Comparison of Six-Week, Three-Month, and One-Year Postoperative Clinical Results of Kinematic and Mechanical Alignment in Primary Medial Pivot Total Knee Arthroplasty.

BACKGROUND

Total knee replacement (TKR) is a common surgical solution for severe osteoarthritis. Kinematic alignment (KA) and mechanical alignment (MA) are two popular techniques. There is ongoing debate over the optimal method, influenced by varying long-term results and a scarcity of data on short-term postoperative outcomes. Early evaluation of these techniques is vital for improving rehabilitation outcomes and ensuring patient satisfaction.  Methods: This study retrospectively analyzed outcomes from 71 KA-TKRs and 85 MA-TKRs performed between 2019 and 2021. Knee flexion, visual analog scale (VAS) scores, EuroQol-5d (EQ-5d) quality of life measures, and dependence on walking aids were evaluated. Evaluations were conducted at baseline, six-weeks, three-months, and 12-months postoperatively using two-sample t-tests for continuous data and Pearson's chi-squared test for categorical data.

RESULTS

At six-weeks and three-months postoperatively, the KA group exhibited significantly better outcomes in knee flexion (98.6° vs. 90.2° at six-weeks; 114.7° vs. 94.2° at three-months), pain management, and reduced walking aids compared to the MA group. By 12-months, these differences were no longer significant, with both groups showing comparable results in knee flexion, pain scores, and patient-reported outcomes.  Conclusion: KA offers substantial short-term advantages over MA for pain relief, increased knee flexion, and independence from walking aids. However, these benefits do not persist at one-year post-surgery, indicating a convergence of outcomes between the two techniques. Larger studies with extended follow-ups are required to determine the long-term implications of these alignment strategies.

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Copyright © 2024, Reinisch et al.

Déclaration de conflit d'intérêts

Human subjects: Consent was obtained or waived by all participants in this study. Kantonale Ethikkommission Zürich issued approval 2023-00949. The ethics commission confirms that it operates according to ICH-GCP. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.