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Mechanical or anatomical alignment techniques create a supposedly ‘biomechanically friendly’ but often functionally limited prosthetic knee.
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Alternative techniques for alignment in total knee arthroplasty (TKA) aim at being more anatomical and patient-specific, aiming to improve functional outcomes after TKA.
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The kinematic alignment (KA) technique for TKA has shown good early clinical outcomes. Its role in extreme anatomical variation remains to be defined.
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The restricted KA technique for TKA might be a reasonable option for patients with extreme anatomical variation.
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While unicompartmental knee arthroplasty (UKA) has many advantages over TKA, the revision rate remains higher compared with TKA. One major explanation is the relative ease with which a UKA can be converted to a TKA, compared with revising a TKA. This can be considered as an additional advantage of UKA. Another reason is that surgeons favour revising a UKA to a TKA in cases of degeneration of the other femorotibial compartment rather than performing a relatively simple re-operation of the knee by doing an additional UKA (staged bi-UKA).
Cite this article: EFORT Open Rev 2018;3:1–6. DOI: 10.1302/2058-5241.3.170021
South West London Elective Orthopaedic Centre, UK
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Patients with hip osteoarthritis often have an abnormal spine-hip relation (SHR), meaning the presence of a clinically deleterious spine-hip and/or hip-spine syndrome.
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Definition of the individual SHR is ideally done using the EOS® imaging system or, if not available, with conventional lumbopelvic lateral radiographs.
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By pre-operatively screening patients with abnormal SHR, it is possible to refine total hip replacement (THR) surgical planning, which may improve outcomes.
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An important component of the concept of kinematically aligned total hip arthroplasty (KA THA) consists of defining the optimal acetabular cup design and orientation based on the assessment of an individual’s SHR, and use of the transverse acetabular ligament to adjust the cup positioning.
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The Bordeaux classification might advance the understanding of SHR and hopefully help improve THR outcomes.
Cite this article: EFORT Open Rev 2018;3:39-44. DOI: 10.1302/2058-5241.3.170020
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Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality.
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Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined.
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By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity.
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The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation.
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The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy.
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The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
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MSK Lab, Imperial College London, UK
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Multimodal protocols for pain control, blood loss management and thromboprophylaxis have been shown to benefit patients by being more effective and as safe (fewer iatrogenic complications) as conventional protocols.
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Proper patient selection and education, multimodal protocols and a well-defined clinical pathway are all key for successful day-case arthroplasty.
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By potentially being more effective, cheaper than and as safe as inpatient arthroplasty, day-case arthroplasty might be beneficial for patients and healthcare systems.
Cite this article: EFORT Open Rev 2018;3:130-135. DOI: 10.1302/2058-5241.3.170031
