Alignment and fixation in total knee arthroplasty: changing paradigms

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Rehabilitation medicine

Background:

• Total knee arthroplasty (TKA) has undergone significant advancements since its introduction.
• Improvements in prosthetic design, fixation methods, polyethylene durability, and rehabilitation protocols have markedly reduced revision rates.
• Current patients expect long-lasting prostheses and enhanced functional recovery following TKA.

Purpose of the Study:

• To examine the evolving paradigms in total knee arthroplasty.
• To investigate the shift from traditional mechanical alignment to a focus on restoring native joint kinematics.
• To explore the potential of combining kinematic alignment with modern fixation techniques for improved TKA outcomes.

Main Methods:

• Review of historical and contemporary TKA literature.
• Analysis of trends in prosthetic design and fixation technologies.
• Evaluation of the impact of alignment strategies on TKA revision rates and functional results.

Main Results:

• Modern TKA components and techniques have led to substantial reductions in revision surgery.
• There is a growing emphasis on achieving kinematic restoration over strict mechanical alignment for better joint function.
• Uncemented, adaptable fixation methods are emerging as promising alternatives.

Conclusions:

• The evolution of TKA has significantly improved patient outcomes and implant longevity.
• Restoring physiological joint kinematics, alongside advancements in fixation, is crucial for future TKA success.
• A combined approach of kinematic alignment and adaptable fixation may represent the next frontier in knee replacement surgery.