Aflatooni Justin O, Wininger Austin E, Park Kwan J, Incavo Stephen J
Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX, United States.
Front Surg. 2023 Feb 9;10:1106608. doi: 10.3389/fsurg.2023.1106608. eCollection 2023.
Total knee arthroplasty is one of the most widely performed surgical procedures today. Its widespread popularity has helped drive innovation and improvement in the field. Different schools of thought have developed regarding the best way to perform this operation. Specifically, there are controversaries regarding the best alignment philosophy for the femoral and tibial components to optimize implant stability and longevity. Traditionally, neutral mechanical alignment has been the preferred alignment target. More recently, some surgeons advocate for alignment matching the patient's pre-arthritic anatomic alignment ("physiologic" varus or valgus), which has been described as kinematic alignment. Functional alignment is a hybrid technique that focuses on the coronal plane minimizing soft tissue releases. To date, there is no evidence demonstrating superiority of one method over another. There is growing popularity of robotic surgical techniques to improve accuracy of implant position and alignment. The choice of alignment philosophy is an important aspect of robotic assisted TKA surgery and has the potential to clarify the optimal alignment technique.
全膝关节置换术是当今实施最为广泛的外科手术之一。其广泛应用推动了该领域的创新与进步。关于实施该手术的最佳方式，已形成了不同的学派观点。具体而言，在股骨和胫骨组件的最佳对线理念上存在争议，目的是优化植入物的稳定性和使用寿命。传统上，中立机械对线一直是首选的对线目标。最近，一些外科医生主张采用与患者关节炎前解剖对线（“生理性”内翻或外翻）相匹配的对线方式，即所谓的运动学对线。功能对线是一种混合技术，专注于冠状面，尽量减少软组织松解。迄今为止，尚无证据表明一种方法优于另一种方法。机器人手术技术越来越受欢迎，以提高植入物位置和对线的准确性。对线理念的选择是机器人辅助全膝关节置换手术的一个重要方面，有可能阐明最佳的对线技术。
