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Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A systematic review was conducted to answer the following questions: (1) Does kinematically aligned (KA) total knee arthroplasty (TKA) achieve clinical outcomes comparable to those of mechanically aligned (MA) TKA? (2) How do the limb, knee, and component alignments differ between KA and MA TKA? (3) How is joint line orientation angle (JLOA) changed from the native knee in KA TKA compared to that in MA TKA?

Methods

Nine full-text articles in English that reported the clinical and radiological outcomes of KA TKA were included. Five studies had a control group of patients who underwent MA TKA. Data on patient demographics, clinical scores, and radiological results were extracted. There were two level I, one level II, three level III, and three level IV studies. Six of the nine studies used patient-specific instrumentation, one study used computer navigation, and two studies used manual instrumentation.

Results

The clinical outcomes of KA TKA were comparable or superior to those of MA TKA with a minimum 2-year follow-up. Limb and knee alignment in KA TKA was similar to those in MA TKA, and component alignment showed slightly more varus in the tibial component and slightly more valgus in the femoral component. The JLOA in KA TKA was relatively parallel to the floor compared to that in the native knee and not oblique (medial side up and lateral side down) compared to that in MA TKA. The implant survivorship and complication rate of the KA TKA were similar to those of the MA TKA.

Conclusion

Similar or better clinical outcomes were produced by using a KA TKA at early-term follow-up and the component alignment differed from that of MA TKA. KA TKA seemed to restore function without catastrophic failure regardless of the alignment category up to midterm follow-up. The JLOA in KA TKA was relatively parallel to the floor similar to the native knee compared to that in MA TKA. The present review of nine published studies suggests that relatively new kinematic alignment is an acceptable and alternative alignment to mechanical alignment, which is better understood. Further validation of these findings requires more randomized clinical trials with longer follow-up.

Level of evidence

Level II.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-Si, Gyeonggi-do, 463-707, South Korea

    Yong Seuk Lee, O-Sung Lee & Seung Hoon Lee

  2. 8120 Timberlake Way Ste 112, Sacramento, CA, 95823, USA

    Stephen M. Howell

  3. Department of Orthopedic Surgery, Ajou University College of Medicine, Suwon, South Korea

    Ye-Yeon Won

  4. Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA

    Yong Seuk Lee & Hamed Vahedi

  5. Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Seow Hui Teo

Authors
  1. Yong Seuk Lee
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  2. Stephen M. Howell
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  3. Ye-Yeon Won
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  4. O-Sung Lee
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  5. Seung Hoon Lee
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  7. Seow Hui Teo
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Corresponding author

Correspondence to Stephen M. Howell.

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The authors declare that we have no conflict of interest.

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Ethical approval

This is systematic review. Therefore, IRB was waived.

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Appendix

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Lee, Y.S., Howell, S.M., Won, YY. et al. Kinematic alignment is a possible alternative to mechanical alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 3467–3479 (2017). https://doi.org/10.1007/s00167-017-4558-y

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