Comparison of Gait Pattern and Functional Recovery Following Total Knee Arthroplasty: Kinematic Alignment Vs. Mechanical Alignment

Background: Total Knee Arthroplasty (TKA) is a well-established surgical procedure for relieving pain and restoring function in patients with end-stage knee osteoarthritis.However, optimal alignment strategy, whether kinematic alignment (KA) or mechanical alignment (MA) remains a subject of ongoing debate.Emerging evidence suggests that KA may better replicate native knee kinematics, improving postoperative gait and recovery.This systematic review aims to systematically compare gait patterns and functional outcomes in patients undergoing TKA with KA versus MA, evaluating evidence from recent randomized controlled trials and comparative cohort studies.Methods: A comprehensive literature search was conducted using databases including PubMed, Scopus, Web of Science, and Google Scholar up to May 2025.Seven peer-reviewed studies were included based on predefined inclusion and exclusion criteria, focusing on gait parameters (e.g., walking speed, step length, joint kinematics), patientreported outcome measures (PROMs), and radiological findings post-TKA.The PRISMA guidelines were followed, and quality assessment was performed using the ROB 2 and Newcastle-Ottawa tools.Results: The majority of included studies demonstrated that KA-TKA leads to improved or equivalent outcomes compared to MA-TKA.Patients with KA showed better restoration of natural knee kinematics, increased walking speed, more symmetric gait cycles, and higher satisfaction scores in the early and midterm follow-ups.Several meta-analyses supported these findings, indicating a significant reduction in mechanical axis deviation and improved functional scores with KA.However, long-term survivorship data and complications were comparable between the two techniques.Conclusion: KA appears to offer superior or at least non-inferior gait restoration and functional outcomes compared to MA.The approach may lead to more personalized and physiologically favourable results, especially in terms of early postoperative recovery.However, further high-quality, long-term RCTs are needed to validate its adoption, durability and implant longevity.