臨床整形外科59巻6号

2024年06月発行

特集 TKAにおける最新Topics

TKA Alignment，概念の変遷と用語の定義について

著者： 平中崇文¹

所属機関： ¹社会医療法人愛仁会高槻病院整形外科・関節センター

ページ範囲：P.753 - P.761

人工膝関節置換術が一般的となって約半世紀，いまかつてない大きなパラダイムシフトを迎えようとしている．これまでgold standardと考えられていた，機械的安定性を重視するmechanical alignment(MA)ばかりでなく，personalized alignment(PA)という患者個別に最適ゴールを目指す新しい方法が芽生えてきている．しかしPAには多種多様の方法が提唱されており，その目的とするところも微妙に異なる．その結果混乱がみられていることも事実である．各アライメント手法の目指すところを，正しい用語とともに使用し，おのおのの方法を理解したうえで建設的な議論が必要である．

参考文献

1) Insall JN, Binazzi R, Soudry M, et al. Total knee arthroplasty. Clin Orthop Relat Res 1985;(192):13-22.

2) National Joint Registry. National Joint Registry 19th 2022 Annual Report.　https://www.njrcentre.org.uk/njr-annual-report-2022/(2024年3月4日アクセス)

3) The Australian Orthopaedic Association. Australian Orthopaedic Association National Joint Replacement Registry.　https://aoanjrr.sahmri.com/documents/10180/668596/Hip%2C+Knee+%26+Shoulder+Arthroplasty/c287d2a3-22df-a3bb-37a2-91e6c00bfcf0(2024年3月4日アクセス)

4) New Zealand Joint Registry. The New Zealand Joint Registry 21 year Report. 2019　https://www.nzoa.org.nz/sites/default/files/DH8426_NZJR_2020_Report_v5_30Sep.pdf(2024年3月4日アクセス)

5) Berend ME, Ritter MA, Meding JB, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004;(428):26-34.

6) Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty:just how important is it? J Arthroplasty 2009;24(6 Suppl):39-43.

7) Lee BS, Cho HI, Bin SI, et al. Femoral component varus malposition is associated with tibial aseptic loosening after TKA. Clin Orthop Relat Res 2018;476(2):400-7.

8) Bellemans J, Colyn W, Vandenneucker H, et al. The Chitranjan Ranawat award:is neutral mechanical alignment normal for all patients? the concept of constitutional varus. Clin Orthop Relat Res 2012;470(1):45-53.

9) Hovinga KR, Lerner AL. Anatomic variations between Japanese and caucasian populations in the healthy young adult knee joint. J Orthop Res 2009;27(9):1191-6.

10) Tang WM, Zhu YH, Chiu KY. Axial alignment of the lower extremity in Chinese adults. J Bone Joint Surg Am 2000;82(11):1603-8.

11) Gu Y, Roth JD, Howell SM, et al. How frequently do four methods for mechanically aligning a total knee arthroplasty cause collateral ligament imbalance and change alignment from normal in white patients? AAOS Exhibit Selection. J Bone Joint Surg Am 2014;96(12):e101. Doi:10.2106/JBJS.M.00306.

12) Thienpont E, Schwab PE, Cornu O, et al. Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 2017;137(3):393-400.

13) MacDessi SJ, Griffiths-Jones W, Harris IA, et al. Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 2021;103-B(2):329-37.

14) Luyckx T, Vandenneucker H, Ing LS, et al. Raising the joint line in TKA is associated with mid-flexion laxity:a study in cadaver knees. Clin Orthop Relat Res 2018;476(3):601-11.

15) Lingard EA, Sledge CB, Learmonth ID;Kinemax Outcomes Group. Patient expectations regarding total knee arthroplasty:differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am 2006;88(6):1201-7.

16) Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty:Who is satisfied and who is not? Clin Orthop Relat Res 2010;468(1):57-63.

17) Bourne RB, Chesworth B, Davis A, et al. Comparing patient outcomes after THA and TKA:is there a difference? Clin Orthop Relat Res 2010;468(2):542-6.

18) Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement:a growing concern? Bone Joint J 2014;96-B(11 Supple A):96-100.

19) Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J 2018;100-B(4):432-5.

20) Wiik AV, Aqil A, Tankard S, et al. Downhill walking gait pattern discriminates between types of knee arthroplasty:improved physiological knee functionality in UKA versus TKA. Knee Surg Sports Traumatol Arthrosc 2015;23(6):1748-55.

21) Jones GG, Kotti M, Wiik AV, et al. Gait comparison of unicompartmental and total knee arthroplasties with healthy controls. Bone Joint J 2016;98-B(10 Supple B):16-21.

22) Klatt BA, Goyal N, Austin MS, et al. Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty 2008;23(1):26-9.

23) Howell SM, Hull ML, Nedopil AJ, et al. Caliper-verified kinematically aligned total knee arthroplasty:Rationale, targets, accuracy, balancing, implant survival, and outcomes. Instr Course Lect 2023;72:241-59.

24) Lee YS, Howell SM, Won YY, et al. Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017;25(11):3467-79.

25) Nedopil AJ, Dhaliwal A, Howell SM, et al. A surgeon that switched to unrestricted kinematic alignment with manual instruments has a short learning curve and comparable resection accuracy and outcomes to those of an experienced surgeon. J Pers Med 2022;12(7):1152.

26) Howell SM. Calipered kinematically aligned total knee arthroplasty:an accurate technique that improves patient outcomes and implant survival. Orthopedics 2019;42(3):126-35.

27) MacDessi SJ, Allom RJ, Griffiths-Jones W, et al. The importance of joint line obliquity:a radiological analysis of restricted boundaries in normal knee phenotypes to inform surgical decision making in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022;30(9):2931-40.

28) MacDessi SJ, Griffiths-Jones W, Chen DB, 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(1):117-24.

29) Hiranaka T, Jackson WFM, Fujishiro T, et al. The lateral malleolus is a simple and reliable landmark that can be used to reliably perform restricted kinematically aligned total knee arthroplasty-anatomical and clinical studies in Japanese population. J Knee Surg 2022;37(1):37-42.

30) Matsumoto T, Takayama K, Ishida K, et al. Intraoperative soft tissue balance/kinematics and clinical evaluation of modified kinematically versus mechanically aligned total knee arthroplasty. J Knee Surg 2020;33(8):777-84.

31) Suda Y, Hiranaka T, Kamenaga T, et al. Approximately 80％ of Japanese osteoarthritic patients fall out of the safety range in restricted kinematically-aligned total knee arthroplasty in an analysis of preoperative long-leg radiograms. Knee 2022;35:54-60.

32) Brown JHM. Traction during total knee arthroplasty leads to a bone-conserving tibial resection:a retrospective comparative study. Int J Orthop 2020;7(3):1283-8.

33) Soda Y, Nakamura M, Adachi N. Coronal alignment of three different types of implants in kinematically aligned total knee arthroplasty:a comparative study. Open J Orthop 2021;11(6):183-98.

34) Ishikawa M, Ishikawa M, Nagashima H, et al. Effects of unrestricted kinematically aligned total knee arthroplasty with a modified soft-tissue respecting technique on the deformity of limb alignment in Japanese patients. Medicina (Kaunas) 2023;59(11):1969.

35) McEwen P, Balendra G, Doma K. Medial and lateral gap laxity differential in computer-assisted kinematic total knee arthroplasty. Bone Joint J 2019;101-B(3):331-9.

36) Clement ND, Calliess T, Christen B, et al. An alternative technique of restricted kinematic alignment of the femur and gap balanced alignment of the tibia using computer aided navigation. Bone Joint Res 2020;9(6):282-4.

37) Chang JS, Kayani B, Wallace C, et al. Functional alignment achieves soft-tissue balance in total knee arthroplasty as measured with quantitative sensor-guided technology. Bone Joint J 2021;103-B(3):507-14.

38) Clark G, Steer R, Wood D. Functional alignment achieves a more balanced total knee arthroplasty than either mechanical alignment or kinematic alignment prior to soft tissue releases. Knee Surg Sports Traumatol Arthrosc 2023;31(4):1420-6.

39) Shatrov J, Batailler C, Sappey-Marinier E, et al. Kinematic alignment fails to achieve balancing in 50％ of varus knees and resects more bone compared to functional alignment. Knee Surg Sports Traumatol Arthrosc 2022;30(9):2991-9.

40) Orsi AD, Wakelin E, Plaskos C, et al. Restricted inverse kinematic alignment better restores the native joint line orientation while achieving similar balance, laxity, and arithmetic hip-knee-ankle angle to gap balancing total knee arthroplasty. Arthroplast Today 2023;19:101090. doi:10.1016/j.artd.2022.101090.

41) Van Essen J, Stevens J, Dowsey MM, et al. Kinematic alignment results in clinically similar outcomes to mechanical alignment:systematic review and meta-analysis. Knee 2023;40:24-41.

42) Howell SM, Akhtar M, Nedopil AJ, et al. Reoperation, implant survival, and clinical outcome after kinematically aligned total knee arthroplasty:a concise clinical follow-up at 16 years. J Arthroplasty 2024;39(3):695-700.

43) Toyooka S, Osaki Y, Masuda H, et al. Distribution of coronal plane alignment of the knee classification in patients with knee osteoarthritis in Japan. J Knee Surg 2023;36(7):738-43.

44) Klasan A, de Steiger R, Holland S, et al. Similar risk of revision after kinematically aligned, patient-specific instrumented total knee arthroplasty, and all other total knee arthroplasty:combined results from the Australian and New Zealand joint replacement registries. J Arthroplasty 2020;35(10):2872-7.

45) Tran T, McEwen P, Peng Y, et al. Kinematic alignment in total knee arthroplasty:a five-year prospective, multicentre, survivorship study. Bone Jt Open 2022;3(8):656-65.

46) Griffiths-Jones W, Chen DB, Harris IA, et al. Arithmetic hip-knee-ankle angle (aHKA):An algorithm for estimating constitutional lower limb alignment in the arthritic patient population. Bone Jt Open 2021;2(5):351-8.

47) Hiranaka T, Suda Y, Saitoh A, et al. Current concept of kinematic alignment total knee arthroplasty and its derivatives. Bone Jt Open 2022;3(5):390-7.

48) Lustig S, Sappey-Marinier E, Fary C, et al. Personalized alignment in total knee arthroplasty:current concepts. SICOT J 2021;7:19. doi:10.1051/sicotj/2021021.

49) Hiranaka T. Current concept:personalized alignment total knee arthroplasty as a contrast to classical mechanical alignment total knee arthroplasty. Arthroplasty 2024, in press.

50) Hungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clin Orthop Relat Res 2006;(192):23-33.

51) Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life?:comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009;24(4):560-9.

52) Vanlommel L, Vanlommel J, Claes S, et al. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc 2013;21(10):2325-30.

53) Matsumoto T, Nakano N, Ishida K, et al. Targeting the neutral hip-to-calcaneus axis in kinematically aligned total knee arthroplasty is feasible with fewer alignment outliers for varus osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 2023;31(9):3880-8.

54) Matsumoto T, Nakano N, Ishida K, et al. Ground kinematically aligned total knee arthroplasty:new personalized technique which enables a stable knee with deep flexion. Int Orthop 2023;47(9):2215-23.

55) Crawford DA, Duwelius PJ, Sneller MA, et al. 2021 Mark Coventry Award:use of a smartphone-based care platform after primary partial and total knee arthroplasty:a prospective randomized controlled trial. Bone Joint J 2021;103-B(6 Supple A):3-12.

56) Knight SR, Ng N, Tsanas A, et al. Mobile devices and wearable technology for measuring patient outcomes after surgery:a systematic review. NPJ Digit Med 2021;4(1):157. doi:10.1038/s41746-021-00525-1.

57) Tripuraneni KR, Foran JRH, Munson NR, et al. A smartwatch paired with a mobile application provides postoperative self-directed rehabilitation without compromising total knee arthroplasty outcomes:a randomized controlled trial. J Arthroplasty 2021;36(12):3888-93.

58) Yocum D, Housholder E, Yergler J. Manipulation under anesthesia following TKA with persona IQ:a case series. J Orthop Case Rep 2023;13(8):127-31.