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Department of Orthopaedic Surgery, University of Cape Town, South Africa
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floor during single leg stance. 5 Insall, on the other hand, focussed on restoring neutral mechanical alignment (MA) with orthogonal femoral and tibial resections, subsequently balancing flexion and extension gaps with soft tissue releases ( Fig. 1
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view that residual varus of femoral origin was acceptable, but neutral mechanical alignment of the tibial component was mandatory. 1 More recently, a number of authors have challenged this principle, suggesting “malalignment” of the mechanical axis
Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, Leeds, UK
Leeds Teaching Hospitals Trust, UK
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The Lister Hospital, Chelsea Bridge, London, UK
Centre de l’Arthrose - Clinique du Sport, Bordeaux-Mérignac, France
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Leeds Teaching Hospitals Trust, UK
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need for further intervention and early revision surgery. 7 Such wear is unlikely to occur with modern-day polyethylene and implants. A study by Yeo et al comparing AA with mechanical alignment (MA) showed comparable clinical, radiological and
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studies with a total of 577 knees undergoing TKA were included. Compared with conventional surgery, active robotic TKA showed better outcomes in precise mechanical alignment (p < 0.05) and implant position, with lower outliers (p < 0.05), better functional
Orthopaedic Department, University General Hospital of Larissa, Greece
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and the differences between dynamic and static loading conditions. 19 , 21 , 22 In mechanical alignment, osteotomy in the frontal plane is designed in such a way that the mechanical axis falls upon the centre of the knee joint in order to reduce
Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Nuffield Orthopaedic Centre, Headington, Oxford, UK
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
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South-West London Elective Orthopaedic Centre, Epsom, UK
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Shamir Medical Center, Zriffin, Israel
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Département de Chirurgie, Université de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
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reduces the extent of soft tissue releases compared to more traditional mechanical alignment surgery. 10 , 11 In a study assessing 4884 lower limb computerized tomography (CT) scans of patients scheduled for TKA (performed with patient
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‘balanced knee replacement’ and how this relates to the native knee. The article addresses the mechanical alignment and rotation of the knee joint, before then reviewing the issues of soft-tissue tensioning. These aspects have influence over how the knee
Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Department of Knee Surgery, Casa di Cura Solatrix, Rovereto, TN, Italy
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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neutral (0°) mechanical alignment (MA) during TKA fails to reproduce individual patient anatomy and joint kinematics ( 2 , 3 , 4 , 5 , 6 ). A variety of personalized implant alignment techniques, including kinematic alignment (KA) ( 7 ), restricted
Princess Grace Hospital, London, UK
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Princess Grace Hospital, London, UK
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Princess Grace Hospital, London, UK
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Princess Grace Hospital, London, UK
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TKA versus 50 robotic TKA, and found robotic TKA improved accuracy of mechanical alignment and reduced outliers of greater than 3° in planned alignment compared to conventional manual TKA. 25 , 26 Bellemans et al reviewed outcomes in 25 patients
Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
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). Such cases can often be anticipated based on preoperative imaging, and mechanical alignment philosophy is applied. When more constraint is needed, the authors tend to use short cemented stems. In our experience, with rKA, those stems are not impinging
