Comparative research progress of kinematic and mechanical alignment techniques in total knee arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2023.04.014

Abstract

Abstract:

Kinematic Alignment (KA) is a method of aligning the lower extremity alignment in total knee arthroplasty (TKA), which is different from Mechanical Alignment (MA), which aims to Restore the original motion trajectory of the patient's natural knee joint. Existing literature reports show that KA-TKA is superior to MA-TKA in terms of clinical efficacy and patient satisfaction, and is not inferior to MA-TKA in terms of complications and prosthesis survival. However, some domestic joint surgeons still have some confusion about the process of KA technology from concept to application. This paper reviewed the latest comparative research progress of KA-TKA and MA-TKA, in order to provide some reference for joint surgeons.

Key words: Arthroplasty, replacement, knee, Osteoarthritis, knee

Xiaoqiang Zhou, Yujie Jin, Zhiqiang Li, Renjie Xu, Xiangxin Zhang, Guangxiang Chen, Xiao Yu. Comparative research progress of kinematic and mechanical alignment techniques in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(04): 554-559.

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References 37

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手术技术	软骨补偿	胫骨截骨	股骨截骨	软组织平衡
传统器械联合卡尺校验	术中软骨全层磨损补偿2 mm，非全层磨损补偿1 mm。	标记外侧胫骨关节面椭圆形长轴，以后叉止点向前做平行线，旋转定位。髓外定位近端参照旋转定位标记线，远端参照术前规划体表标志点安装截骨模板进行截骨。	在传统技术的基础上，不设定外翻角度行股骨远端截骨，四合一截骨导板外旋0°行股骨后髁截骨。截骨块的厚度用卡尺校验。	二次截骨调整，尽可能减少软组织松解。
PSI	术中关节软骨补偿厚度2 mm。	参照与PSI配套的胫骨近端3D模型，刮除胫骨平台的残余软骨，保证相应部位和PSI紧密贴合安放，固定导向器后进行等量截骨。	参照与PSI配套的股骨远端3D模型，刮除股骨远端的残余软骨，保证相应部位和PSI能够紧密贴合安放，固定导向器后进行等量截骨。	较少使用软组织平衡技术。不推荐做广泛的软组织松解。
CAS	术中软骨补偿根据术前截骨计划及术中导航测量制定补偿厚度。	安装红外线示踪器于股骨、胫骨侧。探针收集注册骨性标志，确定髋、膝、踝关节活动中心，测量膝关节内/外翻角度制定出胫骨近端截骨计划，固定胫骨截骨模块进行胫骨截骨。	导航系统收集胫骨平台截骨后的数据分析以后，对安装股骨假体后进行模拟，股骨截骨模板连接探针，计算机导航定位截骨模板的位置后进行股骨截骨。	根据术中计算机测量膝关节间隙数据，决定是否行软组织松解。

手术技术	软骨补偿	胫骨截骨	股骨截骨	软组织平衡
传统器械联合卡尺校验	术中软骨全层磨损补偿2 mm，非全层磨损补偿1 mm。	标记外侧胫骨关节面椭圆形长轴，以后叉止点向前做平行线，旋转定位。髓外定位近端参照旋转定位标记线，远端参照术前规划体表标志点安装截骨模板进行截骨。	在传统技术的基础上，不设定外翻角度行股骨远端截骨，四合一截骨导板外旋0°行股骨后髁截骨。截骨块的厚度用卡尺校验。	二次截骨调整，尽可能减少软组织松解。
PSI	术中关节软骨补偿厚度2 mm。	参照与PSI配套的胫骨近端3D模型，刮除胫骨平台的残余软骨，保证相应部位和PSI紧密贴合安放，固定导向器后进行等量截骨。	参照与PSI配套的股骨远端3D模型，刮除股骨远端的残余软骨，保证相应部位和PSI能够紧密贴合安放，固定导向器后进行等量截骨。	较少使用软组织平衡技术。不推荐做广泛的软组织松解。
CAS	术中软骨补偿根据术前截骨计划及术中导航测量制定补偿厚度。	安装红外线示踪器于股骨、胫骨侧。探针收集注册骨性标志，确定髋、膝、踝关节活动中心，测量膝关节内/外翻角度制定出胫骨近端截骨计划，固定胫骨截骨模块进行胫骨截骨。	导航系统收集胫骨平台截骨后的数据分析以后，对安装股骨假体后进行模拟，股骨截骨模板连接探针，计算机导航定位截骨模板的位置后进行股骨截骨。	根据术中计算机测量膝关节间隙数据，决定是否行软组织松解。

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