Chen Darren B
Department of Knee Surgery, Sydney Knee Specialists, Sydney, New South Wales, Australia.
J Knee Surg. 2025 Jun;38(7):344-350. doi: 10.1055/s-0044-1795074. Epub 2024 Dec 6.
Total knee arthroplasty (TKA) remains the gold standard surgical care for end-stage knee arthritis. Since its inception, TKA has seen many transformative factors with advances in material properties, implant design, and fixation. Improvements in implant longevity has culminated in TKA being recognized as one of modern medicine's most successful surgical procedures. Patient satisfaction, however, remains a significant challenge. Recent studies report that patient satisfaction with current implants and techniques remains at 80 to 90%, suggesting that up to one in five patients remain dissatisfied with their procedure. A balanced knee, defined as equal medial and lateral gaps in knee extension and flexion, is a desired outcome in TKA. This has been shown to be associated with improved clinical outcomes. Given the poor rate of surgeon-defined balance, intraoperative knee balance can be confirmed with objective load data using sensor-embedded smart inserts or by measuring gaps using computer-assisted or robotic platforms. Currently, there is no consensus on the correct alignment or laxity targets for individualized alignment strategies in TKA, and further research in this area is required to answer this. Tremendous advances in our understanding of knee anatomy and kinematics have come to light in the recent past, and these insights have spawned interest in alternative alignment techniques in TKA. More recently, an appreciation of individual knee phenotypes and associated classification systems have provided a platform and the scientific justification behind these contemporary alignment strategies. Paired with enabling technologies, it is becoming an accepted paradigm that surgeons have the ability to select a desired alignment target when undertaking an individualized alignment strategy in TKA and execute the surgery with a high degree of precision. It is hoped that this may reduce the rate of dissatisfaction following TKA and improve clinical outcomes. This review article provides an overview of the concepts of knee phenotypes, current alignment strategies in TKA, and the emerging benefits of enabling technologies.
全膝关节置换术（TKA）仍然是终末期膝关节炎的金标准手术治疗方法。自其问世以来，随着材料特性、植入物设计和固定技术的进步，TKA经历了许多变革性因素。植入物使用寿命的提高最终使TKA被公认为现代医学最成功的外科手术之一。然而，患者满意度仍然是一个重大挑战。最近的研究报告称，患者对当前植入物和技术的满意度仍在80%至90%之间，这表明多达五分之一的患者对其手术仍不满意。平衡的膝关节，即在膝关节伸展和屈曲时内侧和外侧间隙相等，是TKA期望达到的结果。这已被证明与改善临床结果相关。鉴于外科医生定义的平衡率较低，术中膝关节平衡可以通过使用嵌入传感器的智能插入物获得客观负荷数据或通过使用计算机辅助或机器人平台测量间隙来确认。目前，对于TKA中个体化对线策略的正确对线或松弛度目标尚无共识，该领域需要进一步研究来回答这一问题。最近，我们对膝关节解剖学和运动学的理解有了巨大进展，这些见解引发了人们对TKA中替代对线技术的兴趣。最近，对个体膝关节表型及相关分类系统的认识为这些当代对线策略提供了一个平台和科学依据。与使能技术相结合，外科医生在TKA中采用个体化对线策略时能够选择期望的对线目标并以高度精确性实施手术，这正成为一种被接受的范式。希望这可能会降低TKA后的不满意率并改善临床结果。这篇综述文章概述了膝关节表型的概念、TKA当前的对线策略以及使能技术的新益处。
