ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Mechanical versus kinematic alignment for total knee arthroplasty: a meta-analysis.Archives of orthopaedic and trauma surgery · 2025Pooled it
- Gait analysis after TKA: Do different alignment strategies lead to different outcomes? A systematic review.Musculoskeletal surgery · 2026Review
- Intentional asymmetric balancing in robotic-assisted valgus TKA: Early outcomes and intraoperative laxity changes.Journal of experimental orthopaedics · 2026Article
- The Degree of Joint Line Obliquity Change Is Not Associated with Patient Preference in Bilateral Posterior-Stabilized Total Knee Arthroplasties.Journal of clinical medicine · 2026Article
- Implant design may influence knee flexor activation patterns during stair ascent and descent.Bone & joint research · 2025Article
- Preserving joint line orientation in TKA improves short- to mid-term outcomes: A systematic review and meta-analysis.Journal of experimental orthopaedics · 2025Review
- Increased varus deformity requires greater personalisation of alignment: A finite element biomechanical study.Journal of experimental orthopaedics · 2025Article
- Restoration of Joint Line Obliquity May Not Influence Lower Extremity Peak Frontal Plane Moments During Stair Negotiation.Bioengineering (Basel, Switzerland) · 2025Article
- Effect of posterior-stabilized and cruciate-retaining implants on three-dimensional kinematic characteristics after total knee arthroplasty.Joint diseases and related surgery · 2025Article
- Robotic-Assisted Medial Unicompartmental Knee Arthroplasty Provides Better FJS-12 Score and Lower Mid-Term Complication Rates Compared to Conventional Implantation: A Systematic Review and Meta-Analysis.Journal of personalized medicine · 2024Review
- Effect of inverse kinematic alignment total knee arthroplasty on coronal alignment of the ankle joint in patients with varus knee deformity.Archives of orthopaedic and trauma surgery · 2024Article
- Personalized total knee arthroplasty in patients with extra-articular deformities.EFORT open reviews · 2024Review
- Asymmetric gap balancing improves knee kinematic following primary total knee arthroplasty.Arthroplasty (London, England) · 2024Article
- Editorial: Alignment options and robotics in total knee arthroplasty (TKA) "Alignment, alignment, alignment, but TKA fail mainly for infections and instability".Frontiers in surgery · 2023Article
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePatient-specific alignment in total knee arthroplasty (TKA) has shown promising patient-reported outcome measures; however, the clinical and biomechanical effects of restoring the native knee anatomy remain debated. The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment-aMA) and a patient-specific alignment TKA cohort (inverse kinematic alignment-iKA).
methodsAt two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case-control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients' demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON). Data collection was conducted by a blinded investigator. The primary outcomes were knee flexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS).
resultsDuring walking, the maximum knee flexion did not differ between the iKA group (53.0°) and the control group (55.1°), whereas the aMA group showed lower amplitudes of sagittal motion (47.4°). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225 N mm/kg) compared to aMA group (276 N mm/kg). No significant differences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs differed significantly between patients receiving aMA and healthy controls. The OKS was significantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; p = 0.05. The FJS was significantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; p = 0.002.
conclusionAt two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity. LEVEL OF EVIDENCE: Level III.
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