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Adjusted mechanical alignment to achieve a well-balanced knee with less soft tissue releases: Surgical tips and tricks for a modified “extension gap first technique” in TKA

Published in N° 003 - September / October 2019
Article viewed 112 times

Adjusted mechanical alignment to achieve a well-balanced knee with less soft tissue releases: Surgical tips and tricks for a modified “extension gap first technique” in TKA

By Hagen Hommel (1,2), Peter Fennema (3) in category
(1). KH-MOL GmbH Sonnenburger Weg 3, 16269 Wriezen, Germany (2). Medizinische Hochschule Brandenburg (MHB), Theodor Fontane, Fehrbelliner Straße 38, 16816 Neuruppin, Germany - (3). AMR Advanced Medical Research GmbH, Hofenstrasse 89b, 8708 Männedorf, Switzerland / Email: [email protected]

In total knee arthroplasty (TKA), one of the primary goals has been a well-balanced stable knee with a neutrally aligned lower limb because this has been considered to be necessary for positive clinical outcomes and implant survivorship.

Introduction

In total knee arthroplasty (TKA), one of the primary goals has been a well-balanced stable knee with a neutrally aligned lower limb because this has been considered to be necessary for positive clinical outcomes and implant survivorship [1]. Mechanical alignment (MA) technique for TKA aims to systematically create a “biomechanically friendly prosthetic knee” rather than restore the constitutional patient-specific anatomy [1,2]. MA technique has three aims. The first aim is to create a neutral frontal limb mechanical axis with the femorotibial joint line perpendicular to this mechanical axis. The second aim is to align the femoral component parallel to the trans-epicondylar axis (TEA) in the axial plane. Third, the MA technique aims to align the extensor mechanism to the components in all three planes [3]. It has been recommended that this implant positioning prevents patella instability and maltracking, early implant loosening and accelerated polyethylene wear because it generates less and more-evenly-distributed stress inside the joint and at the bony interfaces [1]. This concept aims for a “systematic target” rather than a restoration of the patient anatomy, and it can therefore be defined as the “systematic approach for TKA implantation” [1].

Although MA...

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