PMID- 36403396
OWN - NLM
STAT- MEDLINE
DCOM- 20230203
LR  - 20230203
IS  - 1873-5800 (Electronic)
IS  - 0968-0160 (Linking)
VI  - 40
DP  - 2023 Jan
TI  - Kinematic alignment results in clinically similar outcomes to mechanical 
      alignment: Systematic review and meta-analysis.
PG  - 24-41
LID - S0968-0160(22)00178-8 [pii]
LID - 10.1016/j.knee.2022.11.001 [doi]
AB  - 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.
CI  - Copyright (c) 2022 Elsevier B.V. All rights reserved.
FAU - Van Essen, James
AU  - Van Essen J
AD  - University of Melbourne, Parkville, Victoria 3010, Australia.
FAU - Stevens, Jarrad
AU  - Stevens J
AD  - St. Vincent's Hospital (Melbourne) - Department of Orthopaedics, PO Box 2900, 
      Fitzroy, Victoria 3065, Australia.
FAU - Dowsey, Michelle M
AU  - Dowsey MM
AD  - University of Melbourne, Parkville, Victoria 3010, Australia; St. Vincent's 
      Hospital (Melbourne) - Department of Orthopaedics, PO Box 2900, Fitzroy, Victoria 
      3065, Australia. Electronic address: mmdowsey@unimelb.edu.au.
FAU - Choong, Peter F
AU  - Choong PF
AD  - University of Melbourne, Parkville, Victoria 3010, Australia; St. Vincent's 
      Hospital (Melbourne) - Department of Orthopaedics, PO Box 2900, Fitzroy, Victoria 
      3065, Australia. Electronic address: pchoong@unimelb.edu.au.
FAU - Babazadeh, Sina
AU  - Babazadeh S
AD  - University of Melbourne, Parkville, Victoria 3010, Australia; St. Vincent's 
      Hospital (Melbourne) - Department of Orthopaedics, PO Box 2900, Fitzroy, Victoria 
      3065, Australia; Australian Orthopaedic Research Group, Kew East, Victoria 3102, 
      Australia. Electronic address: sbabazadeh@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20221117
PL  - Netherlands
TA  - Knee
JT  - The Knee
JID - 9430798
SB  - IM
MH  - Humans
MH  - *Knee Prosthesis
MH  - *Osteoarthritis, Knee/surgery
MH  - Biomechanical Phenomena
MH  - Knee Joint/surgery
MH  - *Arthroplasty, Replacement, Knee/methods
MH  - Range of Motion, Articular
OTO - NOTNLM
OT  - Clinical outcomes
OT  - Kinematic
OT  - Mechanical
OT  - Meta-analysis
OT  - Systematic review
OT  - Total knee arthroplasty
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2022/11/21 06:00
MHDA- 2023/02/04 06:00
CRDT- 2022/11/20 18:14
PHST- 2022/03/24 00:00 [received]
PHST- 2022/08/28 00:00 [revised]
PHST- 2022/11/03 00:00 [accepted]
PHST- 2022/11/21 06:00 [pubmed]
PHST- 2023/02/04 06:00 [medline]
PHST- 2022/11/20 18:14 [entrez]
AID - S0968-0160(22)00178-8 [pii]
AID - 10.1016/j.knee.2022.11.001 [doi]
PST - ppublish
SO  - Knee. 2023 Jan;40:24-41. doi: 10.1016/j.knee.2022.11.001. Epub 2022 Nov 17.