Lustig Sébastien, Sappey-Marinier Elliot, Fary Camdon, Servien Elvire, Parratte Sébastien, Batailler Cécile
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France - Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France.
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France.
SICOT J. 2021;7:19. doi: 10.1051/sicotj/2021021. Epub 2021 Mar 26.
Traditionally in total knee arthroplasty (TKA), a post-operative neutral alignment was the gold standard. This principle has been contested as functional outcomes were found to be inconsistent. Analysis of limb alignment in the non-osteoarthritic population reveals variations from neutral alignment and consideration of a personalized or patient-specific alignment in TKA is challenging previous concepts. The aim of this review was to clarify the variations of current personalized alignments and to report their results. Current personalized approaches of alignment reported are: kinematic, inverse kinematic, restricted kinematic, and functional. The principle of "kinematic alignment" is knee resurfacing with restitution of pre-arthritic anatomy. The aim is to resurface the femur maintaining the native femoral joint line obliquity. The flexion and extension gaps are balanced with the tibial resection. The principle of the "inverse kinematic alignment" is to resurface the tibia with similar medial and lateral bone resections in order to keep the native tibial joint line obliquity. Gap balancing is performed by adjusting the femoral resections. To avoid reproducing extreme anatomical alignments there is "restricted kinematic alignment" which is a compromise between mechanical alignment and true kinematic alignment with a defined safe zone of alignment. Finally, there is the concept of "functional alignment" which is an evolution of kinematic alignment as enabling technology has progressed. This is obtained by manipulating alignment, bone resections, soft tissue releases, and/or implant positioning with a robotic-assisted system to optimize TKA function for a patient's specific alignment, bone morphology, and soft tissue envelope. The aim of personalizing alignment is to restore native knee kinematics and improve functional outcomes after TKA. A long-term follow-up remains crucial to assess both outcomes and implant survivorship of these current concepts.
传统上，在全膝关节置换术（TKA）中，术后中立位对线是金标准。随着发现功能结果不一致，这一原则受到了质疑。对非骨关节炎人群肢体对线的分析揭示了与中立位对线的差异，并且在TKA中考虑个性化或患者特异性对线正在挑战以往的概念。本综述的目的是阐明当前个性化对线的差异并报告其结果。目前报道的个性化对线方法有：运动学对线、逆向运动学对线、受限运动学对线和功能对线。“运动学对线”的原则是通过恢复关节炎前的解剖结构来进行膝关节表面置换。目的是在保留股骨自然关节线倾斜度的情况下对股骨进行表面置换。通过胫骨截骨来平衡屈伸间隙。“逆向运动学对线”的原则是通过类似的内外侧骨切除来对胫骨进行表面置换，以保持胫骨自然关节线倾斜度。通过调整股骨截骨来进行间隙平衡。为避免重现极端的解剖学对线，存在“受限运动学对线”，它是机械对线和真正运动学对线之间的折衷，具有定义的安全对线区域。最后，还有“功能对线”的概念，随着使能技术的进步，它是运动学对线的演变。这是通过使用机器人辅助系统操纵对线、骨切除、软组织松解和/或植入物定位来实现的，以针对患者的特定对线、骨形态和软组织包膜优化TKA功能。个性化对线的目的是恢复膝关节的自然运动学并改善TKA后的功能结果。长期随访对于评估这些当前概念的结果和植入物生存率仍然至关重要。
