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Alignment concept: Total Knee Replacement

by Blogs for Doctors

Personalized Alignment in Total Knee Replacement

A Shift from One-Size-Fits-All

Total Knee Arthroplasty (TKA) has undergone a major evolution—from focusing on generic mechanical alignment to modern, personalized alignment strategies. Dr. Ulhas Sonar, a globally trained orthopedic surgeon, shares insights into how understanding joint anatomy and using technology can lead to better surgical outcomes.

From Mechanical to Personalized Alignment

Traditional mechanical alignment aimed to achieve a neutral 180° hip-knee-ankle (HKA) axis. While it offers good implant survival, it doesn’t reflect natural limb variations and may compromise function in some patients. Studies have shown many people naturally fall outside the “neutral” alignment range.

Newer Concepts: Kinematic, Inverse Kinematic & Functional Alignment

Modern alignment techniques—like Kinematic Alignment (KA) and Inverse KA—strive to replicate the patient’s pre-arthritic anatomy by resurfacing bone and preserving soft tissue. Restricted KA adds safety limits to avoid overloading implants, while Functional Alignment uses robotic systems to balance implants around native soft-tissue tension in real-time.

The Role of Technology

With robotic-assisted systems and computer navigation, surgeons can now plan precise resections, adjust for gap balancing, and reduce soft-tissue damage. This shift improves patient satisfaction, functional scores, and may reduce revision risks over time.

Conclusion:

The future of knee replacement is personalized. By understanding individual anatomy and combining it with cutting-edge surgical tools, TKA outcomes are becoming more functional, durable, and patient-friendly than ever.

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The Evolution of TKR Implants

by Blogs for Doctors

The Evolution of TKR Implants

Advancing Toward Precision and Performance

Total Knee Replacement (TKR) implants have come a long way from the early days of hinge prostheses to today’s advanced, patient-specific systems. In this blog, Dr. Ulhas Sonar, a UK-trained orthopedic surgeon, provides a concise overview of how TKR implant design has evolved to enhance stability, longevity, and patient satisfaction.

From Hinges to Modularity

Early implants like the Walldius hinge and McIntosh designs were simple and rigid. Over time, the need for anatomical movement and joint stability led to innovations like the Total Condylar Prosthesis and femoral rollback mechanisms, improving function and wear resistance.

Design Philosophies

Modern implants are designed around concepts of modularity, constraint, and stability. Options now range from cruciate-retaining (CR) to posterior-stabilized (PS), and more constrained or hinged models — each suited for different anatomical and clinical needs.

Key Advancements

  • Mobile-bearing designs reduce wear and enhance mobility.
  • Highly congruent liners and rotating-hinge systems improve patellar tracking and soft tissue balance.
  • Patient-specific instrumentation (PSI) allows for more personalized and precise alignment.

Data-Driven Choices

UK NJR (National Joint Registry) data supports newer designs like PFC Sigma (Depuy), NexGen (Zimmer), and Triathlon (Stryker) for their improved outcomes in flexibility, longevity, and anatomical compatibility.

Conclusion:

The evolution of TKR implants reflects a shift toward personalization, functionality, and surgical flexibility. With a range of implant types tailored to individual cases, modern knee replacements offer better outcomes and quicker recoveries than ever before.

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Steps in Total Knee Replacement

by Blogs for Doctors

Steps in Total Knee Replacement

A Surgical Overview by Dr. Ulhas Sonar

Total Knee Replacement (TKR) is a complex yet highly rewarding procedure aimed at restoring mobility and relieving chronic pain in patients with severe knee arthritis or injury. Dr. Ulhas Sonar, a British-Indian orthopedic surgeon with global training, outlines a step-by-step guide to modern TKR, emphasizing precision, alignment, and patient-specific care.

Pre-operative Evaluation

The process begins with a thorough clinical examination, including assessment of skin condition, deformity correction, ligament stability, and range of motion. X-rays—ideally long-leg views—help assess bone quality and alignment.

  • A popping sound or sensation at injury
  • Swelling within hours
  • Instability — “giving way” feeling when walking

Positioning & Preparation

Patients are positioned supine, and a strict sterile protocol is followed with double prep, antibiotics, and theater discipline to minimize infection risk.

Key Surgical Goals

The technical objectives include achieving proper alignment, restoring joint line, balancing ligaments, and ensuring smooth patella tracking.

The Surgical Technique

  • Approach: Most commonly via the medial parapatellar approach.
  • Femur First: Involves removing osteophytes, using intramedullary alignment, and making accurate femoral cuts.
  • Tibia Preparation: Typically done using extramedullary referencing, ensuring proper slope and varus/valgus alignment.
  • Trialing & Balancing: Components are trialed to check fit, gaps, and tracking before final fixation.
  • Patella & Cementation: Patella is prepared, and components are cemented with careful handling.

Flexion & Extension Gap Management

Fine-tuning is done through balancing soft tissues and adjusting cuts. Scenarios like tight flexion or extension gaps are managed with augmentations or component adjustments.

Closure

The surgery concludes with layered closure in flexion, using appropriate dressings to support healing.

Conclusion:

TKR is a technical procedure, but with the right approach, attention to detail, and patient-specific planning, excellent outcomes are achievable. Dr. Ulhas Sonar’s systematic method ensures both new and experienced surgeons understand the balance between mechanics and clinical decision-making.

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