{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:14:21Z","timestamp":1778742861001,"version":"3.51.4"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Total knee arthroplasty (TKA) is widely performed for end-stage osteoarthritis; however, 15\u201320% of patients continue to experience dissatisfaction despite successful surgery. Traditional mechanical alignment (MA) aims for a neutral limb axis, but this approach may not restore the individual\u2019s constitutional coronal alignment, potentially affecting functional recovery. The coronal plane alignment of the knee (CPAK) classification offers a phenotype-based system to characterize native knee alignment and joint line obliquity (JLO). This multicentric prospective randomized study aimed to evaluate whether CPAK-guided alignment leads to superior early post-operative functional outcomes compared with conventional MA in TKA.\n\nMaterials and Methods: This multicentric, prospective, randomized cohort study was conducted over 18 months across three tertiary orthopedic centers. Fifty patients undergoing unilateral primary TKA were enrolled and randomized into two groups: CPAK-guided alignment (n = 25) and MA (n = 25). Inclusion criteria were patients aged 45\u201380 years with primary osteoarthritis and available long-leg radiographs for CPAK classification. Exclusion criteria included post-traumatic arthritis, inflammatory arthropathy, neuromuscular disorders, and prior major knee surgery. Standardized surgical protocols and post-operative rehabilitation pathways were followed across all centers. Functional outcomes were assessed using knee society score (KSS), oxford knee score (OKS), and Visual Analog Scale (VAS) for pain at baseline, 3 months, and 6 months. Radiographic parameters included hip\u2013knee\u2013ankle (HKA) angle deviation and JLO. Statistical analysis included independent t-tests and correlation analysis.\n\nResults: Both groups demonstrated significant post-operative improvement; however, the CPAK-guided group achieved superior functional outcomes. At 6 months, mean KSS was significantly higher in the CPAK group (89.4 \u00b1 7.2) compared with the mechanical group (82.1 \u00b1 9.0; P = 0.004). OKS also favored the CPAK group (41.6 \u00b1 4.1 vs. 37.9 \u00b1 5.0; P = 0.01). VAS pain scores were significantly lower in the CPAK group at both follow-up intervals (1.4 \u00b1 0.8 vs. 2.4 \u00b1 1.0; P = 0.002). The need for medial soft-tissue release was markedly lower in the CPAK group (12% vs. 40%; P = 0.02). Radiographically, the CPAK-guided group showed significantly closer restoration of constitutional alignment and reduced joint line deviation. Correlation analysis demonstrated that greater deviation from native alignment was associated with poorer functional outcomes (r = \u22120.48, P = 0.004).\n\nConclusion: CPAK-guided alignment resulted in better early functional outcomes, reduced pain, and fewer soft-tissue releases compared with traditional MA in TKA. Personalized coronal alignment based on CPAK phenotype appears to enhance post-operative recovery and may offer a more physiological approach to knee arthroplasty.\n\nKeywords: Coronal plane alignment of the knee classification, functional outcomes, kinematic alignment, mechanical alignment, total knee arthroplasty.<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i05.7302","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:06:55Z","timestamp":1778742415000},"page":"354-363","source":"Crossref","is-referenced-by-count":0,"title":["Coronal Plane Alignment of the Knee Classification and Its Correlation with Post-operative Functional Outcomes in Total Knee Arthroplasty: A Prospective Cohort Study"],"prefix":"10.13107","volume":"16","author":[{"given":"Siddharth","family":"Malik","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Maharishi Markendeshwar Medical College and Hospital Solan, Solan, Himachal Pradesh, India,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gourab","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Max Superspeciality Hospital, New Delhi, India,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nithin","family":"Sundaresan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Arunai Medical College Hospital and Research Centre, Tiruvannamalai, Tamil Nadu, India,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sitansu Sekhar","family":"Samantaray","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, B J Government Medical College and Sassoon General Hospital, Pune, Maharashtra, India,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akash Pradip","family":"Bera","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Gauri Devi Institute of Medical Sciences and Hospital, Rajbandh, West Bengal, India,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hunaid Zoeb","family":"Haider","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T07:07:01Z","timestamp":1778742421000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/05\/coronal-plane-alignment-of-the-knee-classification-and-its-correlation-with-post-operative-functional-outcomes-in-total-knee-arthroplasty-a-prospective-cohort-study\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i05.7302","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}