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Inverse kinematic alignment outperforms adjusted mechanical alignment in varus TKA at 5 years.

Philip Winnock de Grave1, Oscar Roosens1,2, Hannes Vermue1,3

  • 1Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|April 9, 2026
PubMed
Summary
This summary is machine-generated.

Inverse kinematic alignment (iKA) in robotic-assisted total knee arthroplasty (TKA) shows better 5-year functional outcomes for varus knees compared to adjusted mechanical alignment (aMA). iKA better preserves native knee anatomy, leading to improved patient scores.

Keywords:
inverse kinematic alignmentmechanical alignmentoutcomerobotic surgerytotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Robotic Surgery

Background:

  • Varus knee alignment presents unique challenges in total knee arthroplasty (TKA).
  • Patient-specific alignment may offer advantages over traditional methods in these cases.
  • Robotic-assisted TKA allows for precise execution of alignment strategies.

Purpose of the Study:

  • To compare 5-year functional outcomes of robotic-assisted TKA using inverse kinematic alignment (iKA) versus adjusted mechanical alignment (aMA).
  • To specifically evaluate outcomes in patients with preoperative varus knee alignment.
  • To assess the impact of alignment strategy on native knee anatomy preservation.

Main Methods:

  • Retrospective matched cohort analysis of 90 patients (45 iKA, 45 aMA) with preoperative varus alignment undergoing robotic-assisted TKA.
  • Patients were matched based on demographics, preoperative alignment, osteoarthritis severity, and baseline scores (OKS, EQ-5D).
  • Functional outcomes (Oxford Knee Score, Forgotten Joint Score, Metabolic Equivalent of Task) and radiographic parameters were assessed at 5 years.

Main Results:

  • The iKA group demonstrated significantly higher 5-year functional outcomes, including Oxford Knee Score (OKS) and Forgotten Joint Score (FJS).
  • Metabolic Equivalent of Task (MET) scores were also significantly higher in the iKA group.
  • Radiographically, iKA resulted in a higher postoperative medial proximal tibial angle (MPTA) and smaller distal medial femoral resections, indicating better preservation of native tibial and femoral anatomy.

Conclusions:

  • Inverse kinematic alignment (iKA) provides superior 5-year functional outcomes for patients with varus knee alignment undergoing robotic-assisted TKA compared to adjusted mechanical alignment (aMA).
  • iKA is associated with better preservation of native tibial and medial femoral anatomy.
  • These findings support the use of iKA for optimizing TKA outcomes in varus knees.