The combination of a medial pivot design with kinematic alignment principles in total knee arthroplasty can ensure a closer to normal knee kinematics than combining mechanical alignment and more traditional implant designs: An umbrella review

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-18 DOI:10.1002/jeo2.70358

Pier F. Indelli, Bruno Violante, Pawel Skowronek, Marko Ostojić, Nicolas Bouguennec, Giuseppe Aloisi, Christian Schaller, Giuseppe U. Longo

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引用次数: 0

Abstract

Purpose

The recent introduction of personalized alignment strategies in total knee arthroplasty (TKA) has transformed adult reconstruction. Proponents advocate for these techniques due to their kinematic benefits compared to traditional methods. Current literature supports combining medial-pivot designs with kinematic alignment (KA) surgery. This review summarizes the application of gait analysis in KA medial-pivot TKA and recommends gait parameters related to patient satisfaction.

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). One hundred twenty-one articles from the three search engines underwent a preliminary title/abstract and full-text screening. The final screening resulted in 23 systematic reviews (SR), meta-analyses (M-A) and narrative reviews (NR) as core articles of the current umbrella review.

Results

Out of the original 121 SR/M-A/NR articles, 23 (19%) were ultimately evaluated based on the reported results. Twelve articles fell into the first category (gait analysis following TKA as the main topic), five articles were designated for the second category (knee implant design), only one article was classified in the third category (kinematic alignment) and five articles were assigned to the fourth category (a combination of all main topics).

Conclusions

The literature investigating the relationship between kinematic and spatiotemporal data and clinical outcomes following KA medial pivot TKA is limited. Few studies included in the current review showed that remote measurements using wearable sensors are more informative than patients' reported outcome measurements (PROMs) regarding a patient's daily level of activities and, ultimately, gait. The current review demonstrated that combining KA and MP designs can ensure a knee kinematic closer to normal than combining MA and more traditional implant designs.

Level of Evidence

Level I.

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在全膝关节置换术中，将内侧支点设计与运动学对齐原则相结合，比将机械对齐与更传统的植入物设计相结合，可以确保更接近正常的膝关节运动学

目的：最近在全膝关节置换术（TKA）中引入的个性化对齐策略已经改变了成人的重建。由于与传统方法相比，这些技术具有运动学优势，因此支持者提倡这些技术。目前的文献支持将内枢轴设计与运动学对齐（KA）手术相结合。本文综述了步态分析在KA - medial-pivot TKA中的应用，并推荐了与患者满意度相关的步态参数。方法本综述遵循系统评价首选报告项目和meta分析扩展范围评价（PRISMA-ScR）。来自三个搜索引擎的121篇文章进行了初步的标题/摘要和全文筛选。最终筛选产生了23篇系统综述（SR）、元分析（M-A）和叙述性综述（NR），作为当前总括性综述的核心文章。在最初的121篇SR/M-A/NR文章中，23篇（19%）最终根据报告的结果进行了评估。12篇文章属于第一类（以TKA为主要主题的步态分析），5篇文章被指定为第二类（膝关节植入物设计），只有1篇文章被分类为第三类（运动学对齐），5篇文章被分配到第四类（所有主要主题的组合）。结论研究枢椎体置换术后运动学和时空数据与临床结果之间关系的文献有限。当前综述中包含的一些研究表明，使用可穿戴传感器的远程测量比患者报告的结果测量（PROMs）更能提供关于患者日常活动水平和最终步态的信息。目前的研究表明，与结合MA和更传统的假体设计相比，结合KA和MP设计可以确保膝关节运动学更接近正常。证据等级一级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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