Deciding upon the optimal coronal alignment for total knee arthroplasty (TKA) remains an area of debate. Mechanical alignment (MA), resulting in a horizontal joint line and neutral mechanical axis, has long been considered the ‘gold standard’ in TKA, and has demonstrated good long-term survivorship.1 Despite this long-term success, it is now recognised that the MA technique disregards any inter-individual variations in coronal alignment, and the biomechanical consequences of a ‘one-size-fits-all’ approach to TKA alignment.1
In the quest to improve patient satisfaction, some have suggested a more personalized technique that re-establishes the patient’s pre-arthritic constitutional alignment in an attempt to create a more natural feeling knee. However, at present there remain several unanswered questions about the most appropriate alignment targets, the optimal technique and patient selection. Such a gap in current knowledge emphasises the need for a “clear, simple and universal classification system for coronal alignment of the knee.”1
Follow the link to the open-access article on the Coronal Plane Alignment of the Knee (CPAK) classification. This framework can be used pre-operatively to help select those patients most likely to benefit from personalized TKA alignment.