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Department of Orthopaedic Surgery, University of Cape Town, SA
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Total knee arthroplasty (TKA) has evolved into a successful, cost-effective treatment for end-stage knee arthrosis.
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The patellofemoral articulation in TKA has largely been ignored during its development despite being an important determinant of outcome.
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New technologies still need further development to incorporate the patella in TKA surgical planning and operative technique.
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Alternative approaches to alignment in TKA will have a secondary impact on patellofemoral mechanics and possibly future implant designs.
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Technologies that assist with precise implant positioning may alter our understanding and overall practice of TKA.
Cite this article: EFORT Open Rev 2019;4:503-512. DOI: 10.1302/2058-5241.4.180094
Department of Orthopaedic Surgery, University of Cape Town, South Africa
Search for other papers by Mark Anthony Roussot in
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Search for other papers by Georges Frederic Vles in
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Although mechanical alignment (MA) has traditionally been considered the gold standard, the optimal alignment strategy for total knee arthroplasty (TKA) is still debated.
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Kinematic alignment (KA) aims to restore native alignment by respecting the three axes of rotation of the knee and thereby producing knee motion more akin to the native knee.
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Designer surgeon case series and case control studies have demonstrated excellent subjective and objective clinical outcomes as well as survivorship for KA TKA with up to 10 years follow up, but these results have not been reproduced in high-quality randomized clinical trials.
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Gait analyses have demonstrated differences in parameters such as knee adduction, extension and external rotation moments, the relevance of which needs further evaluation.
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Objective improvements in soft tissue balance using KA have not been shown to result in improvements in patient-reported outcomes measures.
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Technologies that permit accurate reproduction of implant positioning and objective measurement of soft tissue balance, such as robotic-assisted TKA and compartmental pressure sensors, may play an important role in improving our understanding of the optimum alignment strategy and implant position.
Cite this article: EFORT Open Rev 2020;5:486-497. DOI: 10.1302/2058-5241.5.190093
