Abstract
This review discusses the correction of coronal deformity and intercompartmental imbalance
through bone resection in total knee arthroplasty (TKA). To achieve functional knee
balance, coronal, rotational, and sagittal alignment are critical to successful patient
outcomes. Though variations in coronal alignment are debated as a correlate to positive
results, advancements in utilizing implant position, alignment, and soft tissue balance
to improve patient outcomes and function are an evolving discussion. This study draws
upon existing literature, clinical studies, and surgical techniques related to TKA,
including advancements in navigation and robotics. The study highlights the importance
of individualized alignment strategies for varus and valgus knees. While mechanical
neutral alignment has shown excellent long-term data, reevaluating the anatomic recreation
of the patient's joint line obliquity is now being studied extensively. Sensor data
and navigation systems contribute to improved outcomes and patient satisfaction. The
evolution of navigation and robotics has led surgeons to achieve their target angles
consistently and accurately; now, the discussion is around the most effective alignment
targets. The classification of various phenotypes assists in the proposed starting
points for implant position, but soft tissue tension is required in the input data
to achieve global balance and stable motion. Each approach's advantages and limitations
are considered. In conclusion, achieving optimal coronal alignment, joint line obliquity,
and soft tissue balance is crucial for successful TKA outcomes. Personalized alignment
philosophies, supported by three-dimensional data and sensor technology, are evolving
to minimize critical errors and enhance functional results. Robotic assistance and
future advancements in artificial intelligence and machine learning hold promise for
further improving TKA outcomes in the quest for soft tissue stabilization.
Keywords
orthopaedics - total knee - robotics - ligament - balance
