Rehabilitation Guidelines for Kinematic Alignment in Primary Total Knee Arthroplasty: A Prospective Cohort Study

Authors

  • Kumar Gaurav
  • Mukesh Tiwari
  • Sourav Shukla
  • Lakshya Bhakhtiani
  • Soumyabrata Bera

Keywords:

Kinematic Alignment, Total Knee Arthroplasty, Rehabilitation,, Physical Therapy, Patient-Reported Outcome Measures, Functional Recovery

Abstract

Background: Kinematic alignment (KA) in total knee arthroplasty (TKA) is a surgical philosophy that aims to restore the patient's native, pre-arthritic knee anatomy and kinematics. This approach differs significantly from traditional mechanical alignment (MA), particularly in its preservation of the soft-tissue envelope without the need for ligamentous releases. While surgical outcomes have been extensively studied, there is a lack of specific, evidence-based rehabilitation guidelines tailored to the unique biomechanical principles of KA TKA.

Aim and Objective: The primary objective of this study was to develop and prospectively evaluate a specialized rehabilitation protocol for patients undergoing primary TKA with kinematic alignment. We aimed to assess the safety, efficacy, and functional outcomes associated with this protocol.

Methods: We conducted a prospective cohort study involving 60 patients who underwent primary KA TKA for osteoarthritis. A standardized, four-phase rehabilitation protocol was implemented, emphasizing immediate weight-bearing, early range of motion, and targeted patellofemoral stabilization exercises. Patient-reported outcome measures (PROMs), including the Knee Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score (FJS), and Knee Society Score (KSS), were collected preoperatively and at 6 weeks, 3 months and 6 months postoperatively. Longitudinal data were analysed using repeated measures ANOVA.

Results: All 60 enrolled patients completed the 6-month follow-up. Significant improvements were observed across all PROMs from the preoperative baseline to the 6-month mark (p<0.001). The mean FJS improved from 35.2 (SD 25.1) at 6 weeks to 72.5 (SD 18.8) at 6 months (p<0.001). Mean knee flexion improved from 108° (SD 12.5°) preoperatively to 125° (SD 8.5°) at 6 months. Functional milestones were achieved rapidly, with 92% of patients walking without an assistive device by 6 weeks. No implant failures, revisions for loosening, or deep infections occurred within the study period.

Conclusion: This study presents a structured rehabilitation protocol specifically designed for the kinematic alignment TKA population. The protocol was found to be safe and effective, leading to excellent early functional recovery and high patient satisfaction. These guidelines, which leverage the biomechanical advantages of the KA technique, can help standardize postoperative care and optimize outcomes for this growing patient cohort

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References

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Published

2025-10-13

How to Cite

1.
Gaurav K, Tiwari M, Shukla S, Bhakhtiani L, Bera S. Rehabilitation Guidelines for Kinematic Alignment in Primary Total Knee Arthroplasty: A Prospective Cohort Study. J Neonatal Surg [Internet]. 2025Oct.13 [cited 2025Oct.22];14(9S):1144-9. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/9340

Issue

Vol. 14 No. 9S (2025): Journal of Neonatal Surgery

Section

Original Article

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