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Current Controversies of Alignment in Total Knee Replacements
James Donaldson1, James Joyner1, Francois Tudor1
1Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences, Toronto, Canada.
The Open Orthopaedics Journal
|November 21, 2015
Summary
Total knee replacement (TKR) improves pain and function for most arthritis patients. This review examines traditional alignment versus newer techniques aiming to enhance TKR outcomes and patient satisfaction.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Medical Technology
Background:
- Total knee replacement (TKR) is a common procedure for end-stage knee arthritis, generally improving pain and function.
- A significant minority of patients (up to 20%) report dissatisfaction despite well-aligned implants.
- Traditional TKR aims for a neutral mechanical axis, supported by historical data for function and implant survival.
Purpose of the Study:
- To review traditional knee alignment principles in TKR.
- To explore newer alignment techniques that aim to replicate pre-arthritic knee kinematics.
- To evaluate the evidence supporting traditional and novel TKR alignment strategies.
Main Methods:
- Literature review of traditional and emerging TKR alignment concepts.
- Analysis of studies investigating functional outcomes and patient satisfaction related to alignment.
- Examination of technologies such as computer navigation, robotics, and patient-specific instrumentation.
Main Results:
- Traditional neutral alignment has historical support but does not guarantee patient satisfaction.
- Emerging techniques focus on patient-specific kinematics, potentially improving function.
- Advanced technologies aim to increase surgical accuracy in achieving desired alignments.
Conclusions:
- The optimal alignment strategy for TKR remains an evolving area of research.
- Patient-specific kinematic alignment shows promise for improving outcomes beyond traditional methods.
- Further evidence is needed to fully establish the benefits of newer alignment techniques and technologies in TKR.
