Substantial healthcare resources have been devoted to computer navigation and patient-specific instrumentation systems that improve the reproducibility with which neutral mechanical alignment can be achieved following total knee replacement (TKR). This choice of alignment is based on the long-held tenet that the alignment of the limb post-operatively should be within 3° of a neutral mechanical axis. Several recent studies have demonstrated no significant difference in survivorship when comparing well aligned versus malaligned TKRs. Our aim was to review the anatomical alignment of the knee, the historical and contemporary data on a neutral mechanical axis in TKR, and the feasibility of kinematically-aligned TKRs.
Review of the literature suggests that a neutral mechanical axis remains the optimal guide to alignment.
Cite this article: Bone Joint J 2014;96-B:857–62.
- Total knee replacement; Coronal alignment; Neutral mechanical alignment; Anatomic alignment; Kinematically aligned total knee replacement
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One of the authors (FSH), or a member of his immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Smith & Nephew) for products not discussed in this chapter. One of the authors (MPA) works in a department that receives institutional research support from multiple commercial entities (Biomet, DePuy, Stryker, and Zimmer), while another author (FSH) works in a department that receives institutional research support from multiple commercial entities (Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer).
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non- profit organisation with which one or more of the authors are associated.
- Received February 10, 2014.
- Accepted April 23, 2014.
- ©2014 The British Editorial Society of Bone & Joint Surgery