Key Takeaways & Executive Findings
- •• The United States leads in total knee arthroplasty alignment research, with the University of California as the top institution and Howell, Stephen M as the most prolific author. • Kinematic alignment and robotic navigation are emerging as key research hotspots in total knee arthroplasty alignment techniques. • Despite advances in computer-assisted navigation and patient-specific instrumentation, no optimal alignment technique has been universally accepted. • Future research should focus on robot-assisted navigation, patient satisfaction, long-term survival, and patient-specific alignment to improve outcomes.
Abstract
BACKGROUND: Some patients report dissatisfaction after total knee arthroplasty due to persistent issues like limited mobility, joint instability, and residual pain. To address these challenges, various osteotomy methods and alignment strategies have been proposed and clinically implemented. However, the optimal approach remains debated, with no clear consensus. OBJECTIVE: To comprehensively analyze global trends in alignment techniques for total knee arthroplasty and identify research hotspots through bibliometric and visual analysis, offering evidence-based insights to guide clinical decision-making. METHODS: We retrieved publications (articles and reviews) on total knee arthroplasty alignment techniques published between January 1, 2015 and December 31, 2024, from the Web of Science database (https://www.webofscience.com, developed by the Institute for Scientific Information, USA). Data on countries, institutions, publication years, authors, journals, mean citation rates, H-index, titles, keywords, and the top 25 most-cited articles were extracted and analyzed. VOSviewer and Citespace software were used to analyze keyword co-occurrence and predict research hotspots. RESULTS AND CONCLUSION: A total of 866 publications were identified, including 792 articles and 74 reviews. The United States had the highest number of publications, with the University of California being the most prolific institution and Howell, Stephen M being the most prolific author. The journal 'Knee Surgery Sports Traumatology Arthroscopy' had the highest publication and citation counts. Common keywords included total knee arthroplasty, alignment technique, arthroplasty, clinical outcomes, and survival rate. Keyword and reference burst detection indicated that kinematic alignment and robotic navigation are future research hotspots. The number of publications on total knee arthroplasty alignment techniques is increasing annually. The United States is currently the leading contributor, followed by the United Kingdom. Increasingly precise tools, such as computer-assisted navigation and patient-specific instrumentation, are being developed and applied to achieve alignment goals, but no optimal solution has yet been established. Future research frontiers may include 'robot-assisted navigation', 'patient satisfaction', 'long-term survival', 'indication range', and 'patient-specific alignment'.
1. Introduction
Total knee arthroplasty (TKA) is one of the most effective treatments for end-stage knee osteoarthritis, with surgical technique and implant positioning significantly influencing outcomes. However, patient satisfaction after TKA varies, and lower limb alignment and knee range of motion are critical factors affecting postoperative satisfaction. For nearly three decades, mechanical alignment has been the gold standard, emphasizing standardized osteotomy perpendicular to the mechanical axis to restore neutral alignment and evenly distribute stress, thereby reducing polyethylene wear and extending implant survival. Nevertheless, this approach may disrupt anatomical structures and rely on soft tissue releases, potentially contributing to lower satisfaction.
In recent years, kinematic alignment has emerged as an alternative, aiming to restore the patient's pre-arthritic anatomy and kinematics by precisely positioning the femoral and tibial components to match the knee's natural flexion-extension axis, rotational alignment, and patellar tracking. Other techniques, such as anatomical alignment, adjusted mechanical alignment, and functional alignment, have also been introduced with promising clinical results. However, consensus on the optimal alignment technique remains elusive, making it a hot topic in knee arthroplasty research.
Bibliometric analysis, using mathematical and statistical methods, provides a quantitative assessment of research trends and hotspots. This study aims to evaluate the current research landscape of TKA alignment techniques, compare contributions from different countries, institutions, and authors, and predict future research directions to inform clinical decision-making.
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Lin Haishan, Wang Wei, Ding Xuming, Wang Jindong, Wang Yaohua (2026). Total knee arthroplasty alignment technology: visual analysis of the latest research hotspots. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21700
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Frequently Asked Questions
What are the main alignment techniques in total knee arthroplasty?
The main alignment techniques include mechanical alignment, kinematic alignment, anatomical alignment, adjusted mechanical alignment, and functional alignment. Mechanical alignment has been the traditional gold standard, while kinematic alignment aims to restore pre-arthritic anatomy and kinematics. Other techniques are variations or combinations of these principles.
Which country leads in research on total knee arthroplasty alignment?
According to the bibliometric analysis, the United States has the highest number of publications on total knee arthroplasty alignment techniques, followed by the United Kingdom. The University of California is the most prolific institution, and Howell, Stephen M is the most prolific author.
What are the current research hotspots in total knee arthroplasty alignment?
Current research hotspots include kinematic alignment, robotic navigation, patient-specific instrumentation, and functional alignment. These topics are gaining attention due to their potential to improve patient satisfaction and long-term outcomes.
Is there a consensus on the best alignment technique for total knee arthroplasty?
No, there is no consensus on the best alignment technique. While mechanical alignment has been the standard, kinematic and other techniques have shown promising results. The choice of technique may depend on individual patient anatomy and surgeon preference, and further research is needed to determine the optimal approach.
What future trends are predicted in total knee arthroplasty alignment research?
Future trends likely include increased use of robotic-assisted navigation, focus on patient satisfaction and long-term survival, expansion of indications for various alignment techniques, and development of patient-specific alignment strategies to optimize outcomes.
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