1Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China; 2Department of Orthopedics, Peking University First Hospital TaiYuan Hospital, Taiyuan 030001, China
Abstract:Objective This study aimed to summarize the research progress on joint line reconstruction methods in total knee arthroplasty. Methods In the CNKI, Wanfang Data, and PubMed database, “关节线”“膝”“置换” and “knee” “replacement” and “joint line” were used as Chinese and English keywords to search for related studies from January 2008 to August 2022. A total of 711 articles were retrieved, and those with inconsistent content, low quality, duplication, low evidence level, and unavailable full text were excluded. In total, 53 articles were finally included and summarized. Results The common methods for the reconstruction of joint line inclination include mechanical alignment, anatomic alignment, kinematic alignment, and restricted kinematic alignment technique. The common anatomical landmarks that guide knee line reconstruction include the adductor tubercle, fibular head, tibial tubercle, and the medial and lateral condyles. The computer-aided navigation system was used to establish a three-dimensional skeletal model of the knee joint, determine the size of the prosthesis, and develop a surgical plan. The application of tracer technology can guide the precise osteotomy of the femur and tibia, which can improve the reconstruction of the joint line. The robot-assisted total knee arthroplasty system uses computer software to precisely execute the individualized surgical plan by using the intraoperative robotic device, thus improving the accuracy of knee line positioning. The 3D printing technology allows for the precise and individualized surgery by printing individualized knee models, creating osteotomy slot guides, and positioning nail guides, and spacer block tools with markers to guide intraoperative joint line positioning. Conclusion In total knee arthroplasty, according to the morphological characteristics of the patient's knee anatomical node, the selection of appropriate anatomical markers and alignment technology combined with computer-aided navigation technology, orthopedic robot surgery system, 3D printing technology, and other digital technologies, can improve the accuracy of the reconstruction of joint lines.
Bugelli G, Ascione F, Cazzella N, et al.Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2018,26(6):1831-1837. DOI: 10.1007/s00167-017-4828-8
[2]
Iacono F, Lo Presti M, Bruni D, et al.The adductor tubercle: a reliable landmark for analysing the level of the femorotibial joint line[J]. Knee Surg Sports Traumatol Arthrosc, 2013,21(12):2725-2729. DOI: 10.1007/s00167-012-2113-4
[3]
Maderbacher G, Keshmiri A, Schaumburger J, et al.Accuracy of bony landmarks for restoring the natural joint line in revision knee surgery: an MRI study[J]. Int Orthop, 2014,38(6):1173-1181. DOI: 10.1007/s00264-014-2292-3
[4]
van Lieshout W, Valkering KP, Koenraadt K, et al. The negative effect of joint line elevation after total knee arthroplasty on outcome[J]. Knee Surg Sports Traumatol Arthrosc, 2019,27(5):1477-1486. DOI: 10.1007/s00167-018-5099-8
[5]
Han HS, Yu CH, Shin N, et al.Femoral joint line restoration is a major determinant of postoperative range of motion in revision total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2019,27(7):2090-2095. DOI: 10.1007/s00167-019-05361-1
[6]
Malito LG, Arevalo S, Kozak A, et al.Material properties of ultra-high molecular weight polyethylene: comparison of tension, compression, nanomechanics and microstructure across clinical formulations[J]. J Mech Behav Biomed Mater, 2018,83:9-19. DOI: 10.1016/j.jmbbm.2018.03.029
[7]
Lin KJ, Wei HW, Huang CH, et al.Change in collateral ligament length and tibiofemoral movement following joint line variation in TKA[J]. Knee Surg Sports Traumatol Arthrosc, 2016,24(8):2498-2505. DOI: 10.1007/s00167-014-3400-z
[8]
Gómez-Vallejo J, Albareda-Albareda J, Seral-García B, et al.The importance of the restoration of the joint line in revision total knee arthroplasty. Clinical indexes, quality of life and survival[J]. Acta Ortop Mex, 2017,31(5):222-227
[9]
Luyckx T, Vandenneucker H, Ing LS, et al.Raising the joint line in TKA is associated with mid-flexion laxity: a study in cadaver knees[J]. Clin Orthop Relat Res, 2018,476(3):601-611. DOI: 10.1007/s11999.0000000000000067
[10]
Konrads C, Rejaibia J, Grosse LC, et al.Patella-height analysis and correlation with clinical outcome after primary total knee arthroplasty[J]. J Orthop, 2021,23:169-174. DOI: 10.1016/j.jor.2021.01.001
[11]
Minoda Y, Sugama R, Ohta Y, et al.Joint line elevation is not associated with mid-flexion laxity in patients with varus osteoarthritis after total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2020,28(10):3226-3231. DOI: 10.1007/s00167-019-05828-1
[12]
Tanaka Y, Nakamura S, Kuriyama S, et al.Medial tilting of the joint line in posterior stabilized total knee arthroplasty increases contact force and stress[J]. Clin Biomech (Bristol, Avon), 2018,53:54-59. DOI: 10.1016/j.clinbiomech.2018.02.008
[13]
高振中, 向川. 关节线位置对初次全膝关节置换术及关节置换翻修术后功能的影响[J].中华骨科杂志,2020,40(8):553-560. DOI:10.3760/cma.j.cn121113-20191204-00485.Gao ZZ, Xiang C.The clinical significance of joint line in primary total knee arthroplasty and revision total knee arthroplasty[J].Chin J Orthop,2020, 40(8):553-560. DOI:10.3760/cma.j.cn121113-20191204-00485
[14]
潘浩, 赵慧慧, 王江静, 等. 运动学对线与机械力学对线指导全膝关节置换后步态分析的比较[J].中国组织工程研究,2022,26(3):365-370. DOI: 10.12307/2022.060.Pan H, Zhao HH, Wang JJ, et al.Comparison of kinematic alignment and mechanical alignment to guide gait after total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(3): 365-370. DOI:10.12307/2022.060
Almaawi AM, Hutt J, Masse V, et al.The Impact of mechanical and restricted kinematic alignment on knee anatomy in total knee arthroplasty[J]. J Arthroplasty, 2017,32(7):2133-2140. DOI: 10.1016/j.arth.2017.02.028
[17]
马德思, 王志为, 温亮, 等. 运动学及机械对线全膝关节置换术早期临床结果对比[J].中华关节外科杂志(电子版),2021,15(2):163-170. DOI: 10.3877/cma.j.issn.1674-134X.2021.02.006.Ma DS, Wang ZW, Wen L, et al.Comparison of early clinical outcomes of kinematic and mechanical alignments in total knee arthroplasty[J]. Chin J Joint Surg (Electronic Edition),2021,15(2):163-170. DOI: 10.3877/cma.j.issn.1674-134X.2021.02.006
[18]
郑恺, 孙厚义, 张韦成, 等. 导航辅助下全膝关节置换术的力线重建选择研究进展[J].中华骨与关节外科杂志,2022,15(5):395-400. DOI:10.3969/j.issn.2095-9958.2022.05.12.Zheng K, Sun HY, Zhang WC, et al.Progress of alignment techniques in computer navigation assisted total knee arthroplasty[J]. Chin J Bone Joint Surg, 2022,15(5):395-400.DOI:10.3969/j.issn.2095-9958.2022.05.12
[19]
Iacono F, Raspugli GF, Filardo G, et al.The adductor tubercle: an important landmark to determine the joint line level in revision total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2016,24(10):3212-3217. DOI: 10.1007/s00167-015-3556-1
[20]
Yeh KT, Chen IH, Wang CC, et al.The adductor tubercle can be a radiographic landmark for joint line position determination: an anatomic-radiographic correlation study[J]. J Orthop Surg Res, 2019,14(1):189. DOI: 10.1186/s13018-019-1221-y
[21]
Iacono F, Raspugli GF, Bruni D, et al.The adductor tubercle as an important landmark to determine the joint line level in total knee arthroplasty: from radiographs to surgical theatre[J]. Knee Surg Sports Traumatol Arthrosc, 2014,22(12):3034-3038. DOI: 10.1007/s00167-013-2809-0
[22]
Fan A, Xu T, Li X, et al.Using anatomical landmarks to calculate the normal joint line position in Chinese people: an observational study[J]. J Orthop Surg Res, 2018,13(1):261. DOI: 10.1186/s13018-018-0963-2
[23]
Sadaka C, Kabalan Z, Hoyek F, et al.Joint line restoration during revision total knee arthroplasty: an accurate and reliable method[J]. Springerplus, 2015,4:736. DOI: 10.1186/s40064-015-1543-0
[24]
Maderbacher G, Keshmiri A, Zeman F, et al.Assessing joint line positions by means of the contralateral knee: a new approach for planning knee revision surgery?[J]. Knee Surg Sports Traumatol Arthrosc, 2015,23(11):3244-3250. DOI: 10.1007/s00167-014-3157-4
[25]
Hodel S, Calek AK, Fürnstahl P, et al.Accuracy of joint line restoration based on three-dimensional registration of the contralateral tibial tuberosity and the fibular tip[J]. J Exp Orthop, 2021,8(1):84. DOI: 10.1186/s40634-021-00400-8
[26]
Pereira GC, von Kaeppler E, Alaia MJ, et al. Calculating the position of the joint line of the knee using anatomical landmarks[J]. Orthopedics, 2016,39(6):381-386. DOI: 10.3928/01477447-20160729-01
[27]
Agrawal VO, Gadekar AP, Vaidya N.Does robotic technology successfully restore the joint line after total knee arthroplasty? A retrospective analysis[J]. Arthroplasty, 2022,4(1):6. DOI: 10.1186/s42836-021-00103-6
[28]
Tang Q, Zhou Y, Yang D, et al.The knee joint line position measured from the tibial side in Chinese people[J]. J Arthroplasty, 2011,26(7):989-993. DOI: 10.1016/j.arth.2011.02.027
[29]
Servien E, Viskontas D, Giuffrè BM, et al.Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2008,16(3):263-269. DOI: 10.1007/s00167-007-0449-y
[30]
Akça MÇ, Akalın Y, Çevik N, et al.Joint line reestablishment in revision total knee arthroplasty[J]. Arthroplasty, 2020,2(1):27. DOI: 10.1186/s42836-020-00046-4
[31]
Lee M, Ho J, Chen JY, et al.The relationship of transepicondylar width with the distal and posterior femoral condyles and its clinical implications: a three-dimensional study[J]. J Knee Surg, 2022,35(3):280-287. DOI: 10.1055/s-0040-1713733
[32]
Ozkurt B, Sen T, Cankaya D, et al.The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty[J]. Bone Joint Res, 2016,5(7):280-286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1
[33]
Bieger R, Huch K, Kocak S, et al.The influence of joint line restoration on the results of revision total knee arthroplasty: comparison between distance and ratio-methods[J]. Arch Orthop Trauma Surg, 2014,134(4):537-541. DOI: 10.1007/s00402-014-1953-4
[34]
Xiao J, Wang S, Chen W, et al.A study to assess the accuracy of adductor tubercle as a reliable landmark used to determine the joint line of the knee in a Chinese population[J]. J Arthroplasty, 2017,32(4):1351-1355. DOI: 10.1016/j.arth.2016.10.002
[35]
Gao Z, Mao X, Xiang C, et al.An accurate method for locating the joint line during revision total knee arthroplasty: a radiologic study in the Chinese population[J]. Knee, 2021,29:510-519. DOI: 10.1016/j.knee.2021.03.003
[36]
Laoruengthana A, Rattanaprichavej P, Tantimethanon T, et al.Usefulness of an accelerometer-based navigation system in bilateral one-stage total knee arthroplasty[J]. BMC Musculoskelet Disord, 2021,22(1):164. DOI: 10.1186/s12891-021-04027-9
[37]
Minoda Y, Hayakawa K, Hagio K, et al.Usefulness of an accelerometer-based portable navigation system for total knee arthroplasty: a multicenter prospective randomized controlled trial[J]. J Bone Joint Surg Am, 2020,102(22):1993-2000. DOI: 10.2106/JBJS.20.00387
[38]
Deep K, Shankar S, Mahendra A.Computer assisted navigation in total knee and hip arthroplasty[J]. SICOT J, 2017,3:50. DOI: 10.1051/sicotj/2017034
[39]
Kim YH, Park JW, Kim JS.The clinical outcome of computer-navigated compared with conventional knee arthroplasty in the same patients: a prospective, randomized, double-blind, long-term study[J]. J Bone Joint Surg Am, 2017,99(12):989-996. DOI: 10.2106/JBJS.16.00791
[40]
Ochs BG, Schreiner AJ, de Zwart PM, et al. Computer-assisted navigation is beneficial both in primary and revision surgery with modular rotating-hinge knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2016,24(1):64-73. DOI: 10.1007/s00167-014-3316-7
[41]
Huang TW, Chuang PY, Lee CY, et al.Total knee arthroplasty in patients with Ranawat type-II valgus arthritic knee with a marked coronal femoral bowing deformity: comparison between computer-assisted surgery and intra-articular resection[J]. J Orthop Surg Res, 2016,11(1):88. DOI: 10.1186/s13018-016-0422-x
[42]
Brown MJ, Matthews JR, Bayers-Thering MT, et al.Low incidence of postoperative complications with navigated total knee arthroplasty[J]. J Arthroplasty, 2017,32(7):2120-2126. DOI: 10.1016/j.arth.2017.01.045
[43]
Siddiqi A, Hardaker WM, Eachempati KK, et al.Advances in computer-aided technology for total knee arthroplasty[J]. Orthopedics, 2017,40(6):338-352. DOI: 10.3928/01477447-20170831-02
[44]
Kalavrytinos D, Koutserimpas C, Kalavrytinos I, et al.Expanding robotic arm-assisted knee surgery: the first attempt to use the system for knee revision arthroplasty[J]. Case Rep Orthop, 2020,2020:4806987. DOI: 10.1155/2020/4806987
[45]
Vaidya NV, Deshpande AN, Panjwani T, et al.Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial[J]. Knee Surg Sports Traumatol Arthrosc, 2022,30(2):621-626. DOI: 10.1007/s00167-020-06353-2
[46]
Kayani B, Konan S, Tahmassebi J, et al. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study[J]. Bone Joint J, 2018,100-B(7):930-937. DOI: 10.1302/0301-620X.100B7.BJJ-2017-1449.R1
[47]
Zambianchi F, Bazzan G, Marcovigi A, et al.Joint line is restored in robotic-arm-assisted total knee arthroplasty performed with a tibia-based functional alignment[J]. Arch Orthop Trauma Surg, 2021,141(12):2175-2184. DOI: 10.1007/s00402-021-04039-z
[48]
Kayani B, Konan S, Ayuob A, et al.The current role of robotics in total hip arthroplasty[J]. EFORT Open Rev, 2019,4(11):618-625. DOI: 10.1302/2058-5241.4.180088
温亮, 王志为. 个体化导板辅助全膝关节置换运动学对线技术[J].中华关节外科杂志(电子版),2020,14(1):85-91. DOI: 10.3877/cma.j.issn.1674-134X.2020.01.015.Wen L, Wang ZW.Kinematic alignment in total knee arthroplasty with patient-specific instrumentation.[J/CD]. Chin J Joint Surg (Electronic Edition), 2020, 14(1): 85-91. DOI: 10.3877 /cma.j.issn.1674-134X. 2020. 01. 015
[51]
León-Muñoz VJ, Parrinello A, López-López M, et al.Revision of total knee arthroplasty with the use of patient-specific instruments: an alternative surgical technique[J]. Expert Rev Med Devices, 2020,17(8):795-806. DOI: 10.1080/17434440.2020.1803737
[52]
陈坚锋, 冯宗权, 李知浩. 3D打印定位钉导板在全膝关节置换术中的应用[J].中国矫形外科杂志,2021,29(9):852-855. DOI:10.3977/j.issn.1005-8478.2021.09.19.Chen JF, Feng ZQ, Li ZH.3D printed guider used in total knee arthroplasty[J].Orthopedic Journal of China.2021,29(9):852-855. DOI:10.3977/j.issn.1005-8478.2021.09.19
[53]
Gungor HR, Ok N.Use of a spacer block tool for assessment of joint line position during revision total knee arthroplasty[J]. J Knee Surg, 2022,35(11):1260-1267. DOI: 10.1055/s-0040-1722628