Modern lower extremity alignment philosophies in total knee arthroplasty

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Abstract

Total knee arthroplasty is the primary treatment method for advanced stages of knee osteoarthritis. However, according to the published data, 10%–20% of patients are dissatisfied with the surgical outcome. To improve the results of knee arthroplasty, various lower extremity alignment techniques have been developed and proposed for clinical use over several decades. The review aimed to analyze contemporary techniques of lower extremity alignment in total knee arthroplasty. Scientific data was searched using the Scopus and PubMed databases, the ResearchGate platform, and the eLibrary electronic scientific database. Publications in both Russian and English were retrieved and analyzed. Each alignment philosophy has its own advantages and limitations. The most widely discussed alignment concepts include mechanical alignment, anatomical alignment (systematic techniques aimed at achieving a neutral axis), adjusted mechanical alignment, restricted kinematic alignment (hybrid techniques), kinematic alignment, and functional alignment (personalized techniques). With a more detailed understanding of knee anatomy, kinematics, and the identification of different knee phenotypes, some surgeons advocate the use of hybrid and personalized lower extremity alignment strategies that take into account the constitutional anatomy of the knee joint. Available scientific data indicates that long-term outcomes after total knee arthroplasty using these approaches are either superior to or comparable with those achieved using the classical mechanical alignment philosophy. Nevertheless, the modern alternative axis alignment techniques described in this review are aimed at improving the outcomes of total knee arthroplasty. However, because of insufficient data on long-term implant survivorship, further time and research are required to fully assess the feasibility and appropriateness of their use in orthopedic surgical practice.

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About the authors

Georgii A. Airapetov

Peoples' Friendship University of Russia named after Patrice Lumumba; City Clinical Hospital № 31 named after Academician G.M. Savelyeva

Email: airapetovga@yandex.ru
ORCID iD: 0000-0001-7507-7772
SPIN-code: 7333-6640

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow

Nikolay V. Zagorodniy

Peoples' Friendship University of Russia named after Patrice Lumumba; Priorov National Medical Research Center of Traumatology and Orthopedics

Email: zagorodniy51@mail.ru
ORCID iD: 0000-0002-6736-9772
SPIN-code: 6889-8166

MD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences

Russian Federation, Moscow; Moscow

Armen A. Daniliyants

Peoples' Friendship University of Russia named after Patrice Lumumba; City Clinical Hospital № 31 named after Academician G.M. Savelyeva

Author for correspondence.
Email: armendts@mail.ru
ORCID iD: 0000-0001-6692-0975
SPIN-code: 9880-2555
Russian Federation, Moscow; Moscow

Konstantin A. Dzampaev

Peoples' Friendship University of Russia named after Patrice Lumumba

Email: kostya199921@gmail.com
ORCID iD: 0009-0008-4190-3114
SPIN-code: 5191-4314
Russian Federation, Moscow

Anjum H.A. Al Kafavin

Peoples' Friendship University of Russia named after Patrice Lumumba

Email: anjum.hasan@mail.ru
ORCID iD: 0009-0005-7329-4446
Russian Federation, Moscow

Abdoulaye A. Akhmat

Peoples' Friendship University of Russia named after Patrice Lumumba

Email: dr.ahmataa@gmail.com
ORCID iD: 0009-0000-3654-2408
Russian Federation, Moscow

Dmitry A. Samkovich

Peoples' Friendship University of Russia named after Patrice Lumumba; City Clinical Hospital № 31 named after Academician G.M. Savelyeva

Email: dmitry.samkovitch@gmail.com
ORCID iD: 0000-0001-5770-7304
Russian Federation, Moscow; Moscow

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2. Fig. 1. Schematic diagram of lower extremity angles and axes. aLDFA, anatomical lateral distal femoral angle; JLOА, joint line obliquity; mLDFA, mechanical lateral distal femoral angle; MPTA, medial proximal tibial angle.

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3. Fig. 2. Schematic calculation of the mHKA angle. mHKA, mechanical hip–knee–ankle angle.

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