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Medicina
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Era of Personalized Alignment Total Knee Arthroplasty—a Paradigm Shift
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Era of Personalized Alignment Total Knee Arthroplasty—a Paradigm Shift

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (31 July 2024) | Viewed by 4961

Special Issue Editors

Dr. Takafumi Hiranaka

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Guest Editor
Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, Takatsuki, Osaka, Japan
Interests: total knee arthroplasty; unicompartmental knee arthroplasty; robotic knee surgery; regenerative therapy; femoral neck fracture
Dr. Masahiro Ishikawa

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Guest Editor
Department of Orthopedic Surgery, Nagahama Red Cross Hospital, Niigata, Japan
Interests: total knee arthroplasty; unicompartmental knee arthroplasty; total hip arthroplasty
Dr. Shinya Ishizuka

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
Interests: total knee arthroplasty; unicompartmental knee arthroplasty; total shoulder arthroplasty; knee ligament reconstruction; sports medicine; osteoarthritis; cell biology; rotator cuff repair

Special Issue Information

Dear Colleagues,

Knee arthroplasty has evolved for more than half a century and gained satisfactory implant survival and functional outcomes. However, this surgery is now on a paradigm shift from aiming for a single goal to personalized goals. This movement matches “the era of diversity”, in which individuality is respected. This movement is also the start of seeking the personalized goal, pre-arthritic or constitutional condition, where the patient’s own joint morphology, soft-tissue balance and alignment are harmonized. However, the constitutional situation cannot be perfectly estimated once the knee is involved in osteoarthritis. Thus, several approaches have been advocated.

There are increasing reports that compare the mechanical alignment and personalized alignment TKAs, showing equivalent or better results of personalized alignment TKA over the mechanical alignment. We intend to compare which personalized alignment approach is best for a patient. The answer might be different depending on the patient’s characteristics.

For this Special Issue, we invite authors who have insightful perspectives or are a leader of respective approaches. Through this Special Issue of Medicina, the reader will be able to gain an outlook of the personalized TKA and its deliveries.

Dr. Takafumi Hiranaka
Dr. Masahiro Ishikawa
Dr. Shinya Ishizuka
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • knee
  • arthroplasty
  • alignment
  • mechanical
  • kinematic
  • functional
  • personalize

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Published Papers (2 papers)

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Research

11 pages, 2311 KiB  
Article
Primary Total Knee Arthroplasty for Treating Osteoarthritic Knees with Neglected Patellar Dislocation
by Sung Eun Kim, Seong Hwan Kim, Jung-In Lee, Hyuk-Soo Han, Myung Chul Lee and Du Hyun Ro
Medicina 2024, 60(9), 1492; https://doi.org/10.3390/medicina60091492 - 13 Sep 2024
Viewed by 1408
Abstract
Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary [...] Read more.
Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures. Full article
(This article belongs to the Special Issue Era of Personalized Alignment Total Knee Arthroplasty—a Paradigm Shift)
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13 pages, 1576 KiB  
Article
Effects of Unrestricted Kinematically Aligned Total Knee Arthroplasty with a Modified Soft-Tissue Respecting Technique on the Deformity of Limb Alignment in Japanese Patients
by Masahiro Ishikawa, Masaaki Ishikawa, Hideaki Nagashima, Shinya Ishizuka, Kazuhiko Michishita, Yoshinori Soda and Takafumi Hiranaka
Medicina 2023, 59(11), 1969; https://doi.org/10.3390/medicina59111969 - 8 Nov 2023
Cited by 2 | Viewed by 2926
Abstract
Background and Objectives: Unrestricted kinematic alignment total knee arthroplasty (KA-TKA) with a soft-tissue respecting technique (STRT) is a soft-tissue-dependent tibial resection entailing the restoration of the original soft-tissue tension using ligamentotaxis after resurfacing the femur, based on the concept of restoring the [...] Read more.
Background and Objectives: Unrestricted kinematic alignment total knee arthroplasty (KA-TKA) with a soft-tissue respecting technique (STRT) is a soft-tissue-dependent tibial resection entailing the restoration of the original soft-tissue tension using ligamentotaxis after resurfacing the femur, based on the concept of restoring the native or pre-osteoarthritis alignment in each patient. However, there is no consensus on the indications of unrestricted KA-TKA with the STRT. We modified the STRT, followed by an investigation of the effects of surgery on the postoperative hip–knee–ankle angle (HKAA). Materials and Methods: We retrospectively analyzed the clinical background data, including the preoperative and postoperative HKAA, of 87 patients who underwent unrestricted KA-TKA with the modified STRT. Univariate and multivariate analyses were performed to determine the factors affecting the postoperative HKAA. A receiver operating characteristic (ROC) curve was plotted to investigate the change in the cut-off values of preoperative HKAA with respect to the safe zone of the postoperative HKAA. We generated two regression models, the linear regression model and generalized additive model (GAM) using machine learning, to predict the postoperative HKAA. Results: Univariate and multivariate analyses revealed the preoperative HKAA as the factor most relevant to the postoperative HKAA. ROC analysis revealed that the preoperative HKAA exhibited a high predictive utility, with a cut-off value of −10°, when the safe range of postoperative HKAA was set at ±5°. The GAM was the superior machine learning model, indicating a non-linear association between the preoperative and postoperative HKAA. Patients with preoperative HKAAs ranging from −18° to 4° were more likely to fall within the ±5° safe range of the postoperative HKAA. Conclusions: The preoperative HKAA influences the postoperative HKAA in unrestricted KA-TKA with the modified STRT. Machine learning using the GAM may contribute to the selection of patients eligible for the surgical approach. Full article
(This article belongs to the Special Issue Era of Personalized Alignment Total Knee Arthroplasty—a Paradigm Shift)
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