"Research progress on joint line reconstruction methods in total knee arthroplasty

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.