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COA/CAS Symposium: Total Knee Alignment - MA, is it the End of an Era? Questions & Answers
Description
This transcript documents a discussion about transitioning from mechanical alignment (MA) to kinematic alignment (KA) in total knee replacements, featuring insights from orthopedic surgeons Pascal-André Vendittoli, Charles Riviere, Glen Richardson, and Michael Dunbar.
The dialogue begins with Vendittoli acknowledging the common fears practitioners have regarding the transition to KA, which many perceive as complex. Riviere shares that the main challenge lies not in the technical execution of KA surgeries, but in grasping the philosophical shift required to understand KA. He notes that once one understands the rationale behind KA, they can appreciate and perform it more effectively.
Richardson discusses the complexity of teaching KA to residents, emphasizing that training benefits from navigation tools that visually demonstrate differences in surgical techniques. He reflects on how his own practice has changed to favor cruciate-retaining (CR) knee replacements, citing improvements in patient outcomes when adopting KA principles.
Dunbar adds that CR implants are more effective with KA and suggests that certain older designs may not work as well with KA due to their purpose of resolving MA issues. He expresses caution against prescriptiveness in implant design, advocating for a tailored approach based on patient-specific anatomical considerations.
The conversation covers various topics including the technical ease of KA, the importance of intra-articular anatomical landmarks, the significance of preserving bone, and how KA can simplify surgeries even in cases of severe varus and valgus deformities.
In the concluding remarks, Vendittoli reflects on the session, thanking the attendees and encouraging ongoing dialogue about the benefits of KA in orthopedic practice.