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Personalized alignment in total knee arthroplasty: current concepts

Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment...

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Autores principales: Lustig, Sébastien, Sappey-Marinier, Elliot, Fary, Camdon, Servien, Elvire, Parratte, Sébastien, Batailler, Cécile
Formato: Online Artículo Texto
Lenguaje:English
Publicado: EDP Sciences 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019550/
https://www.ncbi.nlm.nih.gov/pubmed/33812467
http://dx.doi.org/10.1051/sicotj/2021021
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author Lustig, Sébastien
Sappey-Marinier, Elliot
Fary, Camdon
Servien, Elvire
Parratte, Sébastien
Batailler, Cécile
author_facet Lustig, Sébastien
Sappey-Marinier, Elliot
Fary, Camdon
Servien, Elvire
Parratte, Sébastien
Batailler, Cécile
author_sort Lustig, Sébastien
collection PubMed
description Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of “kinematic alignment” is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the “inverse kinematic alignment” is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is “restricted kinematic alignment” which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of “functional alignment” which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient’s specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts.
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spelling pubmed-80195502021-04-05 Personalized alignment in total knee arthroplasty: current concepts Lustig, Sébastien Sappey-Marinier, Elliot Fary, Camdon Servien, Elvire Parratte, Sébastien Batailler, Cécile SICOT J Review Article Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of “kinematic alignment” is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the “inverse kinematic alignment” is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is “restricted kinematic alignment” which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of “functional alignment” which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient’s specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts. EDP Sciences 2021-03-26 /pmc/articles/PMC8019550/ /pubmed/33812467 http://dx.doi.org/10.1051/sicotj/2021021 Text en © The Authors, published by EDP Sciences, 2021 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Lustig, Sébastien
Sappey-Marinier, Elliot
Fary, Camdon
Servien, Elvire
Parratte, Sébastien
Batailler, Cécile
Personalized alignment in total knee arthroplasty: current concepts
title Personalized alignment in total knee arthroplasty: current concepts
title_full Personalized alignment in total knee arthroplasty: current concepts
title_fullStr Personalized alignment in total knee arthroplasty: current concepts
title_full_unstemmed Personalized alignment in total knee arthroplasty: current concepts
title_short Personalized alignment in total knee arthroplasty: current concepts
title_sort personalized alignment in total knee arthroplasty: current concepts
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019550/
https://www.ncbi.nlm.nih.gov/pubmed/33812467
http://dx.doi.org/10.1051/sicotj/2021021
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