Lee Yong Seuk, Howell Stephen M, Won Ye-Yeon, Lee O-Sung, Lee Seung Hoon, Vahedi Hamed, Teo Seow Hui
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, South Korea.
Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3467-3479. doi: 10.1007/s00167-017-4558-y. Epub 2017 Apr 24.
A systematic review was conducted to answer the following questions: (1) Does kinematically aligned (KA) total knee arthroplasty (TKA) achieve clinical outcomes comparable to those of mechanically aligned (MA) TKA? (2) How do the limb, knee, and component alignments differ between KA and MA TKA? (3) How is joint line orientation angle (JLOA) changed from the native knee in KA TKA compared to that in MA TKA?
Nine full-text articles in English that reported the clinical and radiological outcomes of KA TKA were included. Five studies had a control group of patients who underwent MA TKA. Data on patient demographics, clinical scores, and radiological results were extracted. There were two level I, one level II, three level III, and three level IV studies. Six of the nine studies used patient-specific instrumentation, one study used computer navigation, and two studies used manual instrumentation.
The clinical outcomes of KA TKA were comparable or superior to those of MA TKA with a minimum 2-year follow-up. Limb and knee alignment in KA TKA was similar to those in MA TKA, and component alignment showed slightly more varus in the tibial component and slightly more valgus in the femoral component. The JLOA in KA TKA was relatively parallel to the floor compared to that in the native knee and not oblique (medial side up and lateral side down) compared to that in MA TKA. The implant survivorship and complication rate of the KA TKA were similar to those of the MA TKA.
Similar or better clinical outcomes were produced by using a KA TKA at early-term follow-up and the component alignment differed from that of MA TKA. KA TKA seemed to restore function without catastrophic failure regardless of the alignment category up to midterm follow-up. The JLOA in KA TKA was relatively parallel to the floor similar to the native knee compared to that in MA TKA. The present review of nine published studies suggests that relatively new kinematic alignment is an acceptable and alternative alignment to mechanical alignment, which is better understood. Further validation of these findings requires more randomized clinical trials with longer follow-up.
Level II.
进行一项系统评价以回答以下问题：（1）运动学对线全膝关节置换术（TKA）的临床疗效是否与机械学对线TKA相当？（2）运动学对线与机械学对线TKA在肢体、膝关节及假体组件对线方面有何差异？（3）与机械学对线TKA相比，运动学对线TKA中关节线方向角（JLOA）相对于原生膝关节有何变化？
纳入9篇报道运动学对线TKA临床和影像学结果的英文全文文章。5项研究有接受机械学对线TKA的患者作为对照组。提取患者人口统计学、临床评分及影像学结果的数据。有2项I级研究、1项II级研究、3项III级研究和3项IV级研究。9项研究中有6项使用定制器械，1项研究使用计算机导航，2项研究使用手工器械。
至少2年随访时，运动学对线TKA的临床疗效与机械学对线TKA相当或更优。运动学对线TKA的肢体和膝关节对线与机械学对线TKA相似，假体组件对线显示胫骨组件稍内翻更多，股骨组件稍外翻更多。与原生膝关节相比，运动学对线TKA的JLOA相对平行于地面，与机械学对线TKA相比不呈倾斜（内侧向上、外侧向下）。运动学对线TKA的假体生存率和并发症发生率与机械学对线TKA相似。
早期随访时使用运动学对线TKA可产生相似或更好的临床疗效，且假体组件对线与机械学对线TKA不同。运动学对线TKA似乎能恢复功能且无灾难性失败，直至中期随访时无论对线类别如何。与机械学对线TKA相比，运动学对线TKA的JLOA相对平行于地面，与原生膝关节相似。对9项已发表研究的本综述表明，相对较新的运动学对线是机械学对线的一种可接受的替代对线方式，而机械学对线已被更好地理解。这些发现的进一步验证需要更多随访时间更长的随机临床试验。
II级。
