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Restricted kinematic alignment total knee arthroplasty using augmented reality technology to maintain limb alignment
Sachiyuki Tsukada1, Hiroyuki Ogawa2, Tsutomu Nakayama3
1Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan.
Arthroplasty (London, England)
|February 27, 2026
Summary
Augmented reality navigation in total knee arthroplasty (TKA) improves surgical alignment. Restricted kinematic alignment with AR shows better intraoperative soft-tissue balance than mechanical alignment, though early walking recovery is similar.
Area of Science:
- Orthopedic Surgery
- Surgical Navigation
- Biomedical Engineering
Background:
- Augmented reality (AR) navigation systems using smartphones enhance precision in total knee arthroplasty (TKA).
- These systems allow real-time intraoperative quantification of joint gaps, crucial for component alignment.
- This study investigates integrating AR into restricted kinematic alignment for TKA.
Purpose of the Study:
- To evaluate the clinical effectiveness of integrating an AR-aided navigation system into restricted kinematic alignment for TKA.
- To compare AR-guided restricted kinematic alignment with traditional mechanical alignment in TKA.
- To assess intraoperative soft-tissue balance and early postoperative functional recovery.
Main Methods:
- A comparative study involving 45 TKAs using AR-guided restricted kinematic alignment (PCL-retaining) and 40 TKAs using mechanical alignment (PCL-resecting).
- Femoral and tibial components were aligned using calipered and soft-tissue guided techniques, with AR providing real-time angular confirmation.
- The target intraoperative extension gap was a rectangular configuration with equal medial and lateral widths.
Main Results:
- The AR-guided restricted kinematic alignment group demonstrated significantly smaller intraoperative soft-tissue imbalance in extension compared to the mechanical alignment group (1.1° vs 2.5°, P < 0.001).
- No significant differences were found between the groups in the timed up-and-go test or 10-m walk test at 1 week postoperatively after propensity score matching.
Conclusions:
- Restricted kinematic alignment TKA utilizing AR navigation and PCL-retaining prosthesis results in superior intraoperative soft-tissue balancing compared to mechanical alignment.
- Despite improved intraoperative balance, early postoperative functional outcomes like walking speed do not differ significantly between the two alignment techniques.
