Neutral boundary alignment in total knee arthroplasty: a novel concept

The goal of total knee arthroplasty (TKA) surgery is to provide a stable and functional knee joint using current implant designs. Several alignment philosophies and surgical techniques have been introduced to provide a stable and functional knee joint, such as mechanical alignment (MA), kinematic al...

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Bibliographic Details
Published in:Journal of experimental orthopaedics 2020-08, Vol.7 (1), p.62-62, Article 62
Main Authors: Deveza, Lorenzo, Hajizadeh, Khatereh, Song, Benjamin, Park, Ilwhan
Format: Article
Language:English
Subjects:
Anatomical alignment
Functional alignment
Hypothesis
Joint replacement surgery
Joint surgery
Kinematic alignment
Knee
Knee alignment
Mechanical alignment
Medicine
Medicine & Public Health
Neutral boundary alignment
Orthopedics
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Summary:The goal of total knee arthroplasty (TKA) surgery is to provide a stable and functional knee joint using current implant designs. Several alignment philosophies and surgical techniques have been introduced to provide a stable and functional knee joint, such as mechanical alignment (MA), kinematic alignment (KA), and anatomical alignment (AA). Recently, functional alignment (FA) is proposed. In this concept article, we propose a TKA approach, which we termed “ Neutral Boundary Alignment (NBA) .” The proposed approach seeks to establish the overall limb alignment in the direction of gravity at the midstance of gait cycle; consequently, a potential native knee can be restored from an arthritic state by establishing the joint line parallel to the ground. Herein, the NBA approach is described, and an iterative algorithm of structural layout patterns of truss is developed. The following three hypotheses are proposed: 1) The joint line should be parallel to the ground during the midstance of gait as an important initial condition for stability when transitioning toward gait propulsion in the gait cycle; 2) The NBA stability criteria purports that the leg is stable when the direction of gravity is simultaneously situated within the hip, knee and ankle during the midstance of gait, which generally agrees with the Varus/Valgus 3 degree envelope of MA; 3) Femoral and tibial resections that are made parallel to the ground remain within 1.5 degrees of traditional mechanical alignment resections.
ISSN:2197-1153
2197-1153
DOI:10.1186/s40634-020-00280-4