Restricted kinematic alignment leads to uncompromised osseointegration of cementless total knee arthroplasty

Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):705-712. doi: 10.1007/s00167-020-06427-1. Epub 2021 Jan 16.


Purpose: While kinematic alignment (KA) total knee arthroplasty (TKA) with cemented implants has been shown to provide equivalent or better results than mechanical alignment, its combination with cementless fixation has not yet been documented. The purpose of this study is to report (1) revision rate and causes, (2) clinical results based on patient report outcome measures (PROMs), and (3) radiological signs of implant dysfunction in patients with an uncemented TKA implanted with restricted KA (rKA), after a minimum follow-up of 2 years.

Methods: This study included the first 100 consecutive uncemented cruciate retaining TKAs implanted between November 2015 and February 2018 by a single surgeon following rKA principles. At last follow-up, all adverse events and PROMs assessed by WOMAC, KOOS, and FJS scores were documented. Radiographic evaluation was performed to identify signs of implant loosening.

Results: After a mean follow-up of 49 months (32, 60), no implant revision was performed for aseptic loosening. Three revisions were performed: one for malalignment, one for a deep infection, and one for instability. The mean WOMAC score was 20.1 (0-79, 21.3), the mean KOOS score was 71.5 (19.0-96.6, 19.8), and the mean FJS score was 65.9 (0-100, 29.6). No radiological evidence of implant aseptic loosening or osteolysis was identified.

Conclusion: This study shows that in 99% of our cases, rKA combined with the tested cementless TKA implant allowed for adequate secondary fixation and good functional outcomes in the short term. Favourable mid- to long-term implant survivorship is anticipated.

Level of evidence: III.

Keywords: Kinematic alignment; Mechanical; Survival; Total knee arthroplasty; Total knee replacement; Uncemented.

MeSH terms

  • Arthroplasty, Replacement, Knee* / methods
  • Biomechanical Phenomena
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Knee Prosthesis*
  • Osseointegration
  • Prosthesis Failure
  • Treatment Outcome