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Purpose: The purpose of this systematic review was to compare patient satisfaction patient‐reported outcomes (PROMs) levels after mechanically aligned (MA) and kinematically aligned (KA) total knee arthroplasty (TKA). Methods: A systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of March 2013 until the end of October 2023. Only articles reporting satisfaction after KA TKA, MA TKA or both were included, which use valid and reliable tools for the evaluation and reporting of satisfaction after TKA. Title, authors, year of publication, study design, level of evidence, follow‐up period, patients' demographic data, sample size, type of satisfaction score, postoperative satisfaction score, postoperative alignment, statistical significance, as well as other variables, were extracted for analysis. An Agency for Healthcare Research and Quality's (AHRQ) design‐specific scale was used for assessing randomized control trials (RCTs). The nonrandomized control trials were evaluated by using the Joanna Briggs Institute's (JBI) Critical Appraisal Tool. The Newcastle‐Ottawa Scale (NOS) was also used to assess cohort studies, while case series were evaluated using the NIH Quality Assessment Tool for Case Series Studies. Results: The initial search identified 316 studies, of which 178 were considered for screening. Eleven studies completely fulfilled the inclusion criteria, including one RCT, five nonrandomized control trials/quasi‐experiments, three case series, and two cohort studies. The total number of patients recruited for MA TKA was 1740. Conversely, 497 patients were enrolled for KA TKA. Five studies used the visual analogue scale (VAS) for assessing postoperative patient satisfaction, four used the Knee Society Score (KSS) 2011 version and two Likert‐based types of scores. Overall, the highest mean satisfaction score of KSS 2011 was 31.5 ± 6.6 in the MA group, and 29.8 ± 80 in the KA group in four studies. All of them showed high postoperative patient satisfaction rates for both MA and KA TKA, but with no statistically significant difference between them (p > 0.05). Conclusion: Both mechanically aligned total knee arthroplasty, as well as kinematically aligned total knee arthroplasty led to high rates of postoperative patient satisfaction, with no statistically significant differences between them. Level of Evidence: Level III, systematic review. [ABSTRACT FROM AUTHOR]

Purpose: One of the most common types of coronal plane alignment of the knee (CPAK) is type I, which is characterised by varus alignment and apex distal joint line obliquity. The purpose of this study was to evaluate the association of changes in arithmetic hip–knee–ankle angle (aHKA) with both postoperative joint laxity and patient‐reported outcome measures (PROMs) in patients with CPAK type I following mechanical alignment (MA) total knee arthroplasty (TKA). Methods: Of 111 consecutive knees in 92 patients with osteoarthritis who underwent primary TKA, 80 knees (72.0%) with CPAK type I phenotype preoperatively were evaluated. All TKAs were performed to achieve neutral MA by a medial stabilising gap balancing technique. Pre‐ to postoperative change in aHKA was defined as ΔaHKA. The 80 CPAK type I knees were divided into a larger ΔaHKA group (>7°) and a smaller ΔaHKA group (≤7°). PROMs, including the Knee Society Score and Forgotten Joint Score‐12, were assessed before and 2 years after surgery. Pre‐ and postoperative joint laxity was assessed using a Telos arthrometer. Results: Twenty‐two knees showed a larger ΔaHKA, and postoperative lateral joint laxity in varus stress was significantly greater in these patients than in those with a smaller ΔaHKA (6.8° vs. 4.5°, p = 0.006). There were no significant differences between the groups in PROMs (p = n.s.). Conclusions: Postoperative lateral laxity was associated with larger aHKA changes than smaller aHKA changes in CPAK type I knees after TKA. However, no statistically significant differences in PROMs were found according to the amount of change in aHKA. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the differences in lower limb global alignment and anatomical parameters of coronal whole‐leg radiographs, which were generally used in preoperative planning for high tibial osteotomy (HTO), according to different weight‐bearing standing positions. Methods: Between April 2021 and December 2022, 176 patients (60 males and 116 females) were investigated. Full‐weight‐bearing coronal whole‐leg radiographs were obtained with the patella centred on the femoral condyle. Patients were divided by Kellgren–Lawrence grade (KL‐0, KL‐I, KL‐II and KL‐III) and assessed in two standing positions: legs closed and legs spread. Patients with flexion contractures or those unable to stand with full weight bearing were excluded. The mechanical distal femoral angle, medial proximal tibial angle (MPTA), femorotibial angle, joint line convergence angle, percentage weight‐bearing line (%WBL) and hip‐knee‐ankle angle (HKAA) were measured. The Student's t test was used to compare the two standing positions. A p value < 0.05 indicated a statistically significant difference. Results: The MPTAs of legs closed standing and legs spread standing were 84.9 ± 2.6° and 85.1 ± 2.4° in KL‐0, 84.7 ± 2.0° and 84.9 ± 2.1° in KL‐I and 85.0 ± 2.43° and 85.4 ± 2.4° in KL‐II, respectively. There were statistically significant differences in the MPTA between the two standing positions in KL‐0, KL‐I and KL‐II. In contrast, the %WBL and HKAA did not change regardless of the standing position. In the KL‐III group, no statistical significance was observed for any of the anatomical parameters. Conclusion: Several anatomical parameters were changed between the legs closed standing and the legs spread standing positions. It was suggested that the standing position should be taken into consideration in the planning for HTO. Level of Evidence: Level IV, Case series with no comparison group. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to investigate the relationship between the amount of femorotibial alignment correction and the amount of improvement of hindfoot alignment in total knee arthroplasty (TKA). Methods: A total of 159 knees undergoing TKA in 120 patients were assessed preoperatively and at 2 weeks, 1 month, 3 months and 6 months postoperatively. Standing hindfoot alignment was evaluated using the leg‐heel angle (LHA). The amount of change in hindfoot alignment was compared between patients with severe varus knee (Group 1) and those with moderate varus, neutral or valgus knee (Group 2). Results: The mean values of pre‐ and postoperative hip‐knee‐ankle (HKA) angle were −14 ± 4° and −1 ± 3° in Group 1 and −7 ± 5° and −1 ± 3° in Group 2, respectively. The differences between pre‐ and postoperative LHA were significantly larger in Group 1 than in Group 2 at 2 weeks, 1 month and 3 months postoperatively (p = 0.006, 0.001 and 0.03, respectively). At 6 months postoperatively, no differences were observed between the two groups (p = 0.31). Conclusion: The amount of change in hindfoot alignment was larger in Group 1 than in Group 2 at 2 weeks, 1 month and 3 months after TKA, but there was no significant difference between the two groups at 6 months after TKA. Level of Evidence: Prognostic Level II. [ABSTRACT FROM AUTHOR]

Purpose: Computer‐assisted surgery (CAS) during primary total knee arthroplasty (TKA) prosthesis alignment. However, literature on its use during revision TKA (rTKA) is scarce. Moreover, the effect of CAS during rTKA on rotational alignment of the prosthesis has not been described yet. The purpose of this study was to assess the effect of CAS during rTKA, focusing on the number of outliers and coronal, sagittal and rotational prosthetic alignment compared to conventional rTKA. Methods: A prospective cohort study comparing CAS‐rTKA with a historical control group (CON‐rTKA). The CAS‐rTKA group (54 patients/62 knees) underwent rTKA using imageless CAS between 2012 and 2017. The CON‐rTKA group (13 patients/23 knees) was operated using the conventional technique between 2002 and 2012. Postoperative alignment was measured using the EOS‐2D/3D system (coronal and sagittal planes) and computed tomography scan (rotation). Results: No significant differences between the CAS‐rTKA and CON‐rTKA groups were found for coronal and sagittal alignment regarding the mechanical angle of the leg (p = 0.08), mechanical lateral distal femoral angle (p = 0.87), mechanical medial proximal tibial angle (p = 0.40), anatomical proximal posterior tibial angle (p = 0.43) nor femoral (p = 0.80) and tibial rotation (p = 0.15). For the proportions of coronal, sagittal and rotational outliers, no significant differences were found either. Conclusion: This study showed no evidence that use of CAS during rTKA leads to improved coronal, sagittal or rotational alignment of knee prostheses or a difference of outliers between the groups. Level of Evidence: Level III, therapeutic. [ABSTRACT FROM AUTHOR]

Purpose: The Knee Society Scoring System (KSS) is a frequently used outcome score which quantifies functional patients' outcomes before and after total knee arthroplasty (TKA). Several problems arise when trying to implement KSS for obtaining postoperative outcomes after more personalised aligned TKAs. Scoring for valgus femorotibial angle (FTA) intervals outside moderate ranges is often poorly explained, the specific version of KSS used for outcome collection is frequently unclear and the exact measuring methods are typically not described in the literature. The aims of this systematic review were to investigate the latest user practice, the application of KSS and its limitations after kinematically aligned (KA) TKA. Methods: A systematic literature search following PRISMA guidelines was conducted on PubMed, Embase, Medline and Scopus to identify potentially relevant articles for this review, published from the beginning of January 2013 until the end of January 2023. Broad Mesh terms such as 'kinematic alignment', 'total knee arthroplasty' and 'knee society score' were used for building search strategy in each database accordingly. Articles reporting postoperative values of the objective surgeon‐assessed KSS after KA TKA or KA and mechanically aligned TKA were included. For assessing included randomised control trials (RCTs), an Agency for Healthcare Research and Quality's design‐specific scale for assessing RCTs was used. The non‐RCTs were assessed by using the Joanna Briggs Institute Critical Appraisal Tool. The Ottawa–Newcastle Score system was also used. Studies were additionally evaluated for their radiological methodology by using a five‐question checklist (Radiological Assessment Qualit criteria). Results: The initial search identified 167 studies, of which 129 were considered for screening. Ten studies reporting outcomes after KA TKA did not use the objective surgeon‐assessed part of KSS for clinical outcome measurement, and 30 studies reporting outcomes after KA TKA did not use KSS at all for clinical and/or functional outcomes. From the 10 included studies, only six have used the latest KSS score (2011), the rest using its 1989 variant; and out of these six studies, only two presented values of the FTA, which is needed for calculating the KSS's 'alignment' subcomponent, the rest presenting hip–knee–ankle angle (HKA) values. Additionally, when converting these HKA values to FTA intervals, the authors of this systematic review found that KA TKA FTA intervals display limits, which tend to be outside the 'well‐scored' KSS anatomical alignment interval. Conclusion: The inconsistent and nonstandardised use of the surgeon‐assessed KSS across studies reviewed compromises assessment reliability and patient outcome scores. To enhance precision and comparability, it is crucial to standardise the KSS application, incorporating personalised alignment strategies for more accurate patient evaluations. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Many classical examples of models of self-organized dynamics, including the Cucker-- Smale, Motsch--Tadmor, multi-species, and several others, include an alignment force that is based upon density-weighted averaging protocol. Those protocols can be viewed as special cases of "environmental averaging". In this paper we formalize this concept and introduce a unified framework for systematic analysis of alignment models. A series of studies are presented including the mean-field limit in deterministic and stochastic settings, hydrodynamic limits in the monokinetic and Maxwellian regimes, hypocoercivity and global relaxation for dissipative kinetic models, several general alignment results based on chain connectivity and spectral gap analysis. These studies covermany of the known results and reveal new ones, which include asymptotic alignment criteria based on connectivity conditions, new estimates on the spectral gap of the alignment force that do not rely on the upper bound of the macroscopic density, uniform gain of positivity for solutions of the Fokker--Planck-alignment model based on smooth environmental averaging. As a consequence, we establish unconditional relaxation result for global solutions to the Fokker--Planck-alignment model, which presents a substantial improvement over previously known perturbative results. [ABSTRACT FROM AUTHOR]

Multi-modal fusion technology gradually become a fundamental task in many fields, such as autonomous driving, smart healthcare, sentiment analysis, and human-computer interaction. It is rapidly becoming the dominant research due to its powerful perception and judgment capabilities. Under complex scenes, multi-modal fusion technology utilizes the complementary characteristics of multiple data streams to fuse different data types and achieve more accurate predictions. However, achieving outstanding performance is challenging because of equipment performance limitations, missing information, and data noise. This paper comprehensively reviews existing methods based on multi-modal fusion techniques and completes a detailed and in-depth analysis. According to the data fusion stage, multi-modal fusion has four primary methods: early fusion, deep fusion, late fusion, and hybrid fusion. The paper surveys the three major multi-modal fusion technologies that can significantly enhance the effect of data fusion and further explore the applications of multi-modal fusion technology in various fields. Finally, it discusses the challenges and explores potential research opportunities. Multi-modal tasks still need intensive study because of data heterogeneity and quality. Preserving complementary information and eliminating redundant information between modalities is critical in multi-modal technology. Invalid data fusion methods may introduce extra noise and lead to worse results. This paper provides a comprehensive and detailed summary in response to these challenges. [ABSTRACT FROM AUTHOR]

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Background: Unrestricted kinematic alignment (uKA) in total knee arthroplasty (TKA) has the theoretical advantage of reproducing patients' constitutional alignment and restoring the pre-arthritic joint line position and obliquity. However, modifications of the original uKA technique have been proposed due to the potential risk of mechanical failure and instability. Given the significant variability in soft tissue behavior within the same bony morphology group, uKA pure knee resurfacing could be occasionally detrimental. This study aimed to kinematically compare the outcomes of uKA TKA with those of a robotic-assisted KA TKA technique based on specific soft-tissue boundaries. Methods: In this retrospective gait analysis study, 24 TKA patients and 12 healthy controls were recruited. Inclusion criteria were a 9-month minimum follow-up from successfully, primary medial-pivot or medially-congruent TKA performed for isolated degenerative joint disease. Preoperatively, patients were randomly assigned to two surgical groups: A) uKA (#12) and B) robot-assisted (#12), KA (hybrid-kinematic) with boundaries (±3° from hip-knee-ankle neutral axis) and a slight intercompartmental gap asymmetry (max 2 mm lateral-opening). The gait analysis was performed using instrumented treadmills equipped with 3D cameras. Results: Sagittal knee kinematic data: during the early-stance phase of gait, the uKA group showed a less consistent weight-acceptance phase and a less efficient transition between the first knee-flexion peak and mid-stance-extension plateau with respect to the hybrid-kinematic alignment group. Spatiotemporal and overall gait quality data: no significant differences were found between the two TKA groups regarding walking speed (P = .51) and step length (P = .8534). Control group patients walked more efficiently compared to TKA groups, showing inferior trunk flexion and inferior variation in step length (P < .0001). Conclusions: This study showed that restoring the pre-arthritic joint line, as advocated by surgeons following the uKA philosophy, does not guarantee a closer-to-normal knee kinematics.

This study aimed to conduct a literature review to determine the reason behind the difficulty of strategy implementation. To achieve this objective, 36 articles were collected from 1980 to June 2023 from previous literature reviews and the results of searching several other leading journals. The result showed that it is necessary to add a strategy alignment category as an important bridge between formulation and implementation. Furthermore, 6 important factors in strategy alignment need to be considered as a key success for effective implementation. The article contributes a theoretical strategy alignment framework and guidance questions useful to practitioners to ensure that the process runs well, thereby allowing an effective strategy implementation.

The genomic diversity across strains of a species forms the genetic basis for differences in their behavior. A large-scale assessment of sequence variation has been made possible by the growing availability of strain-specific whole-genome sequences (WGS) and with the advent of large-scale databases of laboratory-acquired mutations. We define the Escherichia coli "alleleome" through a genome-scale assessment of amino acid (AA) sequence diversity in open reading frames across 2,661 WGS from wild-type strains. We observe a highly conserved alleleome enriched in mutations unlikely to affect protein function. In contrast, 33,000 mutations acquired in laboratory evolution experiments result in more severe AA substitutions that are rarely achieved by natural selection. Large-scale assessment of the alleleome establishes a method for the quantification of bacterial allelic diversity, reveals opportunities for synthetic biology to explore novel sequence space, and offers insights into the constraints governing evolution.

Abstract Background The purpose of this study was to clarify (1) the differences in cortical bone thickness (CBT) of the tibial diaphysis between healthy and osteoarthritic knees and (2) the influences of the femorotibial angle (FTA) and inclination of the medial compartment of the proximal tibia (MCT) on tibial CBT. Methods The study assessed 60 subjects with varus knee osteoarthritis (OA) (22 males and 38 females; mean age, 74 ± 7 years) and 53 healthy elderly subjects (28 males and 25 females; mean age, 70 ± 6 years). Three-dimensional estimated CBT of the tibial diaphysis was automatically calculated for 2752–11,296 points using high-resolution measurements from CT. The standardized CBT was assessed in 24 regions by combining six heights and four areas. Additionally, the association between the CBT, each FTA, and MCT inclination was investigated. Results The OA group showed a thicker CBT in the medial areas than in the lateral areas of the proximal tibia, while the healthy group had a thicker lateral CBT. The medial-to-lateral ratio of the proximal tibia was significantly higher in the OA group than in the healthy group. The proximal-medial CBT correlated with FTA and MCT inclinations in the OA group. Conclusions This study demonstrated that varus osteoarthritic knees showed a different trend of proximal-medial CBT with associations in FTA and MCT inclination from healthy knees, possibly due to medial load concentration.

Objectives The etiology of flatfoot and cavus foot is multicausal and controversial. So far, no literature reports the relationship between the sagittal morphology of subtalar joint and the alignment of foot. The purpose of this study was to explore whether the subtalar alignment would influence the configuration of foot. Methods From January 2017 to January 2020, we included 109 feet in the flatfoot group, 95 feet in the cavus group, and 104 feet in the control group in this retrospective comparative study. The Gissane angle and calcaneal posterior articular surface inclination angle represented the sagittal morphology of the subtalar joint. Meary's angle, calcaneal pitch angle, and talar pitch angle reflected the alignment of foot. They were measured in the weightbearing foot X‐rays. The angles in different groups were compared via Mann–Whitney U test. We calculated the correlation between the sagittal alignment of subtalar joint and the alignment of foot using Spearman's correlation analysis. Interobserver and intraobserver reliability were calculated. Results The Gissane angle, calcaneal posterior articular surface inclination angle, Meary's angle, talar pitch angle, and calcaneal pitch angle were significantly different in the three groups. The Gissane angle had an excellent correlation with the Meary's angle (r = 0.850, p

Abstract Mechanical alignment (MA) total knee arthroplasty (TKA), with neutral leg alignment, mechanical component alignment, and parallel gaps, has achieved good long-term survival. Patient satisfaction, however, is not always perfect. In contrast to the MA, which aims for an ideal goal for all patients, an alternative has been proposed: kinematic alignment (KA)-TKA. In KA, the articular surface is replicated using components aligning with the three kinematic axes. KA-TKA has been gaining popularity, and in addition to the true or calipered KA, various derivatives, such as restricted KA, soft-tissue respecting KA, and functional alignments, have been introduced. Moreover, the functional approach encompasses several sub-approaches. This somewhat complicated scenario has led to some confusion. Therefore, the terminology needs to be re-organized. The term “personalized alignment (PA)” has been used in contrast to the MA approach, including all approaches other than MA. The term “PA-TKA” should be used comprehensively instead of KA and it represents the recent trends in distinct and unique consideration of each individual case. In addition to a comparison between MA and KA, we suggest that evaluation should be conducted to decide which approach is the best for an individual patient within the “personalized alignment” concept.