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. 2025 Feb;33(2):654-665.
doi: 10.1002/ksa.12452. Epub 2024 Sep 9.

Excellent results of restricted kinematic alignment total knee arthroplasty at a minimum of 10 years of follow-up

Mina W Morcos  1 , Gautier Beckers  1 , Andrea Giordano Salvi  1 , Mourad Bennani  1 , Vincent Massé  1   2   3 , Pascal-André Vendittoli  1   2   3
Affiliations

Excellent results of restricted kinematic alignment total knee arthroplasty at a minimum of 10 years of follow-up

Mina W Morcos et al. Knee Surg Sports Traumatol Arthrosc. 2025 Feb.

Abstract

Purpose: While restricted kinematic alignment (rKA) total knee arthroplasty (TKA) with cemented implants has been shown to provide a similar survivorship rate to mechanical alignment (MA) in the short term, no studies have reported on the long-term survivorship and function.

Methods: One hundred four consecutive cemented cruciate retaining TKAs implanted using computer navigation and following the rKA principles proposed by Vendittoli were reviewed at a minimum of 10 years after surgery. Implant revisions, reoperations and clinical outcomes were assessed using knee injury and osteoarthritis outcome score (KOOS), forgotten joint score (FJS), patients' satisfaction and joint perception questionnaires. Radiographs were analyzed to identify signs of osteolysis and implant loosening.

Results: Implant survivorship was 99.0% at a mean follow-up of 11.3 years (range: 10.3-12.9) with one early revision for instability. Patients perceived their TKA as natural or artificial without limitation in 50.0% of cases, and 95.3% were satisfied or very satisfied with their TKA. The mean FJS was 67.6 (range: 0-100). The mean KOOS were as follows: pain 84.7 (range: 38-100), symptoms 85.5 (range: 46-100), function in daily activities 82.6 (range: 40-100), function in sport and recreation 35.2 (range: 0-100) and quality of life 79.1 (range: 0-100). No radiological evidence of implant aseptic loosening or osteolysis was identified.

Conclusion: Cemented TKA implanted with the rKA alignment protocol demonstrated excellent long-term implant survivorship and is a safe alternative to MA to improve patient function and satisfaction.

Level of evidence: Level IV, continuous case series with no comparison group.

Keywords: arthroplasty; kinematic alignment; knee; mechanical alignment; personalized surgery; restricted.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Restricted kinematic alignment protocol.
Figure 2
Figure 2
Flow chart at last follow‐up. PROM, patient‐reported outcome measure.
Figure 3
Figure 3
TKA instability and recurrent hemarthroses secondary to femoral component malrotation. Anteroposterior (a) and lateral (b) radiographs of the TKA before implant revision (femur 3° valgus, tibia 1° varus, HKA 2° valgus). Anteroposterior (c) and lateral (d) radiographs after revision TKA with posteromedial femoral augment and stem (femur 4° valgus, tibia 1° varus, HKA 3° valgus). Her knee phenotype did not change over the treatment process: VALFMA3°/VALTMA3°. HKA, hip knee ankle; TKA, total knee arthroplasty.
Figure 4
Figure 4
Periprosthetic TKA fracture. Anteroposterior (a) and lateral (b) radiographs of a periprosthetic femur fracture. Anteroposterior (c) and lateral (d) radiographs after open reduction and internal fixation with a lateral distal femur plate without implant replacement. TKA, total knee arthroplasty.
Figure 5
Figure 5
Box plot of KOOS at minimum 10 years of follow‐up. KOOS, knee injury and osteoarthritis outcome score.
See this image and copyright information in PMC

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