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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Kinematic Alignment Using Conventional Mechanical-Alignment Instruments with 3D-Printed Tibial Recut Guide Versus Manual Mechanical Alignment in Total Knee Arthroplasty: An IPTW-Adjusted Comparative Cohort Study

  • Bui Hong Thien Khanh1
  • Pham Thi Cam Van2
  • Nguyen Phuc Thinh3
  1. 1Orthopaedic Department, University of Medicine and Pharmacy Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
  2. 2Department of Radiology, Diagnostic Medical Center Medic, Ho Chi Minh City 70000, Vietnam
  3. 3Orthopaedic Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
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Abstract

Background/Objectives: Unrestricted kinematic alignment (KA) may produce excessive tibial varus in some knees. We evaluated a modified KA technique using conventional mechanical instruments combined with a standardized 3D-printed 2° tibial recut guide that retained calipered femoral resurfacing while selectively restricting tibial varus, comparing it with historical manual mechanical alignment (MA) controls. Methods: This single-centre comparative cohort study included 120 knees from 104 patients (66 consecutive prospective KA knees and 54 historical MA knees). Inverse probability of treatment weighting targeting the average treatment effect on the treated adjusted for age, sex, body mass index, ASA class, and preoperative hip–knee–ankle angle. Treatment-effect inference used patient-level cluster-robust standard errors across 104 patient clusters. Outcomes included the 2011 Objective Knee Society Score (Objective KSS), patient-reported outcomes, and postoperative coronal alignment. Results: The recut guide was used in 37/66 KA knees (56.1%). KA was associated with a higher Objective KSS (ATT +15.47; 95% CI 9.07–21.87; p < 0.001), driven mainly by alignment (+11.93; 95% CI 5.93–17.94; p < 0.001) and stability (+2.16; 95% CI 0.54–3.79; p = 0.009), while the Objective KSS ROM component did not differ significantly. Patient-reported outcomes were not significantly different, including WOMAC (ATT −4.16; 95% CI −8.33 to 0.02; p = 0.051), OKS (ATT −1.89; 95% CI −3.88 to 0.10; p = 0.062), FJS (ATT +10.70; 95% CI −1.31 to 22.71; p = 0.081), and total KSS (ATT +5.17; 95% CI −2.36 to 12.70; p = 0.179). KA showed less residual varus HKA (−2.03° vs. −4.61°), fewer postoperative HKA outliers beyond ±6° (6.1% vs. 38.9%), higher FMA (91.20° vs. 89.26°), and a more horizontal joint line, whereas TMA did not differ significantly (p = 0.331). Conclusions: Modified KA with selective tibial varus restriction was associated with a higher postoperative Objective KSS and more favorable coronal alignment than historical manual MA, while patient-reported outcomes were largely comparable. These findings support the technical feasibility of the approach but do not establish causal or clinical superiority over contemporary MA.

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Cite

BibTeXRIS
BibTeX
@article{khanh2026kinematic,
  title = {{Kinematic Alignment Using Conventional Mechanical-Alignment Instruments with 3D-Printed Tibial Recut Guide Versus Manual Mechanical Alignment in Total Knee Arthroplasty: An IPTW-Adjusted Comparative Cohort Study}},
  author = {Bui Hong Thien Khanh and Pham Thi Cam Van and Nguyen Phuc Thinh},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218558},
  url = {https://www.mdpi.com/2077-0383/15/21/8558},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Kinematic Alignment Using Conventional Mechanical-Alignment Instruments with 3D-Printed Tibial Recut Guide Versus Manual Mechanical Alignment in Total Knee Arthroplasty: An IPTW-Adjusted Comparative Cohort Study
AU  - Bui Hong Thien Khanh
AU  - Pham Thi Cam Van
AU  - Nguyen Phuc Thinh
PY  - 2026
DA  - 2026/11/03
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218558
UR  - https://www.mdpi.com/2077-0383/15/21/8558
AB  - Background/Objectives: Unrestricted kinematic alignment (KA) may produce excessive tibial varus in some knees. We evaluated a modified KA technique using conventional mechanical instruments combined with a standardized 3D-printed 2° tibial recut guide that retained calipered femoral resurfacing while selectively restricting tibial varus, comparing it with historical manual mechanical alignment (MA) controls. Methods: This single-centre comparative cohort study included 120 knees from 104 patients (66 consecutive prospective KA knees and 54 historical MA knees). Inverse probability of treatment weighting targeting the average treatment effect on the treated adjusted for age, sex, body mass index, ASA class, and preoperative hip–knee–ankle angle. Treatment-effect inference used patient-level cluster-robust standard errors across 104 patient clusters. Outcomes included the 2011 Objective Knee Society Score (Objective KSS), patient-reported outcomes, and postoperative coronal alignment. Results: The recut guide was used in 37/66 KA knees (56.1%). KA was associated with a higher Objective KSS (ATT +15.47; 95% CI 9.07–21.87; p < 0.001), driven mainly by alignment (+11.93; 95% CI 5.93–17.94; p < 0.001) and stability (+2.16; 95% CI 0.54–3.79; p = 0.009), while the Objective KSS ROM component did not differ significantly. Patient-reported outcomes were not significantly different, including WOMAC (ATT −4.16; 95% CI −8.33 to 0.02; p = 0.051), OKS (ATT −1.89; 95% CI −3.88 to 0.10; p = 0.062), FJS (ATT +10.70; 95% CI −1.31 to 22.71; p = 0.081), and total KSS (ATT +5.17; 95% CI −2.36 to 12.70; p = 0.179). KA showed less residual varus HKA (−2.03° vs. −4.61°), fewer postoperative HKA outliers beyond ±6° (6.1% vs. 38.9%), higher FMA (91.20° vs. 89.26°), and a more horizontal joint line, whereas TMA did not differ significantly (p = 0.331). Conclusions: Modified KA with selective tibial varus restriction was associated with a higher postoperative Objective KSS and more favorable coronal alignment than historical manual MA, while patient-reported outcomes were largely comparable. These findings support the technical feasibility of the approach but do not establish causal or clinical superiority over contemporary MA.
SN  - 2077-0383
ER  -