Current concept of kinematic alignment total knee arthroplasty and its derivatives
The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed b...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-05-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.35.BJO-2022-0021.R2 |
| _version_ | 1811218975332237312 |
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| author | Takafumi Hiranaka Yoshihito Suda Akira Saitoh Atsuki Tanaka Akihiko Arimoto Motoki Koide Takaaki Fujishiro Koji Okamoto |
| author_facet | Takafumi Hiranaka Yoshihito Suda Akira Saitoh Atsuki Tanaka Akihiko Arimoto Motoki Koide Takaaki Fujishiro Koji Okamoto |
| author_sort | Takafumi Hiranaka |
| collection | DOAJ |
| description | The kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA, the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered ‘alignment outliers’ in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients’ own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients’ own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal. |
| first_indexed | 2024-04-12T07:18:05Z |
| format | Article |
| id | doaj.art-24174dc8634245efb8c1f553b20a2ed3 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-04-12T07:18:05Z |
| publishDate | 2022-05-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-24174dc8634245efb8c1f553b20a2ed32022-12-22T03:42:25ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-05-013539039710.1302/2633-1462.35.BJO-2022-0021.R2Current concept of kinematic alignment total knee arthroplasty and its derivativesTakafumi Hiranaka0Yoshihito Suda1Akira Saitoh2Atsuki Tanaka3Akihiko Arimoto4Motoki Koide5Takaaki Fujishiro6Koji Okamoto7Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanDepartment of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, JapanThe kinematic alignment (KA) approach to total knee arthroplasty (TKA) has recently increased in popularity. Accordingly, a number of derivatives have arisen and have caused confusion. Clarification is therefore needed for a better understanding of KA-TKA. Calipered (or true, pure) KA is performed by cutting the bone parallel to the articular surface, compensating for cartilage wear. In soft-tissue respecting KA, the tibial cutting surface is decided parallel to the femoral cutting surface (or trial component) with in-line traction. These approaches are categorized as unrestricted KA because there is no consideration of leg alignment or component orientation. Restricted KA is an approach where the periarthritic joint surface is replicated within a safe range, due to concerns about extreme alignments that have been considered ‘alignment outliers’ in the neutral mechanical alignment approach. More recently, functional alignment and inverse kinematic alignment have been advocated, where bone cuts are made following intraoperative planning, using intraoperative measurements acquired with computer assistance to fulfill good coordination of soft-tissue balance and alignment. The KA-TKA approach aims to restore the patients’ own harmony of three knee elements (morphology, soft-tissue balance, and alignment) and eventually the patients’ own kinematics. The respective approaches start from different points corresponding to one of the elements, yet each aim for the same goal, although the existing implants and techniques have not yet perfectly fulfilled that goal.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.35.BJO-2022-0021.R2kneetreatmentarthroplastyalignmentsoft-tissuemechanicalkinematictotal knee arthroplasty (tka)kneeskinematicssoft-tissue balancingsoft-tissuetibial cuttingcartilagetibial componentstibial bonefemur |
| spellingShingle | Takafumi Hiranaka Yoshihito Suda Akira Saitoh Atsuki Tanaka Akihiko Arimoto Motoki Koide Takaaki Fujishiro Koji Okamoto Current concept of kinematic alignment total knee arthroplasty and its derivatives Bone & Joint Open knee treatment arthroplasty alignment soft-tissue mechanical kinematic total knee arthroplasty (tka) knees kinematics soft-tissue balancing soft-tissue tibial cutting cartilage tibial components tibial bone femur |
| title | Current concept of kinematic alignment total knee arthroplasty and its derivatives |
| title_full | Current concept of kinematic alignment total knee arthroplasty and its derivatives |
| title_fullStr | Current concept of kinematic alignment total knee arthroplasty and its derivatives |
| title_full_unstemmed | Current concept of kinematic alignment total knee arthroplasty and its derivatives |
| title_short | Current concept of kinematic alignment total knee arthroplasty and its derivatives |
| title_sort | current concept of kinematic alignment total knee arthroplasty and its derivatives |
| topic | knee treatment arthroplasty alignment soft-tissue mechanical kinematic total knee arthroplasty (tka) knees kinematics soft-tissue balancing soft-tissue tibial cutting cartilage tibial components tibial bone femur |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.35.BJO-2022-0021.R2 |
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