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J Knee Surg
DOI: 10.1055/a-2395-6935
Special Focus Section

Boundaries in Kinematic Alignment: Why, When, and How

Pier Francesco Indelli 
1   Department of Orthopaedic Surgery, Südtiroler Sanitätsbetrieb, Brixen, Italy
2   Paracelsus Medical University (PMU), Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria
3   CESAT, Azienda Sanitaria Toscana Centro, Fucecchio, Italy
4   Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
,
Giuseppe Petralia
5   Dipartimento di Medicina Clinica, Sanita' Pubblica, Scienze della Vita e dell'Ambiente, Universita' degli Studi dell'Aquila, L'Aquila, Italy
,
Stefano Ghirardelli
1   Department of Orthopaedic Surgery, Südtiroler Sanitätsbetrieb, Brixen, Italy
2   Paracelsus Medical University (PMU), Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria
,
Pieralberto Valpiana
1   Department of Orthopaedic Surgery, Südtiroler Sanitätsbetrieb, Brixen, Italy
2   Paracelsus Medical University (PMU), Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria
,
Giuseppe Aloisi
5   Dipartimento di Medicina Clinica, Sanita' Pubblica, Scienze della Vita e dell'Ambiente, Universita' degli Studi dell'Aquila, L'Aquila, Italy
,
Andrea Giordano Salvi
1   Department of Orthopaedic Surgery, Südtiroler Sanitätsbetrieb, Brixen, Italy
,
Salvatore Risitano
2   Paracelsus Medical University (PMU), Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria
6   Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
› Author Affiliations Funding None.
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Abstract

The use of alternative alignments in total knee arthroplasty (TKA) has recently been increasing in popularity: many of these alignments have been included in the broad spectrum of “kinematic alignment.” This alternative approach was recommended to increase patients' satisfaction since many studies based on patient-reported outcome measures (PROMs) showed that every fifth patient is not satisfied with the surgical outcome. In fact, the original kinematic alignment technique was designed as a “pure resurfacing” technique, maintaining the preoperative axes (flexion–extension and axial rotation) of the knee. In adjunct, many new classifications of the preoperative limb deformity have been proposed to include a large range of knee anatomies, few of them very atypical. Following those classifications, many surgeons aimed for a reproduction of unusual anatomies putting in jeopardy the survivorship of the implant according to the classical “dogma” of a poor knee kinematics and TKA biomechanics if the final hip–knee–ankle (HKA) axis was not kept within 5 degrees from neutral. This article reviews the literature supporting the choice of setting alignment boundaries in TKA when surgeons are interested in reproducing the constitutional knee anatomy of the patient within a safe range.

Keywords

boundaries - alignment - kinematic alignment - TKA - arthroplasty - phenotypes


Publication History

Received: 16 June 2024

Accepted: 19 August 2024

Accepted Manuscript online:
20 August 2024

Article published online:
12 September 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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