Davis Kyle R, Soti Varun
Orthopedic Surgery, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Cureus. 2024 Jan 30;16(1):e53230. doi: 10.7759/cureus.53230. eCollection 2024 Jan.
Knee osteoarthritis (OA) is surgically treated with total knee arthroplasty (TKA). Traditionally, TKA has been performed using a mechanical alignment (MA) philosophy. However, due to significant patient dissatisfaction with surgical outcomes, an alternate alignment approach, kinematic alignment (KA), has gained popularity. KA-TKAs have improved functional patient outcomes by restoring the patient's native joint line orientation and minimizing soft tissue releases compared to neutral alignment in MA-TKAs. This review explores the postoperative effectiveness of utilizing KA-TKA to treat knee OA in patients with preoperative varus and valgus deformities. A comprehensive literature search was conducted on PubMed and Biomed Central databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search focused on studies analyzing the postoperative TKA outcomes in knee OA patients with preoperative varus or valgus deformities whose surgeries followed a KA philosophy and those comparing KA-TKA with MA-TKA. The available clinical evidence indicates that KA-TKA can be a viable treatment option for individuals with knee OA. The alignment of phenotypes has little clinical significance concerning functional outcomes and implant survival rates following KA-TKA. Furthermore, surgery outcomes in patients with preoperative deformities who underwent KA-TKA were similar to those who underwent MA-TKA. KA-TKA produced significantly better functional outcomes than MA-TKA in certain aspects. However, studies with larger sample sizes and more extended follow-up periods that directly compare KA-TKA with MA-TKA in treating knee OA patients are needed to fully demonstrate the efficacy of each technique. Furthermore, further research into the effects of KA-TKA on implant survival rates will provide a better understanding of the benefits of this technique and ultimately lead to improved patient outcomes.
膝关节骨关节炎(OA)通过全膝关节置换术(TKA)进行手术治疗。传统上,TKA一直采用机械对线(MA)理念进行。然而,由于患者对手术结果的显著不满,一种替代的对线方法——运动学对线(KA)受到了欢迎。与MA-TKA中的中立对线相比,KA-TKA通过恢复患者的天然关节线方向并尽量减少软组织松解,改善了患者的功能结局。本综述探讨了利用KA-TKA治疗术前存在内翻和外翻畸形的膝关节OA患者的术后有效性。按照系统评价和Meta分析的首选报告项目(PRISMA)指南,在PubMed和生物医学中心数据库上进行了全面的文献检索。文献检索集中于分析遵循KA理念进行手术的术前存在内翻或外翻畸形的膝关节OA患者的术后TKA结局的研究,以及比较KA-TKA与MA-TKA的研究。现有临床证据表明,KA-TKA对于膝关节OA患者可能是一种可行的治疗选择。在KA-TKA后,表型的对线在功能结局和植入物生存率方面几乎没有临床意义。此外,接受KA-TKA的术前畸形患者的手术结果与接受MA-TKA的患者相似。在某些方面,KA-TKA产生的功能结局明显优于MA-TKA。然而,需要更大样本量和更长随访期的研究来直接比较KA-TKA与MA-TKA在治疗膝关节OA患者中的疗效,以充分证明每种技术的有效性。此外,对KA-TKA对植入物生存率影响的进一步研究将有助于更好地理解该技术的益处,并最终改善患者结局。