Instrumentation and Technique

Are Mechanical Instruments Accurate Enough?
  • Peter S. Walker


Fundamental to the instrumentation and technique is a definition of the alignments of the bones of the lower extremity and accounting for the forces transmitted during activities. Lines or axes defined in the femur and tibia provide references for the bone cuts at the knee for component seating. Standard surgical techniques aim to restore the mechanical axis through the center of the knee with the joint line perpendicular. The guides are the intramedullary canal of the femur, and the external axis of the tibia from knee to ankle. In the sagittal view, a normal tibial slope achieves adequate flexion and avoids instability. Using mechanical instruments, a high percentage of cases are aligned to within 3 degrees, the follow-up evidence being that this is sufficiently accurate to avoid problems of abnormal force distribution. Consideration is currently being given to vary the frontal alignment to account for individual patient variations, by using kinematic alignment or other techniques. Computer-assisted surgery can produce advantages such as surgical simplicity or greater accuracy and optimal planning of component placement. Examples are patient-specific instrumentation (PSI), computer navigation, robot surgery, and inertial measurement units (IMUs) cutting guides. Soft tissue balancing is important, aided by tensors or electronic balancing devices. Studies are under way to determine if the newer techniques result in improved function.


Total knee technique Mechanical axis Anatomic axis Joint line Mechanical instrumentation Computer-assisted surgery Navigation PSI Robotic knee surgery Soft tissue balancing Ligament balancing Kinematic alignment Constitutional varus 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Peter S. Walker
    • 1
  1. 1.Department of Orthopedic SurgeryNew York UniversityNew YorkUSA

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