Kinematic Alignment Does Not Result in Clinically Important Improvements After TKA Compared With Mechanical Alignment: A Meta-analysis of Randomized Trials.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(15):4 Clin Orthop Relat Res . 2025 Jun 1;483(6):1020-1030.What this means for my practice?
Clinicians should note that kinematic alignment in TKA does not produce clinically meaningful improvements in PROMs or ROM compared with mechanical alignment, despite small statistical differences. These findings suggest no current justification for its widespread adoption given the added cost, time, and potential risk. Limitations include moderate-to-high risk of bias in half of the included studies and reliance on score conversions for pooled analysis.
Study Summary
Twelve randomized controlled trials including 1033 patients undergoing primary TKA for knee osteoarthritis were included in this systematic review and meta-analysis comparing kinematic alignment versus mechanical alignment. Pooled outcomes of interest included functional scores (OKS/WOMAC), Forgotten Joint Score (FJS), EQ-5D, VAS, and ROM in flexion and extension. Across nine pooled studies, functional score differences favored kinematic alignment statistically but did not exceed the MCID. No significant or clinically important differences were observed for FJS, EQ-5D VAS, or extension ROM, and flexion ROM differences (3°) did not meet MCID thresholds. The findings suggest no clinically important advantage of kinematic alignment over mechanical alignment in TKA outcomes.
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