ArticleJournal of experimental orthopaedics2023
Closed-leg standing long leg radiographs can be a useful tool to assess whether the joint line is parallel to the ground in restricted kinematic alignment total knee arthroplasty.
Article in Journal of experimental orthopaedics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed, 12 citations in OpenAlex.
- Unrestricted kinematic alignment total knee arthroplasty provides favourable five-year outcomes regardless of varus severity in Japanese patients.Journal of experimental orthopaedics · 2026Article
- Functional alignment maintains constant medial stability and a more distinct medial pivot pattern throughout flexion compared to mechanical alignment in medial pivot total knee arthroplasty.Journal of experimental orthopaedics · 2025Article
- Coronal native limb alignment: establishing reporting standards and aligning measurements of key angles.EFORT open reviews · 2025Review
- Kinematic alignment in Japanese patients shows significant improvement 2 years after total knee replacement surgery.Journal of experimental orthopaedics · 2025Article
- Appropriate patient selection based on joint line convergence angle minimizes the difference between the mechanical axis in the standing and supine positions after open-wedge high tibial osteotomy and distal tuberosity osteotomy.Journal of orthopaedic surgery and research · 2025Article
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4 authors at 2 institutions in 1 country.
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Abstract
purposeRestricted kinematic alignment (rKA) is a modified technique of kinematic alignment (KA) total knee arthroplasty (TKA) for patients with an outlier or atypical knee anatomy, striving to preserve the native knee joint line parallel to the ground in a bipedal stance. This study aimed to evaluate the accuracy of rKA TKA with a computed tomography (CT)-based patient-specific instrument (PSI) to achieve the preoperative plan with the joint line parallel to the ground level.
methodsUsing a CT-based PSI, 74 closed-leg standing long-leg radiographs were obtained before and after rKA TKA. The hip-knee-ankle angle (HKA), joint line orientation angle (JLOA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) were measured. Bone resection accuracy was evaluated by postoperative HKA deviations from the planned alignment and joint line by postoperative JLOA deviations from the ground level.
resultsThe mean postoperative JLOA and HKA were 2.1° valgus (range, standard deviation: 6.0° valgus to 3.0° varus, 2.0) and 2.6° varus (3.5° valgus to 12.5° varus, 3.2), respectively. Postoperative JLOA and HKA were within ± 3° of the planned alignment for 69% and 86% of cases, respectively.
conclusionsDespite a static verification, we clarified how the joint line after rKA TKA was reproduced in the closed-leg long leg radiographs to mimic the limb position during gait. However, this imaging method is not well-established, and lack of long-term survivorship and the relationship between joint line inclination and clinical outcomes represented limitations of this study. LEVEL OF EVIDENCE: Level IV.
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