Abstract
Purpose
It is unclear whether a difference in functional outcome exists between kinematically
aligned (KA) and mechanically aligned (MA) knee replacements. The aim of this study
is to perform a comprehensive systematic review and meta-analysis of the available
level I-IV evidence.
Methods
A meta-analysis of randomised controlled trials and observational studies comparing
patient reported outcome measures (PROMs), range of motion (ROM), gait analysis and
complications in TKA with KA and MA was performed. Quality assessment was performed
for each study using the Joanna Briggs Institute (JBI) critical appraisal tools.
Results
Twelve randomised controlled trials and fourteen observational studies published between
2014 and 2022 were included in the final analysis. Meta-analysis revealed KA to have
significantly better Oxford Knee Score (OKS) (p = 0.02), Forgotten Joint Score (FJS) (p = 0.006), Knee Society Score (KSS) Objective Knee (p = 0.03) and KSS Functional Activity (p = 0.008) scores. However, these improvements did not exceed the minimum clinically
important difference (MCID) values reported in the literature. Subgroup analysis showed
robotic assisted KA-TKA to have a clinically superior FJS (p = 0.0002) and trend towards KSS Objective Knee score (p = 0.10), compared to PSI. Gait and plantar pressure distribution of KA cohorts more
closely represented healthy cohorts, and KA showed a weak association of a decreased
knee adduction moment (KAM) compared to MA. Differences in Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome
Score (KOOS), range of motion and complications were not significant between groups.
Conclusion
Although KA results in several improved functional outcomes, these do not reach clinical
significance. Further standardised large-scale randomised studies are required to
improve the quality of evidence. As it stands, it is difficult to recommend one philosophy
over the other.
Keywords
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Article info
Publication history
Published online: November 17, 2022
Accepted:
November 3,
2022
Received in revised form:
August 28,
2022
Received:
March 24,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
