Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?

Current limitations in total knee arthroplasty (TKA) function and patient satisfaction stimulated us to question our practice. Our understanding of knee anatomy and biomechanics has evolved over recent years as we now consider that a more personalized joint reconstruction may be a better-targeted goal for TKA. Implant design and surgical techniques must be advanced to better reproduce the anatomy and kinematics of native knees and ultimately provide a forgotten joint. The availability of precision tools as robotic assistance surgery can help us recreate patient anatomy and ensure components are not implanted in a position that may compromise long-term outcomes. Robotic-assisted surgery is gaining in popularity and may be the future of orthopedic surgery. However, moving away from the concept of neutrally aligning every TKA dogma opens the door to new techniques emergence based on opinion and experience and leads to a certain amount of uncertainty among knee surgeons. Hence, it is important to clearly describe each technique and analyze their potential impacts and benefits. Personalized TKA techniques may be classified into 2 main families: unrestricted or restricted component orientation. In the restricted group, some will aim to reproduce native ligament laxity versus aiming for ligament isometry. When outside of their boundaries, all restricted techniques will induce anatomical changes. Similarly, most native knee having asymmetric ligaments laxity between compartments and within the same compartment during the arc of flexion; aiming for ligament isometry induces bony anatomy changes. In the current paper, we will summarize and discuss the impacts of the different robotic personalized alignment techniques, including kinematic alignment (KA), restricted kinematic alignment (rKA), inverse kinematic alignment (iKA), and functional alignment (FA). With every surgical technique, there are limitations and shortcomings. As our implants are still far from the native knee, it is primordial to understand the impacts and benefits of each technique. Mid to long data will help us in defining the new standards.

Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts.

Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a "forgotten" joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient's abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others.