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The “functional knee phenotype concept” and its impact on the controversy of proper frontal alignment in TKA

Published in N°010 - March / April 2021
Article viewed 11 times

The “functional knee phenotype concept” and its impact on the controversy of proper frontal alignment in TKA

By Silvan Hess(1,2,3), Emma-Louise Robertson(2), Lukas B. Moser(4), Michael T. Hirschmann(2,5) in category UPDATE
(1) Department of Surgery and Traumatology, Kantonsspital Graubünden, 7000 Chur, Switzerland - (2) Department of Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland - (3) University of Bern, 3012 Bern, Switzerland - (4) Universitätsklinikum Krems, 3500 Krems, Austria - (5) University of Basel. 4001 Basel, Switzerland

Despite the general acceptance of TKA as the treatment of choice in end stage osteoarthritis, the best method of performing a TKA is still under debate. The optimal implant alignment is only one topic among many others, but it has increasingly gained attention for many knee surgeons.

Introduction

Despite the general acceptance of TKA as the treatment of choice in end stage osteoarthritis, the best method of performing a TKA is still under debate. The optimal implant alignment is only one topic among many others, but it has increasingly gained attention for many knee surgeons (1). Currently there are at least five different alignment concepts promoted, which have led to some confusion among knee surgeons as differences between these concepts are often not understood well enough (2) (Figure 1). Currently there is no evidence that one of these concepts will be more beneficial for the patient with regards to the functional outcome or long-term survival.

Figure 1: Different Alignment Options for TKA

 

Recent papers proved that there is a very wide anatomical variation in the deformity of the knee in the young non-osteoarthritic knees planned for TKA (3–8). The concept of “deformity analysis” to investigate this broad variation has been described by D. Paley more than 20 years ago for osteotomies (9). However, this simple analysis on full leg films has unfortunately not been widely used by knee surgeons for their TKA planning (9). On the other hand, this deformity analysis builds the foundation for computer navigation, patient specific cutting blocks and...

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