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Review
. 2020 Aug 1;5(7):380-390.
doi: 10.1302/2058-5241.5.200010. eCollection 2020 Jul.

Kinematic alignment in total knee arthroplasty

Sohail Nisar  1   2   3 , Jeya Palan  3 , Charles Rivière  4   5   6 , Mark Emerton  3 , Hemant Pandit  1   3
Affiliations
Review

Kinematic alignment in total knee arthroplasty

Sohail Nisar et al. EFORT Open Rev. .

Abstract

Kinematic alignment (KA) is an alternative philosophy for aligning a total knee replacement (TKR) which aims to restore all three kinematic axes of the native knee.Many of the studies on KA have actually described non-KA techniques, which has led to much confusion about what actually fits the definition of KA.Alignment should only be measured using three-dimensional cross-sectional imaging. Many of the studies looking at the influence of implants/limb alignment on total knee arthroplasty outcomes are of limited value because of the use of two-dimensional imaging to measure alignment, potentially leading to inaccuracy.No studies have shown KA to be associated with higher complication rates or with worse implant survival; and the clinical outcomes following KA tend to be at least as good as mechanical alignment.Further high-quality multi-centre randomized controlled trials are needed to establish whether KA provides better function and without adversely impacting implant survival. Cite this article: EFORT Open Rev 2020;5:380-390. DOI: 10.1302/2058-5241.5.200010.

Keywords: arthroplasty; kinematic alignment; knee.

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Conflict of interest statement

ICMJE Conflict of interest statement: CR reports consultancy for Medacta; a pending patent for TKA design for kinematic implantation, all outside the submitted work. ME reports consultancy for Zimmer-Biomet as an implant design surgeon educational consultant; an educational contract with Medacta; is a designer surgeon for a hip replacement implant for Zimmer-Biomet; has an educational contract for lectures and teaching with Zimmer-Biomet; is a clinician consultant attending expert meetings to discuss novel approaches to arthroplasty for Depuy Synthes, International, all outside the submitted work. HP reports consultancy for Depuy Synthes, Zimmer-Biomet, Medacta Int, GSK, BMS, JRI, Smith and Nephew and Meril Life; consultancy for Kennedy’s Law for work related to metal-on-metal hips from Kennedy’s Law (representing Depuy Synthes and Stryker); that their institution has received/will receive (pending) grant support from Depuy Synthes, ZimmerBiomet, Medacta Int, GSK and Pacira Pharmaceuticals; and that their institution has received funding from NIHR (RFPB, HTA) for conducting randomized controlled trials, all outside the submitted work. HP is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
The orange vertical lines demonstrate the longitudinal axis; the purple horizontal lines represent the transverse axis, about which the patella flexes and extends; and the green horizontal lines represent the transverse axis, about which the tibia flexes and extends.
Fig. 2
Fig. 2
Composite showing a three-dimensional model of an ‘arthritic’ knee (first on the left), a model of a normal knee (second from the left), and a femoral component shape-fitted to anterior, posterior and axial projections of the femur (last three to the right). Shape-fitting the femoral component aligns its flexion-extension axis in the femur, about which the tibia flexes and extends with the femoral component. Source: Reproduced with permission and copyright © of The British Editorial Society of Bone & Joint Surgery.
See this image and copyright information in PMC

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