Coronal alignment in total knee arthroplasty: a review

Matassi, F.; Pettinari, F.; Frasconà, F.; Innocenti, M.; Civinini, R.

doi:10.1186/s10195-023-00702-w

Cited by 18 publications

(5 citation statements)

References 49 publications

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“…They concluded that the phenotype of the femoral component is not suitable to have a great variation [25]. At the same time, the tibial component is considered to be placed perpendicular to the tibial mechanical axis to ensure a balanced distribution of tibial loading and avoid concentration of shear forces [6,23]. As a result, the aMA and rKA strategies seem to be more suitable for Chinese OA knees than the MA, AA and KA strategies.…”

Section: Tka Bone Cut Strategies According To Functional Knee Phenotypesmentioning

confidence: 99%

Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models

Liu,

Lei,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to investigate the distribution of coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes in a Chinese osteoarthritis (OA) population and to compare different lower limb alignment targets according to the distribution characteristics to find suitable total knee arthroplasty (TKA) bone cut strategies for the Chinese OA patients.MethodsThe computed tomography (CT) images were retrospectively collected and the three‐dimensional (3D) models were reconstructed from 434 Chinese OA patients, including 93 males and 341 females, with a mean age of 66.4 ± 9.3 years. Femoral mechanical angle (FMA), tibial mechanical angle (TMA) and mechanical hip–knee–ankle angle (mHKA) were measured on the 3D models. Arithmetic hip–knee–ankle angle (aHKA) was calculated using FMA plus TMA, and joint line obliquity was calculated as 180 + TMA–FMA. The CPAK according to MacDessi and the functional knee phenotypes according to Hirschmann were performed. In addition, the suitable TKA bone cut strategies were explored according to the phenotypes and based on the characteristics of different alignment targets, such as mechanical alignment, anatomic alignment (AA), kinematic alignment, restricted KA (rKA) and adjusted MA (aMA). Statistical differences were determined using the independent‐samples t‐test or the two independent‐samples Wilcoxon test, with p < 0.05 considered statistically significant.ResultsThe Chinese OA population showed a varus alignment tendency (mHKA = 172.1° ± 7.2°), to which the TMA was a major contributor (TMA = 84.7° ± 4.4° vs. FMA = 91.3° ± 3.2°). The mHKA was on average 3.9° more varus than the aHKA. A total of 140 functional knee phenotypes were found and 45.6% were concentrated in VARFMA3°–NEUFMA0° to VARTMA3°–NEUTMA0°. More than 70% of patients had different FMA and TMA phenotypes. There were 92.9% of CPAK distributed in types I to IV, with type I accounting for 53.9%. The FMA phenotypes were less changed if the aMA and rKA were chosen, and the TMA phenotypes were less changed if the AA and rKA were chosen.ConclusionCompared with the CPAK, the functional knee phenotypes were more suitable for the Chinese OA population with a wide distribution and a varus tendency, and it seemed more appropriate to choose aMA and rKA as TKA alignment targets for resection.Level of EvidenceLevel Ⅲ.

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Section: Tka Bone Cut Strategies According To Functional Knee Phenotypesmentioning

confidence: 99%

Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models

Liu,

Lei,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Finalmente, los alineamientos híbridos combinan principios de ambos enfoques sistemáticos y específicos para el paciente. 5,6 Estos métodos apuntan a mantener un ángulo cadera-rodilla dentro de una "zona de seguridad" que varía entre 177 y 183 grados, ofreciendo una solución intermedia que puede adaptarse a las necesidades específicas del paciente.…”

Section: Clasificación De Los Alineamientos Coronales En Prótesis Tot...unclassified

Estrategias de alineamiento en prótesis total de rodilla: La era robótica cambió el juego

Monge,

Figueroa,

Isla

2023

Revista Chilena de Ortopedia y Traumatología

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ResumenLa prótesis total de rodilla es una cirugía ampliamente utilizada en el tratamiento de la gonartrosis moderada y severa, con resultados en general favorables, pero con una controversial tasa de insatisfacción entre los pacientes. Se han estudiado las posibles múltiples causas de esta insatisfacción, tomando mucha fuerza en el último tiempo el debate en torno al tipo de alineamiento utilizado en cirugía protésica de rodilla, sobre todo, considerando el advenimiento y las ventajas que trajo consigo la cirugía robótica. El alineamiento mecánico, se ha considerado a lo largo de los años como el estándar de oro en prótesis de rodilla, pero durante el siglo XXI se han creado nuevas filosofías, muchas de ellas gracias a los avances en cirugía robótica. En el presente trabajo dividiremos los alineamientos en 3 grandes grupos, se comentarán las características generales de cada uno, así como también el enfoque actual utilizado en nuestra institución, donde creemos que la cirugía robótica llegó para cambiar el juego.

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“…The coronal alignment in TKA has gained considerable attention. There are many different alignment principles, such as mechanical alignment (MA), anatomic alignment (AA), restricted kinematic alignment (rKA), adjusted mechanical alignment (aMA), and functional alignment (FA) [ 12 ]. However, sagittal alignment in TKA has been somewhat overlooked.…”

Section: Introductionmentioning

confidence: 99%

Preoperative evaluation of femoral and tibial sagittal alignment in robotic-assisted and conventional total knee arthroplasty and consequences for practice

Peng,

Ding,

et al. 2024

International Orthopaedics (SICOT)

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Purpose Robot-assisted total knee arthroplasty (TKA) was developed to improve the precision and accuracy of implant placement in conventional TKA. However, the angular differences between referenced axes in robot-assisted TKA and conventional TKA remain unclear. The aim of this study was to investigate the angular differences in sagittal alignment between robot-assisted TKA and conventional TKA for both the femur and the tibia and to discuss their clinical implications. Methods We conducted a retrospective analysis of data from 100 patients (97 patients) who underwent computed tomography (CT) for Mako TKA. We measured the angle between the robot femoral axis (RFA) and conventional femoral axis (CFA) in the sagittal plane and the angle between the robot tibial axis (RTA) and the conventional tibial axis (CTA). Angles were compared between the sexes. Correlation analysis was conducted between the angles and height. Results In the sagittal plane, the mean RFA-CFA angle was 2.2° ± 1.6°, and the mean RTA-CTA angle was 2.3° ± 1.6°. There were no significant differences between the two angles among males and females (p > 0.05). There was a correlation between the RFA-CFA angle and RTA-CTA angle (p < 0.001, r = 0.33), and there was a correlation between height and the combination of the RFA-CFA angle and RTA-CTA angle (p = 0.03, r = 0.22). Conclusion There are angular differences between the axes referenced by robot-assisted TKA and those referenced by conventional TKA, which may be influenced by patient height. Correctly understanding these differences is crucial when evaluating the implant position and surgical outcomes after robot-assisted TKA. Furthermore, caution should be taken when assessing the flexion–extension angle of the knee since the angles displayed in the Mako system are different from the angles measured with intramedullary anatomical axes. After all, sagittal alignment principles differ between robot-assisted and conventional TKA; however, further studies are required to determine which principle is more appropriate or to modify these principles.

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Coronal alignment in total knee arthroplasty: a review

Cited by 18 publications

References 49 publications

Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models

Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models

Estrategias de alineamiento en prótesis total de rodilla: La era robótica cambió el juego

Preoperative evaluation of femoral and tibial sagittal alignment in robotic-assisted and conventional total knee arthroplasty and consequences for practice

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