Clinical outcomes of kinematically aligned medial pivot total knee arthroplasty: A systematic review and meta-analysis of current evidence

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-13 DOI:10.1002/jeo2.70348

Francesco Bosco, Giorgio Cacciola, Virginia Masoni, Carmelo Burgio, Mariazzurra Carlino, Michele Centola, Ferdinando Tosto, Daniele Vezza, Lawrence Camarda, Luigi Sabatini

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引用次数: 0

Abstract

Purpose

Kinematic alignment (KA) in total knee arthroplasty (TKA) focuses on restoring the natural joint line and ligament balance, potentially improving biomechanics and outcomes over mechanical alignment (MA). The medial pivot (MP) implant enhances joint stability by mimicking physiological knee motion. Still, its role within a KA protocol and the effects of retaining versus sacrificing the posterior cruciate ligament (PCL) are unclear. This study aimed to evaluate the clinical effectiveness, functional outcomes and biomechanical benefits of KA-TKA with MP implants based on the available literature. It also aimed to assess whether PCL retention or sacrifice leads to better postoperative function.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of PubMed, Embase and Web of Science up to January 2025 identified studies assessing KA-TKA with MP implants. Primary outcomes included patient-reported outcome measures (PROMs), range of motion (ROM), complication rates and implant survivorship. Subgroup analysis compared PCL retention and sacrifice.

Results

Fourteen studies (955 patients) met inclusion criteria. KA-TKA with MP implants resulted in significant ROM improvements (+11.35°, increased to +12.50° after sensitivity analysis) and enhanced PROMs (Oxford Knee Score +18.23, increased to +22.27 after sensitivity analysis; Knee Society Score [KSS] +49.61, functional KSS +42.50). No aseptic loosening or implant failures were reported. PCL sacrifice was associated with greater postoperative flexion (125.4° ± 12.1° vs. 116.4° ± 11.8°, p < 0.001), but functional outcomes were comparable.

Conclusions

KA-TKA with MP implants improves functional recovery, patient satisfaction, and short- to mid-term survivorship, supporting its adoption as a viable alternative to conventional TKA. Further long-term, randomized trials are needed to optimize PCL management and confirm its durability.

Level of Evidence

Level IV.

Abstract Image

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运动学对齐内侧枢轴全膝关节置换术的临床结果：对现有证据的系统回顾和荟萃分析

目的全膝关节置换术（TKA）中的运动学对齐（KA）侧重于恢复自然关节线和韧带平衡，潜在地改善生物力学和机械对齐（MA）的结果。内侧枢轴（MP）植入物通过模拟膝关节的生理运动来增强关节的稳定性。尽管如此，其在KA方案中的作用以及保留与牺牲后交叉韧带（PCL）的影响尚不清楚。本研究旨在根据现有文献评估KA-TKA与MP植入物的临床疗效、功能结局和生物力学效益。它还旨在评估PCL保留或牺牲是否会导致更好的术后功能。方法按照PRISMA指南进行系统评价和荟萃分析。到2025年1月，PubMed， Embase和Web of Science的综合搜索确定了评估KA-TKA与MP植入物的研究。主要结果包括患者报告的结果测量（PROMs）、活动范围（ROM）、并发症发生率和植入物存活率。亚组分析比较PCL保留和牺牲。结果14项研究（955例）符合纳入标准。MP植入KA-TKA可显著改善ROM（+11.35°，敏感性分析后增加到+12.50°），提高PROMs(牛津膝关节评分+18.23，敏感性分析后增加到+22.27；膝关节社会评分[KSS] +49.61，功能性KSS +42.50)。无无菌松动或植入失败的报道。PCL牺牲与较大的术后屈曲相关（125.4°±12.1°vs 116.4°±11.8°，p < 0.001），但功能结果具有可比性。结论MP植入KA-TKA可改善功能恢复、患者满意度和中短期生存率，支持将其作为传统TKA的可行替代方案。需要进一步的长期随机试验来优化PCL的管理并确认其持久性。证据等级四级。

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