Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Sep 10;5(8):486-497.
doi: 10.1302/2058-5241.5.190093. eCollection 2020 Aug.

Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review

Mark Anthony Roussot  1   2 , Georges Frederic Vles  1 , Sam Oussedik  1
Affiliations
Review

Clinical outcomes of kinematic alignment versus mechanical alignment in total knee arthroplasty: a systematic review

Mark Anthony Roussot et al. EFORT Open Rev. .

Abstract

Although mechanical alignment (MA) has traditionally been considered the gold standard, the optimal alignment strategy for total knee arthroplasty (TKA) is still debated.Kinematic alignment (KA) aims to restore native alignment by respecting the three axes of rotation of the knee and thereby producing knee motion more akin to the native knee.Designer surgeon case series and case control studies have demonstrated excellent subjective and objective clinical outcomes as well as survivorship for KA TKA with up to 10 years follow up, but these results have not been reproduced in high-quality randomized clinical trials.Gait analyses have demonstrated differences in parameters such as knee adduction, extension and external rotation moments, the relevance of which needs further evaluation.Objective improvements in soft tissue balance using KA have not been shown to result in improvements in patient-reported outcomes measures.Technologies that permit accurate reproduction of implant positioning and objective measurement of soft tissue balance, such as robotic-assisted TKA and compartmental pressure sensors, may play an important role in improving our understanding of the optimum alignment strategy and implant position. Cite this article: EFORT Open Rev 2020;5:486-497. DOI: 10.1302/2058-5241.5.190093.

Keywords: alignment; clinical outcome; kinematic; mechanical; total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

ICMJE Conflict of interest statement: MAR reports funding to attend the 2019 AAOS Annual Meeting from Ascendis Medical, and funding to attend training workshops from Stryker, outside the submitted work. GFV declares no conflict of interest relevant to this work. SO reports Board membership of Bone & Joint Journal, consultancy for and payment for development of educational presentations from Stryker Orthopaedics, employment by University College London Hospitals NHS Trust, grants/grants pending from Digital Surgery, payment for lectures including service on speakers’ bureaus for Stryker Orthopaedics, royalties from Springer International, and travel/accommodations/meeting expenses unrelated to activities. Listed from EFORT and Stryker Orthopaedics, all outside the submitted work.

Figures

Fig. 1
Fig. 1
Long-leg standing radiograph demonstrating the mechanical axis (MA) relative to the anatomical axis (AA) of the lower extremity (a). Note the joint line forms an angle that is 93° with the MAT, or 3O of varus. Anatomical alignment (b) mimics the native joint line of 3O varus to the mechanical axis of the tibia corresponding 3O valgus to the AA. Mechanical alignment (c) involves resections perpendicular to the mechanical axis of the tibia and distal femur. Note. mLDFA, mechanical lateral distal femoral angle; aLDFA, anatomical lateral distal femoral angle; MPTA, medial proximal tibial angle.
Fig. 2
Fig. 2
Three-dimensional knee model constructed from the Visible Human database (University of Colorado Center for Human Simulation), demonstrating the differences between the epicondylar (yellow) axis, which is the basis of MA TKA, and the axis derived from cylinders of best fit for the femoral condyles (green), which is the basis of KA TKA. Reproduced with permission from: Eckhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH, Flannery NM. Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality. J Bone Joint Surg (Am). 2005 Dec 1;87(suppl_2):71-80.
Fig. 3
Fig. 3
PRISMA Flow Diagram Note. RCT, randomized controlled trial.
Fig. 4
Fig. 4
Operative plan for a robotic-assisted, kinematically aligned TKA. Note that the implant alignment is based on symmetrical 8 mm distal and posterior resections of the femoral condyles. The tibial resection is aligned to the native proximal tibial joint line, taking into consideration 1mm of asymmetrical bone loss from osteoarthritis.
See this image and copyright information in PMC

References

    1. Insall JN, Binazzi R, Soudry M, Mestriner LA. Total knee arthroplasty. Clin Orthop Relat Res 1985;192:13–22. - PubMed
    1. Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977;59:77–79. - PubMed
    1. Abdel MP, Oussedik S, Parratte S, Lustig S, Haddad FS. Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction. Bone Joint J 2014;96-B:857–862. - PubMed
    1. Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med 2014;7:89–95. - PMC - PubMed
    1. Hungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clin Orthop Relat Res 1985;192:23–33. - PubMed