Alignment in total knee arthroplasty, still more questions than answers…

Excerpt

The focus of the current issue is on technologies such as computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) in total knee arthroplasty (TKA). CAS helps the surgeon navigate each individual patient’s case based on bony landmarks in order to identify the correct positioning of the femoral and tibial cutting guides. The presumption was that component sizing and placement should be more accurate using CAS than the more conventional technique, resulting in both better alignment and clinical outcome. Many surgeons were convinced in the past that this technique would become the standard for TKA. Clinical studies have demonstrated that CAS reduces the number of outliers in component positioning and leg alignment as reported in the study by Lützen et al. [9]. Similar results have also been reported in a meta-analysis of level-I studies [6]. Unfortunately, the total time spent in the operating room and the lack of clinical amelioration has tempered its uniform acceptance by the surgical community [3, 14]. …