Published in
N°014 - November / December 2021
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Patient specific alignment and balancing with computer assisted surgery in total knee arthroplasty
By Simon MARMOR, Thomas AUBERT in category SURGICAL TECHNIQUE
Hospital Group Diaconesses Croix Saint Simon 125 rue Avron - 75020 Paris, France
Introduction
A successful knee replacement depends on a complex equation incorporating numerous variables, some relating to the patient, some to the implant, and others to the surgical technique. Surgeons have yet to fully master all of these variables,[1,2] which is most certainly the reason why there is still room for improvement when it comes to unsatisfied patient outcomes.
Traditionally, neutral alignment (hip knee angle (HKA) 177°–183°) was the target for good functional outcome, in particular of improved survivorship. Technically, the only way this goal could be achieved was by making distal femur and proximal tibia cuts perpendicular to the mechanical axis and using ligament releases to maintain satisfactory stability and compensate for the unnatural changes to the native knee anatomy.
In recent years, the debate surrounding this dogma of neutral alignment has been heating up because long-term analysis has in fact revealed no difference in terms of implant survival and functional outcomes between implants that were normally aligned and those that were outside the normal range (outliers > 3°).[1,3,4] At the same time, numerous different alignment strategies have emerged (adjusted mechanical, functional and kinematic)[5], which are personalized and leave a non-neutral...
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