Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society

Abstract

Although hip and knee joint replacements provide excellent clinical results, many patients still do not report the sensation and function of a natural joint. The perception that the joint is artificial may result from the anatomical modifications imposed by the surgical technique and the implant design. Moreover, the joint replacement material may not function similarly to human tissues. To restore native joint kinematics, function, and perception, three key elements play a role: (i) joint morphology (articular surface geometry, bony anatomy, etc.), (ii) lower limb anatomy (alignment, joint orientation), and (iii) soft tissue laxity/tension. To provide a ‘forgotten joint’ to most patients, it is becoming clear that personalizing joint replacement is the key solution. Performing a personalized joint replacement starts with patient selection and preoperative optimization, followed by using a surgical technique and implant design aimed at restoring the patient’s native anatomy, creating optimal implant-to-bone stress transfer, restoring the joint’s native articular range of motion without imposed limitations, macro- and micro-stability of the soft tissues, and a bearing whose wear resistance provides lifetime survivorship with unrestricted activities. In addition, the whole perioperative experience should follow enhanced recovery after surgery principles, favoring a rapid and complication-free recovery. As a new concept, some confusion may arise when applying these personalized surgery principles. Therefore, the Personalized Arthroplasty Society was created to help structure and accelerate the adoption of this paradigm change. This statement from the Society on personalized arthroplasty will serve as a reference that will evolve with time.

Morphological analysis of patellofemoral joint in haemophilic arthropathy: A case‐control study

“…28,29 Recognising the limitations of current implant designs in adequately restoring the anterior femoral anatomy, 30 it is predictable to anticipate that haemophilic arthropathies will also receive their share of the personalised surgical approach in the future. 31 One of the most striking data we found in our study were that the intercondylar depth decreased in the haemophilic group. The intercondylar bone is one of the main elements that provide mechanical support to the implant in total knee arthroplasty surgery, and the decrease in the volume of this area can be interpreted as less bone stock to support the implant.…”

Definition of normal, neutral, deviant and aberrant coronal knee alignment for total knee arthroplasty

“…Personalised medicine has arrived in total knee arthroplasty (TKA) [1,2]. Personalised alignment methods such as kinematic alignment, functional alignment and customised patient specific TKA are intensively debated at meetings and in the current literature [3][4][5][6][7][8][9][10][11].…”

Navigating the Divide: A Comprehensive Review of the Mechanical and Anatomical Axis Approaches in Total Knee Replacement

“…Patient-specific implants represent a significant advancement in personalized medicine within TKR, aiming to enhance the accuracy of implant placement and alignment. These systems utilize preoperative imaging to create customized surgical guides and implants tailored to each patient's anatomy to restore the native knee anatomy and physiological soft-tissue laxity [48,49]. By replicating the unique knee geometry of individuals, which can vary by factors such as gender, ethnicity, and body type, personalized implants offer potential advantages.…”

“…Precision medicine in alignment strategies for TKR seeks to restore the native knee anatomy and accommodate the natural variability of knee phenotypes [48,49]. Utilizing personalized surgical guides, implants, and adjuncts like robotic technology can enhance the precision of implant placement and alignment [51].…”