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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 98 -105. doi: 10.3877/cma.j.issn.1674-134X.2023.01.014

综述

全膝关节置换术下肢对线的研究进展
闫自晓1, 王俏杰1, 张先龙1,†()   
  1. 1. 200233　上海交通大学医学院附属第六人民医院骨科
  • 收稿日期:2022-07-22 出版日期:2023-02-01
  • 通信作者: 张先龙

Research progerss in lower limb alignment for total knee arthroplasty

Zixiao Yan1, Qiaojie Wang1, Xianlong Zhang1,†()   

  1. 1. Department of Orthopedics, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital, Shanghai 200233, China
  • Received:2022-07-22 Published:2023-02-01
  • Corresponding author: Xianlong Zhang
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闫自晓, 王俏杰, 张先龙. 全膝关节置换术下肢对线的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(01): 98-105.

Zixiao Yan, Qiaojie Wang, Xianlong Zhang. Research progerss in lower limb alignment for total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 98-105.

全膝关节置换术(TKA)是骨科中最具有成本效益的手术之一，被广泛认为是治疗有症状的终末期膝关节骨关节炎的金标准。现阶段机械轴对线是TKA中应用最为广泛的一种下肢对线方式。然而，大约只有80%的患者对该手术表示满意。随着技术的发展，假体的设计和手术的精度都有所改进，但TKA的临床及功能结果并没有明显改善。因此，外科医生提出了多种个性化的对线方法，如改良机械轴对线、解剖学对线、运动学对线、限制性运动学对线、反运动学对线、功能性对线以及边界性中立位对线等，并希望通过对比不同对线方式的临床及功能结果，找到最佳对线方式，从而提高患者满意度。本文对现阶段以上几种对线理念及其对比研究结果进行了阐述。

关键词: 膝, 膝关节, 骨关节炎, 关节成形术，置换, 解剖学

Total knee arthroplasty (TKA) is one of the most cost-effective procedures in orthopaedics and is widely considered the gold standard for the treatment of symptomatic end-stage knee osteoarthritis. At present, mechanical alignment is the most widely used method for lower limb alignment in TKA. However, only about 80% of patients are satisfied with the mechanical alignment.With the development of technologies, the prosthesis design and operation accuracy have been improved, but the clinical and functional outcomes of TKA have not been improved significantly. Therefore, more surgeons start seek individualised alignment methods, such as adjusted mechanical alignment, anatomical alignment, kinematic alignment, restricted kinematic alignment, inverse kinematic alignment, functional alignment, and neutral boundary alignment, and hope to improve patient satisfaction by comparing the clinical and functional outcomes of different alignment methods and seeking the optimal alignment. This paper elaborated on the alignment concepts and the comparative studies.

Key words: Knee, Knee joint, Osteoarthritis, Arthroplasty, replacement, Anatomy
[1]
Price AJ, Alvand A, Troelsen A, et al. Knee replacement[J]. Lancet, 2018, 392(10158): 1672－1682.
[2]
边焱焱，程开源，常晓，等. 2011至2019年中国人工髋膝关节置换手术量的初步统计与分析[J]. 中华骨科杂志，2020(21): 1453－1460.
[3]
Gunaratne R, Pratt DN, Banda J, et al. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature[J]. J Arthroplasty, 2017, 32(12): 3854－3860.
[4]
Vaidya NV, Deshpande AN, Panjwani T, et al. Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 621－626.
[5]
van der List JP, Chawla H, Joskowicz L, et al. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(11): 3482－3495.
[6]
Bautista M, Manrique J, Hozack WJ. Robotics in total knee arthroplasty[J]. J Knee Surg, 2019, 32(7): 600－606.
[7]
Kayani B, Konan S, Ayuob A, et al. Robotic technology in total knee arthroplasty: a systematic review[J]. EFORT Open Rev, 2019, 4(10): 611－617.
[8]
Rivière C, Vigdorchik JM, Vendittoli PA. Mechanical alignment: the end of an era！[J]. Orthop Traumatol Surg Res, 2019, 105(7): 1223－1226.
[9]
Freeman MA, Swanson SA, Todd RC. Total replacement of the knee using the Freeman-Swanson knee prosthesis[J]. Clin Orthop Relat Res, 1973(94): 153－170.
[10]
Scuderi GR, Scott WN, Tchejeyan GH. The Insall legacy in total knee arthroplasty[J]. Clin Orthop Relat Res, 2001(392): 3－14.
[11]
Hirschmann MT, Becker R, Tandogan R, et al. Alignment in TKA: what has been clear is not anymore！[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2037－2039.
[12]
Rivière C, Villet L, Jeremic D, et al. What You need to know about kinematic alignment for total knee arthroplasty[J/OL]. Orthop Traumatol Surg Res, 2021, 107(1S): 102773. DOI: 10.1016/j.otsr.2020.102773.
[13]
Tew M, Waugh W. Tibiofemoral alignment and the results of knee replacement[J]. J Bone Joint Surg Br, 1985, 67(4): 551－556.
[14]
Bonner TJ, Eardley WG, Patterson P, et al. The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years[J]. J Bone Joint Surg Br, 2011, 93(9): 1217－1222.
[15]
Blakeney W, Beaulieu Y, Puliero B, et al. Bone resection for mechanically aligned total knee arthroplasty creates frequent gap modifications and imbalances[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(5): 1532－1541.
[16]
Moser LB, Hess S, Amsler F, et al. Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5): 1359－1367.
[17]
Bellemans J, Colyn W, Vandenneucker H, et al. The chitranjan ranawat award: is neutral mechanical alignment normal for all patients？：the concept of constitutional Varus[J]. Clin Orthop Relat Res, 2012, 470(1): 45－53.
[18]
Vendittoli PA, Blakeney W. Redefining knee replacement[J]. Orthop Traumatol Surg Res, 2017, 103(7): 977－979.
[19]
Rivière C, Iranpour F, Auvinet E, et al. Mechanical alignment technique for TKA: are there intrinsic technical limitations？[J]. Orthop Traumatol Surg Res, 2017, 103(7): 1057－1067.
[20]
Hunt NC, Ghosh KM, Athwal KK, et al. Lack of evidence to support present medial release methods in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 3100－3112.
[21]
Vanlommel L, Vanlommel J, Claes S, et al. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2325－2330.
[22]
Hommel H, Tsamassiotis S, Falk R, et al. Adjusted mechanical alignment: operative technique-tips and tricks[J]. Orthopade, 2020, 49(7): 562－569.
[23]
de Grave PW, Luyckx T, Claeys K, et al. Higher satisfaction after total knee arthroplasty using restricted inverse kinematic alignment compared to adjusted mechanical alignment[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 488－499.
[24]
Hommel H, Perka C, Pfitzner T. Preliminary results of a new surgical technique in total knee arthroplasty (TKA) using the native ligament tension for femoral implant positioning in varus osteoarthritis[J]. Arch Orthop Trauma Surg, 2016, 136(7): 991－997.
[25]
Hungerford DS, Krackow KA. Total joint arthroplasty of the knee[J]. Clin Orthop Relat Res, 1985(192): 23－33.
[26]
Romero J, Duronio JF, Sohrabi A, et al. Varus and valgus flexion laxity of total knee alignment methods in loaded cadaveric knees[J]. Clin Orthop Relat Res, 2002(394): 243－253.
[27]
Townley CO. The anatomic total knee resurfacing arthroplasty[J]. Clin Orthop Relat Res, 1985(192): 82－96.
[28]
Yim JH, Song EK, Khan MS, et al. A comparison of classical and anatomical total knee alignment methods in robotic total knee arthroplasty: classical and anatomical knee alignment methods in TKA[J]. J Arthroplasty, 2013, 28(6): 932－937.
[29]
Mugnai R, Digennaro V, Ensini A, et al. Can TKA design affect the clinical outcome? Comparison between two guided-motion systems[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 581－589.
[30]
Maag C, Cracaoanu I, Langhorn J, et al. Total knee replacement wear during simulated gait with mechanical and anatomic alignments[J]. Proc Inst Mech Eng H, 2021, 235(5): 515－522.
[31]
Howell SM, Kuznik K, Hull ML, et al. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients[J]. Orthopedics, 2008, 31(9): 857－863.
[32]
Lustig S, Sappey-Marinier E, Fary C, et al. Personalized alignment in total knee arthroplasty: current concepts[J/OL]. SICOT J, 2021, 7: 19. DOI: 10.1051/sicotj/2021021.
[33]
Rivière C, Iranpour F, Auvinet E, et al. Alignment options for total knee arthroplasty: a systematic review[J]. Orthop Traumatol Surg Res, 2017, 103(7): 1047－1056.
[34]
Maderbacher G, Keshmiri A, Krieg B, et al. Kinematic component alignment in total knee arthroplasty leads to better restoration of natural tibiofemoral kinematics compared to mechanic alignment[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5): 1427－1433.
[35]
Matsumoto T, Takayama K, Ishida K, et al. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty[J]. Bone Joint J, 2017, 99－B(5): 640－646.
[36]
Nakajima A, Sonobe M, Akatsu Y, et al. Association between limb alignment and patient-reported outcomes after total knee arthroplasty using an implant that reproduces anatomical geometry[J/OL]. J Orthop Surg Res, 2018, 13(1): 320. DOI: 10.1186/s13018-018-1030-8.
[37]
Young SW, Sullivan NPT, Walker ML, et al. No difference in 5-year clinical or radiographic outcomes between kinematic and mechanical alignment in TKA: a randomized controlled trial[J]. Clin Orthop Relat Res, 2020, 478(6): 1271－1279.
[38]
McEwen PJ, Dlaska CE, Jovanovic IA, et al. Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery[J]. J Arthroplasty, 2020, 35(2): 443－450.
[39]
Luan C, Xu DT, Chen NJ, et al. How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients？[J/OL]. BMC Musculoskelet Disord, 2020, 21(1): 443. DOI: 10.1186/s12891-020-03472-2.
[40]
Young SW, Walker ML, Bayan, et al. The chitranjan S. ranawat award: no difference in 2-year functional outcomes using kinematic versus mechanical alignment in TKA: a randomized controlled clinical trial[J]. Clin Orthop Relat Res, 2017, 475(1): 9－20.
[41]
Waterson HB, Clement ND, Eyres KS, et al. The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial[J]. Bone Joint J, 2016, 98－B(10): 1360－1368.
[42]
Calliess T, Bauer K, Stukenborg-Colsman C, et al. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(6): 1743－1748.
[43]
Dossett HG, Estrada NA, Swartz GJ, et al. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results[J]. Bone Joint J, 2014, 96－B(7): 907－913.
[44]
Dossett HG, Swartz GJ, Estrada NA, et al. Kinematically versus mechanically aligned total knee arthroplasty[J/OL]. Orthopedics, 2012, 35(2): e160－e169. DOI: 10.3928/01477447-20120123-04.
[45]
马德思，王志为，温亮，等. 运动学及机械对线全膝关节置换术早期临床结果对比[J/CD]. 中华关节外科杂志(电子版), 2021, 15(2): 163－170.
[46]
Lee YS, Howell SM, Won YY, et al. Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3467－3479.
[47]
Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee arthroplasty: a meta-analysis of the literature[J]. J Arthroplasty, 2017, 32(6): 2028－2032.e1.
[48]
Woon JTK, Zeng ISL, Calliess T, et al. Outcome of kinematic alignment using patient-specific instrumentation versus mechanical alignment in TKA: a meta-analysis and subgroup analysis of randomised trials[J]. Arch Orthop Trauma Surg, 2018, 138(9): 1293－1303.
[49]
Almaawi AM, Hutt JRB, Masse V, et al. The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty[J]. J Arthroplasty, 2017, 32(7): 2133－2140.
[50]
Scanlon CM, Sun DQ, Alvarez AM, et al. In kinematically aligned total knee arthroplasty, failure to recreate native tibial alignment is associated with early revision[J]. J Arthroplasty, 2020, 35(11): 3166－3171.
[51]
Berend ME, Ritter MA, Meding JB, et al. Tibial component failure mechanisms in total knee arthroplasty[J]. Clin Orthop Relat Res, 2004(428): 26－34.
[52]
Huber K, Christen B, Calliess S, et al. True kinematic alignment is applicable in 44% of patients applying restrictive indication criteria-a retrospective analysis of 111 TKA using robotic assistance[J/OL]. J Pers Med, 2021, 11(7): 662. DOI: 10.3390/jpm11070662.
[53]
Hutti JR, LeBlanc MA, Massé V, et al. Kinematic TKA using navigation: surgical technique and initial results[J]. Orthop Traumatol Surg Res, 2016, 102(1): 99－104.
[54]
Vendittoli PA, Martinov S, Blakeney WG. Restricted kinematic alignment, the fundamentals, and clinical applications[J/OL]. Front Surg, 2021, 8: 697020. DOI: 10.3389/fsurg.2021.697020.
[55]
Laforest G, Kostretzis L, Kiss MO, et al. Restricted kinematic alignment leads to uncompromised osseointegration of cementless total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(2): 705－712.
[56]
Blakeney W, Clément J, Desmeules F, et al. Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5): 1410－1417.
[57]
Blakeney W, Beaulieu Y, Kiss MO, et al. Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans[J]. Acta Orthop, 2019, 90(6): 602－609.
[58]
Abhari S, Hsing TM, Malkani MM, et al. Patient satisfaction following total knee arthroplasty using restricted kinematic alignment[J]. Bone Joint J, 2021, 103－B(6 Supple A): 59－66.
[59]
Sappey-Marinier E, Shatrov J, Batailler C, et al. Restricted kinematic alignment may be associated with increased risk of aseptic loosening for posterior-stabilized TKA: a case-control study[J]. Knee Surg Sports Traumatol Arthrosc, 2022, 30(8): 2838－2845.
[60]
Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it？[J]. J Arthroplasty, 2009, 24(6 Suppl): 39－43.
[61]
Kayani B, Konan S, Tahmassebi J, et al. A prospective double-blinded randomised control trial comparing robotic arm-assisted functionally aligned total knee arthroplasty versus robotic arm-assisted mechanically aligned total knee arthroplasty[J/OL]. Trials, 2020, 21(1): 194. DOI: 10.1186/s13063-020-4123-8.
[62]
Jacobs CA, Christensen CP, Karthikeyan T. Greater medial compartment forces during total knee arthroplasty associated with improved patient satisfaction and ability to navigate stairs[J]. J Arthroplasty, 2016, 31(9 Suppl): 87－90.
[63]
Gustke KA. Soft-tissue and alignment correction: the use of smart trials in total knee replacement[J]. Bone Joint J, 2014, 96－B(11 Supple A): 78－83.
[64]
Steer R, Tippett B, Khan RN, et al. A prospective randomised control trial comparing functional with mechanical axis alignment in total knee arthroplasty: study protocol for an investigator initiated trial[J/OL]. Trials, 2021, 22(1): 523. DOI: 10.1186/s13063-021-05433-z.
[65]
Begum FA, Kayani B, Magan AA, et al. Current concepts in total knee arthroplasty: mechanical, kinematic, anatomical, and functional alignment[J]. Bone Jt Open, 2021, 2(6): 397－404.
[66]
Oussedik S, Abdel MP, Victor J, et al. Alignment in total knee arthroplasty[J]. Bone Joint J, 2020, 102－B(3): 276－279.
[67]
王俏杰，张先龙. 机器人辅助人工全膝关节置换术中下肢对线选择与软组织平衡策略[J]. 中国修复重建外科杂志，2021, 35(10): 1221－1226.
[68]
Chang JS, Kayani B, Wallace C, et al. Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology[J]. Bone Joint J, 2021, 103－B(3): 507－514.
[69]
Smith AF, Eccles CJ, Bhimani SJ, et al. Improved patient satisfaction following robotic-assisted total knee arthroplasty[J]. J Knee Surg, 2021, 34(7): 730－738.
[70]
Deveza L, Hajizadeh K, Song B, et al. Neutral boundary alignment in total knee arthroplasty: a novel concept[J/OL]. J Exp Orthop, 2020, 7(1): 62. DOI: 10.1186/s40634-020-00280-4.
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