Alignment Techniques in Total Knee Arthroplasty:Where do We Stand Today?

Achieving optimal alignment in total knee arthroplasty(TKA) is a critical factor in ensuring optimal outcomes and long-term implant survival. Traditionally, mechanical alignment has been favored to achieve neutral postoperative joint alignment. However, contemporary approaches, such as kinematic alignments and hybrid techniques including adjusted mechanical, restricted kinematic, inverse kinematic, and functional alignments, are gaining attention for their ability to restore native joint kinematics and anatomical alignment, potentially leading to enhanced functional outcomes and greater patient satisfaction. The ongoing debate on optimal alignment strategies considers the following factors: long-term implant durability, functional improvement, and resolution of individual anatomical variations. Furthermore, advancements of computer-navigated and robotic-assisted surgery have augmented the precision in implant positioning and objective measurements of soft tissue balance. Despite ongoing debates on balancing implant longevity and functional outcomes, there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations. This review evaluates the spectrum of various alignment techniques in TKA, including mechanical alignment, patient-specific kinematic approaches, and emerging hybrid methods. Each technique is scrutinized based on its fundamental principles, procedural techniques, inherent advantages, and potential limitations, while identifying significant clinical gaps that underscore the need for further investigation.

The Electrical and Mechanical Alignment and Accuracy Detection of Numerial Control Machine Tool

In the work of numerical control reformation of general machine tool, the installation and debugging of machine tool is a crucial part. For the C6132 machine tool, and make the use of electrical and mechanical alignment, parameter adjusting, numerical control lathe accuracy debugging and performance examination has been used to finish a series of tailing in the work of numerical control reformation of general machine tool. In this paper, the detailed process of electrical and mechanical alignment, parameter adjusting, numerical control lathe accuracy debugging and performance examination has been demonstrated, meanwhile, the specific operational approach of these work programs has been discussed. Therefore, the present results provides essential reference and approach for the numerical control reformation of general machine tool.

Coronal Alignment of Three Different Types of Implants in Kinematically Aligned Total Knee Arthroplasty: A Comparative Study

Background: The number of total knee arthroplasty (TKA) surgeries performed each year is increasing worldwide and mechanical alignment (MA) is currently seen as the gold standard procedure. However, taking neutral alignment as the universal goal may be mistaken. In our hospital, we currently conduct kinematically aligned TKA (KA-TKA). Three different types of implants are used: the cruciate-retaining (CR) type, cruciate-sacrificing (CS) type, or bi-cruciate-retained (BCR) type. We aimed to compare the coronal alignment observed following KA-TKA and MA-TKA and in normal knees, as well as that achieved with different types of implants. Methods: The study comprised 206 knees of Japanese patients who underwent KA-TKA using varying implants in our Hospital between May 2019 and April 2020. Measurements of pre- and postoperative coronal alignment were determined from weight-bearing full-leg standing radiographs. The postoperative results were compared to measurements taken from patients who underwent MA-TKA (N = 96) and normal knees (N = 60). Results: No significant differences between the KA-TKA group and normal knees were found for the medial proximal tibial angle (MPTA) (–4.2° ± 2.6° vs –3.8° ± 2.5°) or joint line orientation angle (JLOA) (0.2° ± 1.9° vs 0.3° ± 1.4°). However, when MA-TKA was compared to KA-TKA and normal knees, there were significant differences in both the MPTA and JLOA (p < 0.01). Furthermore, for the different implant types, MPTA exhibited significantly greater varus alignment when a CS-type was used than with the other two. Conclusions: Here, we demonstrated that following KA-TKA, the articular surface of the tibia exhibited a similar varus alignment as that of normal knees, meaning that the technique reproduces the native knee. Furthermore, KA is patient-specific, and does not have the same failures as MA-TKA. Therefore, we anticipate a paradigm shift from mechanical to kinematic alignment, which may help reduce the dissatisfaction rate of TKA patients.