a significant incidence of unsatisfied patients.
In recent years conventional total knee arthroplasty surgical technique has been challenged and a modern trend to respect individual anatomy, alignment and soft tissue laxities has been developed.
The indications, limits and outcomes of these modern techniques in selected patients are not well-defined.
Modern technology (navigation, patient-specific instrumentation and robotics) has improved accuracy of the osteotomies but their effect on long-term outcomes is still unclear.
A technique which respects individual anatomy, laxities and alignment in combination with an implant which is designed to incorporate contemporary knee kinematics, without the use of modern technology, is presented.

Cite this article: EFORT Open Rev 2020;5:663-671. DOI: 10.1302/2058-5241.5.190085

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Most cited references 67

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The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus.

Johan Bellemans, William Colyn, Hilde Vandenneucker … (2012)

Most knee surgeons have believed during TKA neutral mechanical alignment should be restored. A number of patients may exist, however, for whom neutral mechanical alignment is abnormal. Patients with so-called "constitutional varus" knees have had varus alignment since they reached skeletal maturity. Restoring neutral alignment in these cases may in fact be abnormal and undesirable and would likely require some degree of medial soft tissue release to achieve neutral alignment.

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Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements.

S Parratte, Mark Pagnano, Robert T. Trousdale … (2010)

One long-held tenet of total knee arthroplasty is that implant durability is maximized when postoperative limb alignment is corrected to 0° ± 3° relative to the mechanical axis. Recently, substantial health-care resources have been devoted to computer navigation systems that allow surgeons to more often achieve that alignment. We hypothesized that a postoperative mechanical axis of 0° ± 3° would result in better long-term survival of total knee arthroplasty implants as compared with that in a group of outliers. Clinical and radiographic data were reviewed retrospectively to determine the fifteen-year Kaplan-Meier survival rate following 398 primary total knee arthroplasties performed with cement in 280 patients from 1985 to 1990. Preoperatively, most knees were in varus mechanical alignment (mean and standard deviation, 6° ± 8.8° of varus [range, 30° of varus to 22° of valgus]), whereas postoperatively most knees were corrected to neutral (mean and standard deviation, 0° ± 2.8° [range, 8° of varus to 9° of valgus]). Postoperatively, we defined a mechanically aligned group of 292 knees (with a mechanical axis of 0° ± 3°) and an outlier group of 106 knees (with a mechanical axis of beyond 0° ± 3°). At the time of the latest follow-up, forty-five (15.4%) of the 292 implants in the mechanically aligned group had been revised for any reason, compared with fourteen (13%) of the 106 implants in the outlier group (p = 0.88); twenty-seven (9.2%) of the 292 implants in the mechanically aligned group had been revised because of aseptic loosening, mechanical failure, wear, or patellar problems, compared with eight (7.5%) of the 106 implants in the outlier group (p = 0.88); and seventeen (5.8%) of the 292 implants in the mechanically aligned group had been revised because of aseptic loosening, mechanical failure, or wear, compared with four (3.8%) of the 106 implants in the outlier group (p = 0.49). A postoperative mechanical axis of 0° ± 3° did not improve the fifteen-year implant survival rate following these 398 modern total knee arthroplasties. We believe that describing alignment as a dichotomous variable (aligned versus malaligned) on the basis of a mechanical axis goal of 0° ± 3° is of little practical value for predicting the durability of modern total knee arthroplasty implants.

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Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty.

Peter Choong, Michelle Dowsey, James D. Stoney (2009)

This is a randomized prospective controlled trial comparing the alignment, function, and patient quality-of-life outcomes between patients undergoing conventional (CONV) and computer-assisted (CAS) knee arthroplasty. One hundred and fifteen patients (60 CAS, 55 CONV) underwent cemented total knee arthroplasty. Three patients were lost to follow-up. Eighty-eight percent (CAS) vs 61% (CONV) of knees achieved a mechanical axis within 3 degrees of neutral (P = .003). Aligning femoral rotation with the epicondylar axis was accurately achieved in CAS and CONV with no significant difference. Patients with coronal alignment within 3 degrees of neutral had superior International Knee Society and Short-Form 12 physical scores at 6 weeks, 3 months, 6 months, and 12 months after surgery. Computer-assisted total knee arthroplasty achieves greater accuracy in implant alignment and this correlates with better knee function and improved quality of life.

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Author and article information

Journal

Journal ID (nlm-ta): EFORT Open Rev

Journal ID (iso-abbrev): EFORT Open Rev

Title: EFORT Open Reviews

Publisher: British Editorial Society of Bone and Joint Surgery

ISSN (Electronic): 2058-5241

Publication date Collection: October 2020

Publication date (Electronic): 26 October 2020

Volume: 5

Issue: 10

Pages: 663-671

Affiliations

[1 ]School of Health Sciences, Faculty of Medicine, University of Thessalia, Greece

[2 ]Orthopaedic Department, University General Hospital of Larissa, Greece

Author notes

[*]Theofilos Karachalios, School of Health Sciences, Faculty of Medicine, University of Thessalia, Biopolis, Mezourlo Region, Larissa 41110, Greece. Email: kar@ 123456med.uth.gr

Article

Publisher ID: 10.1302_2058-5241.5.190085

DOI: 10.1302/2058-5241.5.190085

PMC ID: 7608523

PubMed ID: 33204509

SO-VID: d3929fe4-2682-487d-9f08-27d1e6b1e75c

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This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

Individualized surgery in primary total knee arthroplasty

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EFORT Open Reviews

Most cited references 67

The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus.

Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements.

Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty.

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