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
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on the presumption that it is easier for surgeons to evaluate a 90° angle than a 45° angle. These mechanical alignment guides are limited in that they can only achieve one target angle and lack accuracy ( 16 , 17 , 71 ). When operating with the
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
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and other improvements such as better wear-resistance with modern polyethylene and better cementation, some authors have started to challenge the basics of the mechanical alignment (MA) technique and recently developed and tested more anatomy
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
Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, Montreal, Québec, Canada
Clinique orthopédique Duval, 1487 Boul des Laurentides, Laval
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Bordeaux Arthroplasty Research Institute - Clinique du Sport Bordeaux-Mérignac 04-06 rue Georges Negrevergne, Mérignac, France
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Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
Clinical Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, Switzerland
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Department of Surgery, University of California, San Francisco, California, USA
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. Knee replacement To simplify TKA operations, surgeons selected neutral femoral and tibial cuts to create rectangular flexion and extension gaps and a neutral mechanical axis. Codified under ‘mechanical alignment’, these targets were considered
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technique for TKA For decades, knee components have been positioned following the concept of mechanical alignment (MA), where implants are aligned perpendicular to the femoral and tibial mechanical axes in order to create a straight lower limb with a
