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

Personalized Aligned TKAの最前線

著者： 松本知之¹

所属機関： ¹神戸大学大学院医学研究科整形外科学

ページ範囲：P.763 - P.768

人工膝関節全置換術(TKA)において，個々の生理的膝関節の再現を目指したpersonalized alignmentという新たなアライメントの概念が提唱され，良好な臨床成績が報告されている．なかでもkinematically aligned TKA(KA-TKA)に関しては，その評価を含めたさまざまな報告に基づき，改変された手法が混在するようになってきており，日本人における解剖学的特徴を考慮した手術手技の選択・適応決定が極めて重要である．加えて，original full KA-TKAにおいて長期成績の報告が散見されるようになってきているが，それぞれの手技における報告はまだ少なく，慎重に経過を観察する必要がある．

参考文献

1) Hungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clin Orthop Relat Res 1985;(192):23-33.

2) 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.

3) Parratte S, Pagnano MW, Trousdale RT, et al. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010;92(12):2143-9.

4) 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.

5) Howell SM, Howell SJ, Kuznik KT, et al. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res 2013;471(3):1000-7.

6) Eckhoff DG, Bach JM, Spitzer VM, et al. Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Joint Surg Am 2005;87 Suppl 2:71-80.

7) Nedopil AJ, Singh AK, Howell SM, et al. Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function? J Arthroplasty 2018;33(2):398-406.

8) Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018;33(12):3678-84.

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

10) Howell SM, Papadopoulos S, Kuznik KT, et al. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 2013;21(10):2271-80.

11) Almaawi AM, Hutt JRB, Masse V, et al. The impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty. J Arthroplasty 2017;32(7):2133-40.

12) Matsumoto T, Hashimura M, Takayama K, et al. A radiographic analysis of alignment of the lower extremities--initiation and progression of varus-type knee osteoarthritis. Osteoarthritis Cartilage 2015;23(2):217-23.

13) Nishida K, Matsumoto T, Takayama K, et al. Remaining mild varus limb alignment leads to better clinical outcome in total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2017;25(11):3488-94.

14) Kuroda Y, Takayama K, Hayashi S, et al. Varus deformity in the proximal tibia and immediate postoperative varus alignment result in varus progression in limb alignment in the long term after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020;28(10):3287-93.

15) Matsumoto T, Takayama K, Ishida K, et al. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017;99-B(5):640-6.

16) Oussedik S, Abdel MP, Victor J, et al. Alignment in total knee arthroplasty. Bone Joint J 2020;102-B(3):276-9.

17) Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee arthroplasty:a meta-analysis of the literature. J Arthroplasty 2017;32(6):2028-32. e1. doi:10.1016/j.arth.2017.02.041.

18) Li Y, Wang S, Wang Y, et al. Does kinematic alignment improve short-term functional outcomes after total knee arthroplasty compared with mechanical alignment? A systematic review and meta-analysis. J Knee Surg 2018;31(1):78-86.

19) Luo Z, Zhou K, Peng Q, et al. Similar results with kinematic and mechanical alignment applied in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020;28(6):1720-35.

20) Hiyama S, Takahashi T, Takeshita K. Kinematically aligned total knee arthroplasty did not show superior patient-reported outcome measures:an updated meta-analysis of randomized controlled trials with at least 2-year follow-up. J Knee Surg 2022;35(6):634-9.

21) 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.

22) Kamenaga T, Nakano N, Takayama K, et al. Comparison of plantar pressure distribution during walking and lower limb alignment between modified kinematically and mechanically aligned total knee arthroplasty. J Biomech 2021;120:110379. doi:10.1016/j.jbiomech.2021.110379.

23) 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.

24) 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.