{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:10:28Z","timestamp":1790021428604,"version":"4.0.1"},"reference-count":46,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["arthroplastytoday.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroplasty Today"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.artd.2026.102102","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T15:59:59Z","timestamp":1784995199000},"page":"102102","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["The Coronal Plane Alignment of the Knee Classification May be Unreliable With Advanced Knee Arthritis"],"prefix":"10.1016","volume":"40","author":[{"given":"Brandon H.","family":"Naylor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte C.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita Alex","family":"Bradham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie L.","family":"Gresham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6508-7827","authenticated-orcid":false,"given":"Zachary M.","family":"Ricciardelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Schwab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.artd.2026.102102_bib1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s11999-011-1936-5","article-title":"The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients?: the concept of constitutional varus","volume":"470","author":"Bellemans","year":"2012","journal-title":"Clin Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib2","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2106\/00004623-197961020-00003","article-title":"The total condylar knee prosthesis. A report of two hundred and twenty cases","volume":"61","author":"Insall","year":"1979","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.artd.2026.102102_bib3","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1302\/0301-620X.73B5.1894655","article-title":"Coronal alignment after total knee replacement","volume":"73","author":"Jeffery","year":"1991","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.artd.2026.102102_bib4","first-page":"153","article-title":"Postoperative alignment of total knee replacement. Its effect on survival","author":"Ritter","year":"1994","journal-title":"Clin Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib5","doi-asserted-by":"crossref","first-page":"472","DOI":"10.2106\/JBJS.16.01587","article-title":"Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise Follow-up at 20 years","volume":"100","author":"Abdel","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.artd.2026.102102_bib6","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s00167-021-06811-5","article-title":"What is the \u201csafe zone\u201d for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review","volume":"30","author":"Schelker","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib7","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.2106\/JBJS.I.01398","article-title":"Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements","volume":"92","author":"Parratte","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.artd.2026.102102_bib8","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.2106\/JBJS.25.00480","article-title":"Modern alignment strategies in total knee arthroplasty and how to best achieve them","volume":"107","author":"Harris","year":"2025","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.artd.2026.102102_bib9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","article-title":"Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?","volume":"468","author":"Bourne","year":"2010","journal-title":"Clin Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib10","doi-asserted-by":"crossref","first-page":"778","DOI":"10.3390\/jpm13050778","article-title":"Influence of mechanical alignment on functional knee phenotypes and clinical outcomes in primary TKA: a 1-Year prospective analysis","volume":"13","author":"Rak","year":"2023","journal-title":"J Pers Med"},{"key":"10.1016\/j.artd.2026.102102_bib11","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1302\/0301-620X.106B10.BJJ-2023-1425.R1","article-title":"Pre- and postoperative Coronal Plane Alignment of the Knee classification and its impact on clinical outcomes in total knee arthroplasty","volume":"106-B","author":"Konishi","year":"2024","journal-title":"Bone Jt J"},{"key":"10.1016\/j.artd.2026.102102_bib12","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1007\/s00167-013-2621-x","article-title":"Accurate alignment and high function after kinematically aligned TKA performed with generic instruments","volume":"21","author":"Howell","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib13","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-1050.R1","article-title":"Coronal Plane Alignment of the Knee (CPAK) classification","volume":"103-B","author":"MacDessi","year":"2021","journal-title":"Bone Jt J"},{"key":"10.1016\/j.artd.2026.102102_bib14","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s13018-022-03097-2","article-title":"Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: an updated meta-analysis of randomized controlled trials","volume":"17","author":"Liu","year":"2022","journal-title":"J Orthop Surg"},{"key":"10.1016\/j.artd.2026.102102_bib15","doi-asserted-by":"crossref","first-page":"S849","DOI":"10.1016\/j.arth.2022.01.052","article-title":"Head-to-Head comparison of kinematic alignment versus mechanical alignment for total knee arthroplasty","volume":"37","author":"Elbuluk","year":"2022","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.artd.2026.102102_bib16","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1302\/0301-620X.96B7.32812","article-title":"A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results","volume":"96-B","author":"Dossett","year":"2014","journal-title":"Bone Jt J"},{"key":"10.1016\/j.artd.2026.102102_bib17","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1097\/CORR.0000000000001150","article-title":"No difference in 5-year clinical or radiographic outcomes between kinematic and mechanical alignment in TKA: a randomized controlled trial","volume":"478","author":"Young","year":"2020","journal-title":"Clin Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib18","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.arth.2019.08.064","article-title":"Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery","volume":"35","author":"McEwen","year":"2020","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.artd.2026.102102_bib19","doi-asserted-by":"crossref","first-page":"297","DOI":"10.2106\/JBJS.24.00316","article-title":"Coronal plane alignment of the knee (CPAK) type shifts toward constitutional varus with increasing kellgren and Lawrence Grade: a radiographic analysis of 17,365 knees","volume":"107","author":"Kim","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.artd.2026.102102_bib20","doi-asserted-by":"crossref","first-page":"S215","DOI":"10.1016\/j.arth.2023.02.055","article-title":"Deep learning phenotype automation and cohort analyses of 1,946 knees using the coronal plane alignment of the knee classification","volume":"38","author":"Steele","year":"2023","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.artd.2026.102102_bib21","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann Rheum Dis"},{"key":"10.1016\/j.artd.2026.102102_bib22","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.knee.2023.02.012","article-title":"Quality of long standing radiographs assessment of the patella position","volume":"42","author":"Chen","year":"2023","journal-title":"Knee"},{"key":"10.1016\/j.artd.2026.102102_bib23","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/01.blo.0000238825.63648.1e","article-title":"The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty","volume":"452","author":"Noble","year":"2006","journal-title":"Clin Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib24","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1007\/s00167-013-2481-4","article-title":"Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees","volume":"21","author":"Vanlommel","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib25","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s00402-010-1064-9","article-title":"Varus malalignment has no influence on clinical outcome in midterm follow-up after total knee replacement","volume":"130","author":"Matziolis","year":"2010","journal-title":"Arch Orthop Trauma Surg"},{"key":"10.1016\/j.artd.2026.102102_bib26","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3928\/01477447-20190424-02","article-title":"Calipered kinematically aligned total knee arthroplasty: an accurate technique that improves patient outcomes and implant survival","volume":"42","author":"Howell","year":"2019","journal-title":"Orthopedics"},{"key":"10.1016\/j.artd.2026.102102_bib27","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s40634-021-00361-y","article-title":"Assessment of paradoxical anterior translation in a CR total knee prosthesis coupling dynamic RSA and FE techniques","volume":"8","author":"Mirulla","year":"2021","journal-title":"J Exp Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib28","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.knee.2022.11.001","article-title":"Kinematic alignment results in clinically similar outcomes to mechanical alignment: systematic review and meta-analysis","volume":"40","author":"Van Essen","year":"2023","journal-title":"Knee"},{"key":"10.1016\/j.artd.2026.102102_bib29","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1111\/os.12826","article-title":"Comparison of kinematic alignment and mechanical alignment in total knee arthroplasty: a meta-analysis of randomized controlled clinical trials","volume":"12","author":"Gao","year":"2020","journal-title":"Orthop Surg"},{"key":"10.1016\/j.artd.2026.102102_bib30","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.3928\/01477447-20120123-04","article-title":"Kinematically versus mechanically aligned total knee arthroplasty","volume":"35","author":"Dossett","year":"2012","journal-title":"Orthopedics"},{"key":"10.1016\/j.artd.2026.102102_bib31","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1007\/s00167-016-4136-8","article-title":"PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study","volume":"25","author":"Calliess","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib32","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jor.2019.02.008","article-title":"Kinematic versus mechanical alignment for primary total knee replacement: a systematic review and meta-analysis","volume":"16","author":"Xu","year":"2019","journal-title":"J Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib33","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.arth.2023.08.080","article-title":"Reoperation, implant survival, and clinical outcome after kinematically aligned total knee arthroplasty: a concise clinical Follow-Up at 16 years","volume":"39","author":"Howell","year":"2024","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.artd.2026.102102_bib34","doi-asserted-by":"crossref","first-page":"3678","DOI":"10.1016\/j.arth.2018.07.020","article-title":"Implant survival and function ten years after kinematically aligned total knee arthroplasty","volume":"33","author":"Howell","year":"2018","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.artd.2026.102102_bib35","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.otsr.2018.05.010","article-title":"Kinematic alignment of current TKA implants does not restore the native trochlear anatomy","volume":"104","author":"Rivi\u00e8re","year":"2018","journal-title":"Orthop Traumatol Surg Res"},{"key":"10.1016\/j.artd.2026.102102_bib36","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s00167-020-06081-7","article-title":"Kinematic aligned femoral rotation leads to greater patella tilt but similar clinical outcomes when compared to traditional femoral component rotation in total knee arthroplasty. A propensity score matched study","volume":"29","author":"Koh","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib37","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1007\/s00167-021-06687-5","article-title":"Functional knee phenotypes of OA patients undergoing total knee arthroplasty are significantly more varus or valgus than in a non-OA control group","volume":"30","author":"Jenny","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib38","doi-asserted-by":"crossref","first-page":"5507","DOI":"10.1007\/s00167-023-07604-8","article-title":"Distribution of coronal plane alignment of the knee classification does not change as knee osteoarthritis progresses: a longitudinal study from the Toei study","volume":"31","author":"Nomoto","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib39","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jisako.2022.12.002","article-title":"Changes in coronal knee-alignment parameters during the osteoarthritis process in the varus knee","volume":"8","author":"Colyn","year":"2023","journal-title":"J ISAKOS"},{"key":"10.1016\/j.artd.2026.102102_bib40","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1097\/JS9.0000000000001178","article-title":"Distribution of coronal plane alignment of the knee classification in Chinese osteoarthritic and healthy population: a retrospective cross-sectional observational study","volume":"110","author":"Gao","year":"2024","journal-title":"Int J Surg Lond Engl"},{"key":"10.1016\/j.artd.2026.102102_bib41","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.1007\/s43465-022-00756-8","article-title":"Radiological evaluation of the phenotype of Indian osteoarthritic knees based on the coronal plane alignment of the knee classification (CPAK)","volume":"56","author":"Mulpur","year":"2022","journal-title":"Indian J Orthop"},{"key":"10.1016\/j.artd.2026.102102_bib42","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.jos.2015.12.002","article-title":"The varus alignment and morphologic alterations of proximal tibia affect the onset of medial knee osteoarthritis in rural Japanese women: case control study from the longitudinal evaluation of Matsudai Knee Osteoarthritis Survey","volume":"21","author":"Higano","year":"2016","journal-title":"J Orthop Sci"},{"key":"10.1016\/j.artd.2026.102102_bib43","doi-asserted-by":"crossref","DOI":"10.1016\/j.artd.2025.101869","article-title":"Validation of articular cartilage depth in total knee arthroplasty","volume":"35","author":"Johnson","year":"2025","journal-title":"Arthroplast Today"},{"key":"10.1016\/j.artd.2026.102102_bib44","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s00167-020-06152-9","article-title":"The contralateral limb is no reliable reference to restore coronal alignment in TKA","volume":"30","author":"Beckers","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib45","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1007\/s00167-019-05524-0","article-title":"Contralateral preoperative templating of lower limbs\u2019 mechanical angles is a reasonable option","volume":"28","author":"Jacquet","year":"2020","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"10.1016\/j.artd.2026.102102_bib46","doi-asserted-by":"crossref","first-page":"6580","DOI":"10.3390\/jcm11216580","article-title":"Bilateral knee arthroplasty in patients affected by windswept deformity: a systematic review","volume":"11","author":"Cammisa","year":"2022","journal-title":"J Clin Med"}],"container-title":["Arthroplasty Today"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2352344126001512?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2352344126001512?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:38:42Z","timestamp":1790019522000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2352344126001512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":46,"alternative-id":["S2352344126001512"],"URL":"https:\/\/doi.org\/10.1016\/j.artd.2026.102102","relation":{},"ISSN":["2352-3441"],"issn-type":[{"value":"2352-3441","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The Coronal Plane Alignment of the Knee Classification May be Unreliable With Advanced Knee Arthritis","name":"articletitle","label":"Article Title"},{"value":"Arthroplasty Today","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.artd.2026.102102","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier Inc. on behalf of American Association of Hip and Knee Surgeons.","name":"copyright","label":"Copyright"}],"article-number":"102102"}}