Background: Clinical outcomes of kinematically aligned total knee arthroplasty (KA-TKA) have been reported as comparable or superior to those of mechanically aligned TKA (MA-TKA). However, cruciate-retaining prostheses have mostly been used for KA-TKA. This study used medial pivot knee prostheses for KA-TKA, and knee kinematics after KA-TKA were assessed and compared with those after MA-TKA. Methods: Thirteen knees in 9 patients undergoing primary TKA (8 KAs, 5 MAs) were subjected to two-dimensional (2D) to three-dimensional (3D) registration analysis at 1 year postoperatively. Each patient performed weight-bearing activities, and movements were recorded as intermittent digital radiographic images. Three-dimensional implant positions during activities were analyzed for anterior-posterior translation in the sagittal plane, condylar liftoff and mediolateral translation in the coronal plane, and femoral rotation in the axial plane. Results: Posterior translation of the lateral femoral condyle from 0° to 100° was larger in KA-TKA than in MA-TKA (P = .006). The degrees of condylar liftoff and mediolateral translation were comparable between TKAs. Total external rotation of the femoral component relative to tibial component was significantly greater for KA-TKA (7.7 ± 5.2°) than for MA-TKA (1.3 ± 3.3°; P = .03). The kinematic path of the femoral component revealed greater medial pivoting motion in KA-TKA than in MA-TKA. Conclusions: KA-TKA using a medial pivot knee prosthesis successfully reproduced the medial pivot pattern and achieved larger femoral external rotation relative to the tibia than MA-TKA. KA-TKA was able to maximize the primary concept of the medial pivot knee prosthesis.
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