ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026
Unrestricted kinematic alignment in varus total knee arthroplasty outperforms mechanical alignment in CPAK I phenotype, but yields comparable outcomes in CPAK IV: A retrospective analysis from the FP-UCBM Knee Study Group.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Patellofemoral Joint Outcomes in Kinematically vs. Mechanically Aligned Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.Medicina (Kaunas, Lithuania) · 2026Pooled it
- Dynamic Computed Tomography Evaluation of Patellar Tracking Following Unrestricted Kinematic Versus Mechanical Alignment in Primary Total Knee Arthroplasty: A Prospective Comparative Study.Journal of orthopaedic case reports · 2026Article
- Unrestricted kinematic alignment total knee arthroplasty provides favourable five-year outcomes regardless of varus severity in Japanese patients.Journal of experimental orthopaedics · 2026Article
- Unrestricted Kinematic Alignment Is a Feasible Strategy for Lateral Compartment Osteoarthritis: Short-Term Outcomes of a Contralateral Knee-Referenced Approach.Journal of clinical medicine · 2026Article
- Are Currently Available Joint-Specific Patient-Reported Outcome Measures Fit for Purpose to Assess the Outcome of Knee Arthroplasty?Journal of clinical medicine · 2025Article
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10 authors.
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Abstract
purposeTo compare clinical outcomes in varus-aligned patients undergoing cruciate-retaining total knee arthroplasty (TKA) with mechanical alignment (MA) versus unrestricted kinematic alignment (KA). The hypothesis was that KA would yield superior outcomes, and that preserving joint line obliquity-regardless of alignment technique-would be associated with better results.
methodsA retrospective analysis of prospectively collected data from 140 KA and 209 MA TKA cases was performed. Inclusion criteria were: end-stage varus osteoarthritis (aHKA < 178°), MA or unrestricted KA TKA and ≥ 1-year follow-up. Exclusion criteria included prior major surgery (osteotomies, fractures) on the affected limb, inadequate preoperative full-length radiographs, or post-operative complications unrelated to alignment strategy. Patients were categorised by CPAK phenotype (I, IV and VII) based on the joint line obliquity. Clinical outcomes at 1-year follow-up were assessed using the Knee Society Score (KSS) pt.1 and 2, Oxford Knee Score (OKS), SF-12, and Forgotten Joint Score (FJS). ANOVA was used to compare results of MA and KA in the overall varus population, and in CPAK subgroups. Statistical significance was set at p < 0.05.
resultsKA led to significantly higher KSS pt.1 (84.6 ± 15.3 vs. 73.9 ± 18.9; p < 0.001) and FJS (90.5 ± 15.3 vs. 80.4 ± 15.8; p < 0.001) than MA. In CPAK I patients, KA outperformed MA in KSS pt.1 (83.5 ± 16.2 vs. 74.9 ± 19.1; p < 0.001) and FJS (89.8 ± 15.5 vs. 80.7 ± 17.8; p < 0.001). No differences were found between KA and MA in CPAK IV patients (p > 0.05). KSS pt.1 (80.1 ± 13.8) and FJS (86.5 ± 18.1) achieved with MA in CPAK IV were significantly higher than in both the overall varus aHKA group and CPAK I patients treated with MA (p < 0.05).
conclusionsCruciate-retaining unrestricted KA yields better clinical outcomes compared to MA in varus aHKA patients, and in the CPAK I subgroup. In CPAK IV, preserving joint line obliquity leads to similar outcomes with both MA and KA. LEVEL OF EVIDENCE: Level IV.
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