Coronal alignment in total knee arthroplasty: a review.

Total knee arthroplasty (TKA) alignment has recently become a hot topic in the orthopedics arthroplasty literature. Coronal plane alignment especially has gained increasing attention since it is considered a cornerstone for improved clinical outcomes. Various alignment techniques have been described, but none proved to be optimal and there is a lack of general consensus on which alignment provides best results. The aim of this narrative review is to describe the different types of coronal alignments in TKA, correctly defining the main principles and terms.

Total knee arthroplasty after complex tibial plateau fractures.

Total knee arthroplasty following complex fractures of the tibial plateau is considered a challenge for orthopaedic surgeons and clinical outcomes may vary. A total of 29 total knee replacements were performed after a tibial plateau fracture: 25 patients (16 women, 9 men; average age: 57 years; mean follow-up: 92 months) were available. We had two significative complications: one partial avulsion of the patellar tendon, conservatively treated by bracing, and one case of deep venous thromboembolism, managed with low molecular weight heparin. In two cases (8%) there was a failure of the implant; nine cases were excellent, nine good, four fair and one poor. A percentage of patients with previous complex proximal tibia fractures had an increased rate of postoperative complications due to anatomical deformity, functional deficiency and post-traumatic arthritis and required solutions similar to revision surgery. Total knee arthroplasty is a suitable solution for the treatment of these challenging cases: compared to primary knee replacement, final KSS score is generally lower, but improvement is similar due to poorer pre-operative scores.