Sterneder Christian Manuel, Faschingbauer Martin, Haralambiev Lyubomir, Kasparek Maximilian F, Boettner Friedrich
Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
J Clin Med. 2024 Feb 25;13(5):1302. doi: 10.3390/jcm13051302.
There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient's native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1-2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis.
关于全膝关节置换术（TKA）中最佳对线策略存在争议。机械对线（MA）目标结合必要的软组织松解是终末期外翻骨关节炎TKA的金标准。一些作者提倡采用运动学对线（KA），目的是恢复患者的自然对线并尽量减少软组织松解的需求。我们之前的研究表明，标准化软组织松解的MA能产生可重复的结果，并且术前表型不影响外翻骨关节炎患者的结果。这些数据表明，对于外翻骨关节炎患者，保留外翻对线没有功能上的优势。许多外翻骨关节炎患者存在内侧副韧带受损的情况，使膝关节处于外翻状态可能会增加继发性不稳定的风险。当前文献支持以软组织松解的MA TKA作为金标准。虽然使用更先进的辅助技术如机器人手术可能允许在股骨侧瞄准非常轻微（1-2°）的外翻对线，但应避免超出此范围的任何外翻对线。这篇综述文章总结了我们目前关于外翻骨关节炎患者TKA手术技术的知识。
