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Review
. 2024 Oct 30;11(4):e70044.
doi: 10.1002/jeo2.70044. eCollection 2024 Oct.

Kinematic versus mechanical alignment: A systematic review of systematic reviews and meta-analyses of randomised controlled trials

Amir A Jamali  1 , Adithya Shekhar  1 , Danton Dungy  2 , Susan L Stewart  3   4
Affiliations
Review

Kinematic versus mechanical alignment: A systematic review of systematic reviews and meta-analyses of randomised controlled trials

Amir A Jamali et al. J Exp Orthop. .

Abstract

Purpose: The purpose of this study was to review the currently available systematic reviews and meta-analyses comparing kinematic alignment (KA) and mechanical alignment (MA).

Methods: A literature search was performed to obtain all systematic review and meta-analyses comparing KA to MA that included one or more randomised controlled trials. A total of 18 studies were obtained, three of which were systematic reviews without meta-analysis. Studies were evaluated based on their meta-analysis methodology, appropriate inclusion criteria, the use of correct definitions of each alignment technique, and risk of bias.

Results: These 18 studies included between 3 and 14 RCTs in each study. From the perspective of study design, the majority of papers had low risk of bias. In contrast, most of these reviews had technical issues pertaining to study inclusion in their meta-analyses that would potentially compromise their conclusions. These included mixing time points in the analysis, duplicate inclusion of patients in a meta-analysis, inclusion of studies with incorrect definitions of KA, inclusion of studies performed with restricted kinematic alignment with the KA group, and inappropriate combination of studies with bilateral total knee arthroplasty (TKA) with studies with unilateral TKA.

Conclusions: The current literature is inadequate to determine if there is any advantage to KA compared to MA in TKA. Claims made in systematic reviews and meta-analyses on the subject must be carefully scrutinised based not only on risk of bias but also on the included study populations, the surgical methodology of each underlying study, and the authors' understanding of the definitions of each alignment technique.

Level of evidence: Level 1 based on this study being a systematic review with the inclusion of only systematic reviews and meta-analyses of randomised controlled trials.

Keywords: alignment; kinematic; knee osteoarthritis; total knee arthroplasty; total knee replacement.

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Conflict of interest statement

None of the authors have any conflicts of interest related to this manuscript.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing selection of the systematic reviews and meta‐analyses comparing KA and MA [19].
Figure 2
Figure 2
Technical problems of included systematic reviews/meta‐analyses of RCTs comparing KA to MA in TKA potentially compromising conclusions of the studies.
Figure 3
Figure 3
Risk of Bias in included systematic reviews/meta‐analyses of RCTs comparing KA to MA in TKA.
See this image and copyright information in PMC

Comment in

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