title: Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction.
abstract: Substantial healthcare resources have been devoted to computer navigation and patient-specific instrumentation systems that improve the reproducibility with which neutral mechanical alignment can be achieved following total knee replacement (TKR). This choice of alignment is based on the long-held tenet that the alignment of the limb post-operatively should be within 3° of a neutral mechanical axis. Several recent studies have demonstrated no significant difference in survivorship when comparing well aligned versus malaligned TKRs. Our aim was to review the anatomical alignment of the knee, the historical and contemporary data on a neutral mechanical axis in TKR, and the feasibility of kinematically-aligned TKRs. Review of the literature suggests that a neutral mechanical axis remains the optimal guide to alignment.
authors.affiliation: Mayo Clinic, Department of Orthopedic Surgery, 200 First Street SW, Rochester, Minnesota 55905, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Abdel
authors.affiliation: University College London Hospital, Department of Trauma and Orthopaedics, 235 Euston Road, London NW1 2BU, UK.
authors.forename: S
authors.initials: S
authors.lastname: Oussedik
authors.affiliation: Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Parratte
authors.affiliation: Service de Chirurgie Orthopédique, Centre Albert-Trillat, CHU de Lyon-Nord, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Lustig
authors.forename: F S
authors.initials: FS
authors.lastname: Haddad
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000592:standards; D001696:Biomechanical Phenomena; D017760:Bone Malalignment / Q000517:prevention & control; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D020370:Osteoarthritis, Knee / Q000601:surgery; D017755:Prosthesis Fitting; D012399:Rotation; D025321:Surgery, Computer-Assisted
keywords: Total knee replacement; Coronal alignment; Neutral mechanical alignment; Anatomic alignment; Kinematically aligned total knee replacement