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Related Experiment Video

Updated: Feb 23, 2026

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Mechanical alignment technique for TKA: Are there intrinsic technical limitations?

C Rivière1, F Iranpour1, E Auvinet1

  • 1The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|September 11, 2017
PubMed
Summary

Mechanically aligned total knee arthroplasty (TKA) often leads to poor outcomes due to prosthetic overstuffing and ligament imbalance. Disregarding distal femoral joint line obliquity during surgery is a key factor contributing to these issues.

Keywords:
ImbalanceLaxityMechanical alignmentRetinacula ligamentStuffingTotal knee replacementTrochlea facet

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Medical Imaging

Background:

  • Mechanically aligned (MA) total knee arthroplasty (TKA) has shown disappointing functional outcomes despite surgical advancements.
  • Intrinsic technical limitations may contribute to suboptimal TKA results.
  • This study investigates prosthetic vs. native trochlear surfaces and collateral ligament imbalance in MA TKA.

Purpose of the Study:

  • To compare native and prosthetic trochlear articular surfaces in MA TKA.
  • To estimate the extent of collateral ligament imbalance uncorrectable by release in MA TKA.
  • To test hypotheses regarding prosthetic overstuffing and uncorrectable imbalance related to distal femoral joint line obliquity (DFJLO).

Main Methods:

  • Simulated MA TKA on 20 patients using pre-operative MRI-based 3D knee models.
  • Compared native and prosthetic trochlear articular surfaces using custom software.
  • Applied an algorithm to balance extension and flexion gaps to estimate knee imbalance.

Main Results:

  • Conventional MA TKA resulted in significant distal lateral femoral prosthetic overstuffing (0.6-1.25mm).
  • A high rate of uncorrectable knee imbalance (30% type 1, 40% type 2) was observed.
  • Prosthetic overstuffing and imbalance strongly correlated with DFJLO (r=0.53-0.89).

Conclusions:

  • Conventional MA TKA frequently causes distal femoral prosthetic overstuffing.
  • Technically uncorrectable knee imbalance is common in MA TKA.
  • Disregarding DFJLO during femoral component rotation is linked to overstuffing and imbalance.