Purpose Kinematic alignment technique for TKA aims to restore the individual knee anatomy and ligament tension, to restore native knee kinematics. The aim of this study was to compare parameters of kinematics during gait (knee lexion-extension, adduction-abduction, internal-external tibial rotation and walking speed) of TKA patients operated by either kinematic alignment or mechanical alignment technique with a group of healthy controls. The hypothesis was that the kinematic parameters of kinematically aligned TKAs would more closely resemble that of healthy controls than mechanically aligned TKAs. Methods This was a retrospective case-control study. Eighteen kinematically aligned TKAs were matched by gender, age, operating surgeon and prosthesis to 18 mechanically aligned TKAs. Post-operative 3D knee kinematics analysis, performed with an optoelectronic knee assessment device (KneeKG®), was compared between mechanical alignment TKA patients, kinematic alignment TKA patients and healthy controls. Radiographic measures and clinical scores were also compared between the two TKA groups. ResultsThe kinematic alignment group showed no signiicant knee kinematic diferences compared to healthy knees in sagittal plane range of motion, maximum lexion, abduction-adduction curves or knee external tibial rotation. Conversely, the mechanical alignment group displayed several signiicant knee kinematic diferences to the healthy group: less sagittal plane range of motion (49.1° vs. 54.0°, p = 0.020), decreased maximum lexion (52.3° vs. 57.5°, p = 0.002), increased adduction angle (2.0-7.5° vs. − 2.8-3.0°, p < 0.05), and increased external tibial rotation (by a mean of 2.3 ± 0.7°, p < 0.001). The post-operative KOOS score was signiicantly higher in the kinematic alignment group compared to the mechanical alignment group (74.2 vs. 60.7, p = 0.034). Conclusions The knee kinematics of patients with kinematically aligned TKAs more closely resembled that of normal healthy controls than that of patients with mechanically aligned TKAs. This may be the result of a better restoration of the individual's knee anatomy and ligament tension. A return to normal gait parameters post-TKA will lead to improved clinical outcomes and greater patient satisfaction. Level of evidence III.

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