Zusammenfassung
Studien belegen einen gleichbleibend hohen Anteil von ca. 10–20 % unzufriedener Patienten nach Implantation einer Knietotalendoprothese (KTEP). In Anbetracht der Tatsache, dass nur ca. 15 % der Patienten eine tatsächlich gerade Beinachse und horizontale Gelenklinie aufweisen, wird deutlich, dass das klassische mechanische Alignment in vielen Fällen eine Veränderung der natürlichen Achsverhältnisse mit konsekutiven Auswirkungen auf die Weichteilspannung bewirkt. Vor diesem Hintergrund rücken zunehmend individualisierte Versorgungsstrategien in den Fokus, deren Ziel eine Rekonstruktion der natürlichen Kniegelenkskinematik ist. Die kürzlich veröffentlichte CPAK(Coronal Plane Alignment of the Knee)-Klassifikation definiert 9 konstitutionelle Kniephänotypen anhand der nativen Achsverhältnisse in der Frontalebene und der Neigung der Gelenklinie. Die Kenntnis des individuellen CPAK-Typs ist essenziell für die Anwendung moderner Alignmentstrategien, welche auf eine Rekonstruktion der individuellen Achsverhältnisse, der Gelenklinie sowie der individuellen Weichteilspannung zielen. Der Einsatz roboterassistierter Verfahren ist eine entscheidende Komponente für die präzise Umsetzung dieser individuellen Versorgungsstrategien. Basierend auf der Erfassung der knöchernen Anatomie und der intraoperativen Visualisierung der Weichteilspannung kann die Auswirkung der Komponentenausrichtung auf die Balancierung in Echtzeit simuliert werden und der operative Plan mit einer hohen Präzision ausgeführt werden. Dieser Beitrag soll einen Überblick über die CPAK-Klassifikation konstitutioneller Kniephänotypen und alternative Alignmentstrategien vermitteln. Abschließend wird ein Ansatz für die praktische Anwendung der CPAK-Klassifikation mithilfe roboterassistierter Technologien beschrieben.
Abstract
Restoration of a neutral lower limb alignment was considered the gold standard in total knee arthroplasty (TKA); however, as 10–20% of the patients are dissatisfied following TKA, alternative alignment philosophies were proposed in order to improve clinical and functional outcomes. Indeed, previously published studies report a wide variability of coronal lower limb alignment, suggesting that a correction to neutral inevitably changes the patients’ natural alignment to an unphysiological state associated with altered ligament balance and overall joint kinematics in a relevant proportion of cases. As a consequence, personalized alignment strategies, which aim to restore the patient’s constitutional alignment, have gained popularity in TKA. Preoperative analysis of the patient’s individual knee phenotype is crucial for a personalized arthroplasty approach. Coronal Plane Alignment of the Knee (CPAK) classification defines 9 distinct knee phenotypes by the combination of coronal leg alignment and joint line orientation and allows for the assessment of the prearthritic lower limb alignment. With the implementation of robotic technologies (rTKA), these highly individualized alignment strategies can be precisely applied. Intraoperative virtual component placement allows for real-time simulation of postoperative alignment and gap balance. Using rTKA, the intraoperative plan is executed with high precision, thus targeted component alignment is achieved accurately and alignment outliers are significantly reduced compared to conventional TKA. This article summarizes current evidence on constitutional knee phenotypes and alternative alignment strategies. Finally, we propose an approach for the application of CPAK classification in total knee arthroplasty using robotic technology.
Abbreviations
- AA:
-
Anatomisches Alignment
- aHKA:
-
„Arithmetic hip-knee-ankle angle“
- CPAK:
-
„Coronal plane alignment of the knee“
- FA:
-
Funktionelles Alignment
- JLO:
-
„Joint line obliquity“, Gelenklinienneigung
- KA:
-
Kinematisches Alignment
- KTEP:
-
Knietotalendoprothese
- LDFA:
-
Lateraler distaler Femurwinkel
- MA:
-
Mechanisches Alignment
- MPTA:
-
Medialer proximaler Tibiawinkel
- rKA:
-
„Restricted“ kinematisches Alignment
- rTKA:
-
Roboterassistierte KTEP-Implantation
- TKA:
-
„Total knee arthroplasty“, KTEP-Implantation
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R. Stauss, P. Savov und M. Ettinger geben an, dass kein Interessenkonflikt besteht.
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Stauss, R., Savov, P. & Ettinger, M. Roboterassistierte Knieendoprothetik. Knie J. (2024). https://doi.org/10.1007/s43205-024-00261-y
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DOI: https://doi.org/10.1007/s43205-024-00261-y
Schlüsselwörter
- Kniephänotypen
- Patientenspezifisches Alignment
- Kinematisches Alignment
- Funktionelles Alignment
- Roboterassistierte Knieendoprothetik