Restricted Kinematic Alignment in Total Knee Arthroplasty: Scientific Exploration Involving Detailed Planning, Precise execution, and Knowledge of When to Abort

摘要

Not long ago, we were all transfixed by 50th anniversary tributes to humankind’s most daring achievement to date, the Apollo 11 moon landing. At 2 hours 44 minutes and 19 seconds after launch, the crew performed another jaw-dropping procedure. Translunar injection, a 6-minute burst of Saturn V engines, thrust Apollo 11 out of a low, circular parking orbit around Earth and catapulted it at 25,000 mph toward its precise target: the Moon. The 1969 Moon landing was a monumental feat of human perseverance, technological precision, and risk management. But behind the thousands of protocols and backup systems were hundreds of commands for “Mission Abort”. First and foremost was the safety of the 3 occupants. Exploration of scientific frontiers involves detailed planning, precise execution, and the awareness of when, for safety purposes, to say when. One of the most exciting frontiers in our field is the healthy debate about kinematic alignment (KA), which advocates positioning prosthetics relative to individual constitutional anatomy. Evidence suggests a myriad of benefits over the previous mainstay, mechanical alignment (MA), including significantly improved soft-tissue balance requiring fewer releases [1Blakeney W. Beaulieu Y. Kiss M.O. Riviere C. Vendittoli P.A. Less gap imbalance with restricted kinematic alignment than with mechanically aligned total knee arthroplasty: simulations on 3-D bone models created from CT-scans.Acta Orthop. 2019; 90: 602Crossref PubMed Scopus (12) Google Scholar, 2McEwen P. Balendra G. Doma K. Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty.Bone Joint J. 2019; 101-B: 331Crossref PubMed Scopus (14) Google Scholar, 3MacDessi S.J. Griffiths-Jones W. Chen D.B. et al.Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial.Bone Joint J. 2020; 102-B: 117Crossref PubMed Scopus (32) Google Scholar, 4Chang J.S. Kayani B. Wallace C. Haddad F.S. Functional alignment achieves soft tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology.Bone Joint J. 2021; 103-B: 507Crossref PubMed Scopus (6) Google Scholar, 5Delport H. Labey L. Innocenti B. De Corte R. Vander Sloten J. Bellemans J. Restoration of constitutional alignment in TKA leads to more physiological strains in the collateral ligaments.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2159Crossref PubMed Scopus (43) Google Scholar] and enhanced restoration of physiologic gait patterns, adduction moments, and native knee kinematics [6Blakeney W. Clement J. Desmeules F. Hagemeister N. Riviere C. Vendittoli P.A. Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 1410Crossref PubMed Scopus (43) Google Scholar, 7Maderbacher G. Keshmiri A. Krieg B. Greimel F. Grifka J. Baier C. Kinematic component alignment in total knee arthroplasty leads to better restoration of natural tibiofemoral kinematics compared to mechanic alignment.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 1427Crossref PubMed Scopus (11) Google Scholar, 8Niki Y. Nagura T. Nagai K. Kobayashi S. Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1629Crossref PubMed Scopus (43) Google Scholar]. Comparative clinical studies have demonstrated either equivalence or superiority to MA [[3]MacDessi S.J. Griffiths-Jones W. Chen D.B. et al.Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial.Bone Joint J. 2020; 102-B: 117Crossref PubMed Scopus (32) Google Scholar,9Dossett H.G. Swartz G.J. Estrada N.A. LeFevre G.W. Kwasman B.G. Kinematically versus mecha