Mechanical or anatomical alignment techniques create a supposedly ‘biomechanically friendly’ but often functionally limited prosthetic knee.Alternative techniques for alignment in total knee arthroplasty (TKA) aim at being more anatomical and patient-specific, aiming to improve functional outcomes after TKA.The kinematic alignment (KA) technique for TKA has shown good early clinical outcomes. Its role in extreme anatomical variation remains to be defined.The restricted KA technique for TKA might be a reasonable option for patients with extreme anatomical variation.While unicompartmental knee arthroplasty (UKA) has many advantages over TKA, the revision rate remains higher compared with TKA. One major explanation is the relative ease with which a UKA can be converted to a TKA, compared with revising a TKA. This can be considered as an additional advantage of UKA. Another reason is that surgeons favour revising a UKA to a TKA in cases of degeneration of the other femorotibial compartment rather than performing a relatively simple re-operation of the knee by doing an additional UKA (staged bi-UKA).Cite this article: EFORT Open Rev 2018;3:1–6. DOI: 10.1302/2058-5241.3.170021

No abstract

Multimodal protocols for pain control, blood loss management and thromboprophylaxis have been shown to benefit patients by being more effective and as safe (fewer iatrogenic complications) as conventional protocols.Proper patient selection and education, multimodal protocols and a well-defined clinical pathway are all key for successful day-case arthroplasty.By potentially being more effective, cheaper than and as safe as inpatient arthroplasty, day-case arthroplasty might be beneficial for patients and healthcare systems.Cite this article: EFORT Open Rev 2018;3:130-135. DOI: 10.1302/2058-5241.3.170031

Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality.Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined.By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity.The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation.The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy.The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022

Purpose Owing to the improved understanding of knee kinematics and the successful introduction of the kinematic alignment (KA) technique for implanting total knee arthroplasty (TKA), it was recently understood that the "Cartier angle technique" corresponds to a kinematic implantation of the uni-compartmental knee arthroplasty (UKA) components. When compared to the universally spread mechanical alignment (MA) technique for implanting UKA, the KA method generates a more anatomic prosthetic knee that may be clinically advantageous. The aims of this study are to determine if KA UKAs are associated with acceptable functional performance and patient satisfaction (question 1), rates of residual pain and tibia plateau fracture (question 2), and rates of reoperation and revision (question 3), and to deine the component orientation and limb alignment as measured on radiograph (question 4), and the stress shielding related bone loss in the proximal tibia (question 5) with KA UKA, and where possible to compare with MA UKA. Study hypothesis KA UKA generates good clinical outcomes, similar or superior to the ones of MA UKA. Method Systematic review of literature databases were primarily searched using Healthcare Databases Advanced Search (HDAS). Two primary searches were conducted using the electronic databases MEDLINE, EMBASE, and PubMed, and a secondary search was conducted using review articles and bibliography of obtained papers in order to ascertain more material. Results Nine eligible non-comparative prospective (3) or retrospective (6) cohort studies, which cumulated 593 KA UKAs with follow-up between 3.2 and 12 years, fulilled the inclusion criteria for this systematic review. The indings demonstrated high Knee Society Score (KSS) (from 87 to 95) and function scores (from 81 to above 91) in addition to patient satisfaction scores of 88%. There was no revision for tibia plateau fracture, 0.8% (5 cases) for unexplained pain tibia, 2.0% (12 cases) for component loosening, and 5.6% (33 cases) for any causes of aseptic failures reported for KA UKA. The prosthetic lower limb and tibia implant alignments were both found to be in slight varus (means between 3 and 5°), and the postoperative joint line and tibia component was shown to be parallel to the loor when standing. The KA UKA components migration, as measured on radiostereometry, was acceptable. Discussion/conclusion The KA technique is an alternative, personalised, more physiological method for implanting UKA, which could be clinically advantageous when compared to the MA technique. The literature supports the good mid-to longterm clinical safety and good eicacy of KA UKA; however, comparison between KA and MA techniques for UKA was not performed due to limited literature. Further investigations are needed to better deine the clinical impact of KA UKA, and the acceptable limits for KA of the UKA tibial component. Level of evidence Level 4; systematic review of level 4 studies.

No abstract

The Kinematic Alignment (KA) technique for total knee arthroplasty (TKA) is an alternative surgical technique aiming to resurface knee articular surfaces. The restricted KA (rKA) technique for TKA applies boundaries to the KA technique in order to avoid reproducing extreme constitutional limb/knee anatomies. The vast majority of TKA cases are straightforward and can be performed with KA in a standard (unrestricted) fashion. There are some specific situations where performing KA TKA may be more challenging (complex KA TKA cases) and surgical technique adaptations should be included. To secure good clinical outcomes, complex KA TKA cases must be preoperatively recognized, and planned accordingly. The proposed classification system describes six specific issues that must be considered when aiming for a KA TKA implantation. Specific recommendations for each situation type should improve the reliability of the prosthetic implantation to the benefit of the patient. The proposed classification system could contribute to the adoption of a common language within our orthopaedic community that would ease inter-surgeon communication and could benefit the teaching of the KA technique. This proposed classification system is not exhaustive and will certainly be improved over time. Cite this article: EFORT Open Rev 2021;6:881-891. DOI: 10.1302/2058-5241.6.210042

No abstract