{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:56:07Z","timestamp":1789721767472,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Despite advancements in total knee arthroplasty (TKA), patient dissatisfaction remains notably high (15%\u201325%). This dissatisfaction will be multifactorial, one of which may be the alignment of the components. Kinematic alignment (KA), aimed at restoring pre\u2010arthritic knee anatomy, is proposed as a promising alternative to mechanical alignment (MA), potentially offering better functional outcomes and improved gait characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A randomized controlled trial was conducted involving 100 patients undergoing primary TKA. Patients were randomized into two groups (KA vs. MA) using a navigation\u2010assisted surgical approach, with follow\u2010ups conducted at 1 year post\u2010operatively. Outcomes assessed included patient\u2010reported outcome measures (Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale and Forgotten Joint Score), radiological alignment and comprehensive gait analysis (kinematics, kinetics and spatio\u2010temporal parameters).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Navigation analyses indicated significant post\u2010operative alignment differences, with KA showing significantly more varus tibial (KA: 2.2\u2009\u00b1\u20092.8\u00b0 vs. MA: 0.3\u2009\u00b1\u20090.6\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and more valgus femoral cuts (KA: \u22120.7\u2009\u00b1\u20092.9\u00b0 vs. MA: 0.3\u2009\u00b1\u20090.8\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) compared to MA. However, these differences did not translate into significant clinical or functional differences between groups in patient\u2010related outcome measures, gait kinematics, kinetics, or spatio\u2010temporal parameters at the 1\u2010year mark. Both alignment techniques showed similar deviations from healthy gait patterns, particularly reduced knee flexion (mean ROM healthy 57.3\u00b0, KA 48.6\u00b0, MA 47.8\u00b0), and knee valgus during walking (mean maximal valgus healthy 15.2\u00b0, KA 10.5\u00b0, MA 9.5\u00b0). Notably, KA required fewer intraoperative soft tissue releases, suggesting procedural simplicity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study found no significant differences in clinical or functional outcomes between KA and MA despite distinct radiological alignment outcomes after 1\u2010year follow\u2010up. Both approaches yield comparable patient satisfaction and functional performance 1 year post\u2010operatively. KA offers procedural advantages, specifically reduced soft tissue interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level I.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70004","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T09:53:19Z","timestamp":1755597199000},"page":"596-607","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["No differences in functional and clinical outcomes after rehabilitation between modified kinematic and mechanical alignment in total knee arthroplasty: A randomized controlled trial"],"prefix":"10.1002","volume":"34","author":[{"given":"Leandra","family":"Bauer","sequence":"first","affiliation":[{"name":"Experimental Orthopaedics, University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg Friedrich\u2010Schiller\u2010University Jena Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8114-6121","authenticated-orcid":false,"given":"Frank","family":"Layher","sequence":"additional","affiliation":[{"name":"Experimental Orthopaedics, University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg Friedrich\u2010Schiller\u2010University Jena Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kirschberg","sequence":"additional","affiliation":[{"name":"Orthopaedics, University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg Friedrich\u2010Schiller\u2010University Jena Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Heinecke","sequence":"additional","affiliation":[{"name":"Orthopaedics, University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg Friedrich\u2010Schiller\u2010University Jena Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Woiczinski","sequence":"additional","affiliation":[{"name":"Experimental Orthopaedics, University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg Friedrich\u2010Schiller\u2010University Jena Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Matziolis","sequence":"additional","affiliation":[{"name":"Orthopaedics, University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg Friedrich\u2010Schiller\u2010University Jena Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2011.06.035"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.02.035"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5174-1"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4136-8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2008.11.008"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12545"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.08.191"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B7.32812"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B11.32767"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12143"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12826"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12408"},{"key":"e_1_2_12_14_1","unstructured":"GrimbergA KirschnerS L\u00fctznerJ MelsheimerO PerkaC ReichelH et al. The German Arthroplasty Registry (EPRD)\u2014The Annual Report 2024."},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-012-1634-2"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B10.BJJ.2016.0473.R1"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.01.060"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2010.543749"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12335"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-022-03097-2"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3798-y"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.09.031"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12401"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2010.03.008"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.5.190093"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016470510030661"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12494"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-024-05551-8"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-58178-7_26"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00132-015-3196-7"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/10225536221125952"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00132-020-03932-6"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2022.11.001"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2007.06.001"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5133-x"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05533-z"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-4844-x"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70004","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ksa.70004","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:19:51Z","timestamp":1773015591000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.70004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/ksa.70004"],"URL":"https:\/\/doi.org\/10.1002\/ksa.70004","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]},"assertion":[{"value":"2025-05-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}