Newer Coronal Alignment Philosophies in Total Knee Arthroplasty: A Brief Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 75-79 | Anoop C Dhamangaonkar

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.608


Authors: Anoop C Dhamangaonkar [1, 2]

[1] Adult Joint Reconstruction Surgeon, ORTHOPOD Speciality Clinic, Mumbai, Maharashtra-400 001, India.

Address of Correspondence
Dr. Anoop C Dhamangaonkar,
Adult Joint Reconstruction Surgeon, ORTHOPOD Speciality Clinic, Mumbai, Maharashtra-400 001, India.
E-mail: anoopd_7@yahoo.com


Abstract

Total Knee Arthroplasty (TKA) surgeries have been one of the most successful surgeries over the past half a decade. However a substantial proportion of patients undergoing TKA have the feeling of their replaced knee being an ‘unnatural one’. Also the conventional TKA requires the surgeon to maintain a coronal plane Hip Knee Angle (HKA) of 180 deg with the joint line being parallel to the horizontal and this requires a significant soft tissue release. Recently there are many different pre arthritic knee phenotypes been described with varying joint line obliquities and HKA angles. It is this difference of coronal HKA axis and joint line obliquity in the non replaced and the replaced knee that is believed to be the cause of dissatisfaction after TKA. Many coronal plane alignment philosophies have been reported to bridge this gap as mentioned earlier which replicate the pre arthritic knee anatomy with minimal soft tissue release. The only concern of the different philosophies is the long term implant survival when fixed in a non mechanically aligned position. However robotics have added a significant safety with calibrated execution to prevent outliers and improve implant survivorship. This is a brief review of the different coronal plane alignment philosophies in TKA.

Keywords: Coronal, alignment, dissatisfaction, HKA, joint line obliquity


References

1. Matassi F, Pettinari F, Frasconà F, Innocenti M, Civinini R. Coronal alignment in total knee arthroplasty: A review. J Orthop Traumatol 2023;24:24.
2. Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 1979;61:173-80.
3. Ritter MA. The anatomical graduated component total knee replacement: A long-term evaluation with 20-year survival analysis. J Bone Joint Surg Br 2009;91:745-9.
4. Diduch DR, Insall JN, Scott WN, Scuderi GR, Font-Rodriguez D. Total knee replacement in young, active patients. Long-term follow-up and functional outcome. J Bone Joint Surg Am 1997;79:575-82.
5. Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: A 20-year followup study. Clin Orthop Relat Res 2001;388:10-7.
6. Hungerford DS, Kenna RV, Krackow KA. The porous-coated anatomic total knee. Orthop Clin North Am 1982;13:103-22.
7. Rivière C, Harman C, Boughton O, Cobb J. The kinematic alignment technique for total knee arthroplasty. In: Vendittoli PA, editor. Personalized Hip and Knee Joint Replacement. Ch. 16. Cham, CH: Springer; 2020.
8. Winnock de Grave P, Kellens J, Luyckx T, Tampere T, Lacaze F, Claeys K. Inverse kinematic alignment for total knee arthroplasty. Orthop Traumatol Surg Res 2022;108:103305.
9. Almaawi AM, Hutt JR, Masse V, Lavigne M, Vendittoli PA. The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty. J Arthroplasty 2017;32:2133-40.
10. Innocenti B, Bellemans J, Catani F. Deviations from optimal alignment in TKA: Is there a biomechanical difference between femoral or tibial component alignment? J Arthroplasty 2016;31:295-301.
11. Laforest G, Kostretzis L, Kiss MO, Vendittoli PA. Restricted kinematic alignment leads to uncompromised osseointegration of cementless total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022;30:705-12.
12. Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012;470:45-53.
13. Vanlommel L, Vanlommel J, Claes S, Bellemans J. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 2013;21:2325-30.
14. Zheng K, Sun H, Zhang W, Zhu F, Zhou J, Li R, et al. Mid-term outcomes of navigation-assisted primary total knee arthroplasty using adjusted mechanical alignment. Orthop Surg 2023;15:230-8.
15. Winnock de Grave P, Luyckx T, Claeys K, Tampere T, Kellens J, Müller J, et al. Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2022;30:488-99.
16. Rivière C, Villet L, Jeremic D, Vendittoli PA. What you need to know about kinematic alignment for total knee arthroplasty. Orthop Traumatol Surg Res 2021;107:102773.
17. Hommel H, Tsamassiotis S, Falk R, Fennema P. Adjusted mechanical alignment: Operative technique-Tips and tricks. Orthopade 2020;49:562-9.
18. Kayani B, Konan S, Tahmassebi J, Oussedik S, Moriarty PD, Haddad FS. A prospective double-blinded randomised control trial comparing robotic arm-assisted functionally aligned total knee arthroplasty versus robotic arm-assisted mechanically aligned total knee arthroplasty. Trials 2020;21:194.
19. Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: Concepts and practical applications. Curr Rev Musculoskelet Med 2014;7:89-95.
20. Matziolis G, Adam J, Perka C. Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement. Arch Orthop Trauma Surg 2010;130:1487-91.
21. Chapleau J, Lambert BS, Sullivan TC, Clyburn TA, Incavo SJ. Impact of valgus vs varus mechanical axis correction during primary total knee arthroplasty on postoperative periarticular bone mineral density. J Arthroplasty 2021;36:1792-8.
22. Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD. The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: A prospective randomised control trial. Bone Joint J 2016;98-B:1360-8.
23. Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: Two-year clinical results. Bone Joint J 2014;96-B:907-13.
24. Dossett HG, Swartz GJ, Estrada NA, LeFevre GW, Kwasman BG. Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics 2012;35:e160-9.
25. Sappey-Marinier E, Pauvert A, Batailler C, Swan J, Cheze L, Servien E, et al. Kinematic versus mechanical alignment for primary total knee arthroplasty with minimum 2 years follow-up: A systematic review. SICOT J 2020;6:18.
26. Keshmiri A, Maderbacher G, Baier C, Benditz A, Grifka J, Greimel F. Kinematic alignment in total knee arthroplasty leads to a better restoration of patellar kinematics compared to mechanic alignment. Knee Surg Sports Traumatol Arthrosc 2019;27:1529-34.
27. Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee arthroplasty: A meta-analysis of the literature. J Arthroplasty 2017;32:2028-32.e1.
28. Lustig S, Sappey-Marinier E, Fary C, Servien E, Parratte S, Batailler C. Personalized alignment in total knee arthroplasty: Current concepts. SICOT J 2021;7:19.
29. Maniar RN, Johorey AC, Pujary CT, Yadava AN. Margin of error in alignment: A study undertaken when converting from conventional to computer-assisted total knee arthroplasty. J Arthroplasty 2011;26:82-7.
30. Schroeder L, Pumilia CA, Sarpong NO, Martin G. Patient satisfaction, functional outcomes, and implant survivorship in patients undergoing customized cruciate-retaining TKA. JBJS Rev 2021;9:e2000074-7.
31. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 2021;103-B:329-37.
32. Oh SM, Bin SI, Kim JY, Lee BS, Kim JM. Impact of preoperative varus deformity on postoperative mechanical alignment and long-term results of “mechanical” aligned total knee arthroplasty. Orthop Traumatol Surg Res 2019;105:1061-6.

How to Cite this article: Dhamangaonkar AC. Newer Coronal Alignment Philosophies in Total Knee Arthroplasty: A Brief Review. Journal of Clinical Orthopaedics 2023;8(2)75-79.

(Abstract Text HTML)  (Download PDF)