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The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment\u2014aMA) and a patient\u2010specific alignment TKA cohort (inverse kinematic alignment\u2014iKA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>At two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case\u2013control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients\u2019 demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON)<jats:bold>.<\/jats:bold> Data collection was conducted by a blinded investigator. The primary outcomes were knee flexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During walking, the maximum knee flexion did not differ between the iKA group (53.0\u00b0) and the control group (55.1\u00b0), whereas the aMA group showed lower amplitudes of sagittal motion (47.4\u00b0). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225\u00a0N mm\/kg) compared to aMA group (276\u00a0N mm\/kg). No significant differences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs differed significantly between patients receiving aMA and healthy controls. The OKS was significantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; <jats:italic>p<\/jats:italic>\u2009=\u20090.05. The FJS was significantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; <jats:italic>p<\/jats:italic>\u2009=\u20090.002.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>At two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity.\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07464-2","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T22:01:50Z","timestamp":1686693710000},"page":"4692-4704","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7337-6944","authenticated-orcid":false,"given":"Philip","family":"Winnock de Grave","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--><!--<institution-id institution-id-type=\"ROR\">https:\/\/ror.org\/05f950310<\/institution-id>--> Department Rehabilitation Sciences KU Leuven Brugge Belgium"},{"name":"<!--<label>2<\/label>--> Department Orthopaedic Surgery AZ Delta Roeselare Brugsesteenweg 90 8800 Roeselare Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamaya","family":"Van Criekinge","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--><!--<institution-id institution-id-type=\"ROR\">https:\/\/ror.org\/05f950310<\/institution-id>--> Department Rehabilitation Sciences KU Leuven Brugge Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Luyckx","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department Orthopaedic Surgery AZ Delta Roeselare Brugsesteenweg 90 8800 Roeselare Belgium"},{"name":"<!--<label>3<\/label>--><!--<institution-id 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