Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty

Yasuo Niki, Takeo Nagura, Katsuya Nagai, Shu Kobayashi, Kengo Harato

Research output: Contribution to journalArticlepeer-review

79 Citations (Scopus)


Purpose: Knee adduction moment (KAM) has been recognized as a good clinical surrogate for medial tibiofemoral joint loading and is associated with implant durability after total knee arthroplasty (TKA). This study aimed to examine the effects of joint line obliquity in kinematically aligned TKA (KA-TKA) on KAM during gait. Methods: The study enrolled 21 knees from 18 patients who underwent cylindrical axis reference KA-TKA and a matched group of 21 knees from 18 patients who underwent mechanically aligned (MA)-TKA as controls. Gait analyses were performed the day before TKA and at an overall mean of 2.6 years postoperatively. First peak KAM and variables associated with frontal knee kinetics were determined and compared between groups. Results: In KA-TKA, the proximal tibia was resected with 3.4° ± 1.5° of varus in relation to the mechanical axis, and the final femorotibial shaft axis was 176.7° ± 3.8° with KA-TKA and 174.4° ± 3.0° with MA-TKA. KAM was significantly smaller with KA-TKA than with MA-TKA (p < 0.032). Regarding variables affecting KAM, significant differences were evident between the two TKAs for knee adduction angle (p = 0.0021), lever arm (p = 0.028), and Δlever arm (p = 0.0001). Conclusions: In KA-TKA, joint line obliquity reduced peak KAM during gait, despite slight varus limb alignment, and this reduced KAM in KA-TKA can tolerate constitutional varus alignment. In clinical settings, KA-TKA thus represents a promising technical option for patients with large coronal bowing of the shaft carrying a risk of increased KAM after TKA. Level of evidence: III.

Original languageEnglish
Pages (from-to)1629-1635
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number6
Publication statusPublished - 2018 Jun 1


  • Constitutional varus
  • Gait analysis
  • Joint line obliquity
  • Kinematically aligned total knee arthroplasty
  • Knee adduction moment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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