Equivalent Clinical Outcomes Between Anatomical Alignment Versus Mechanical Alignment of Simultaneous Bilateral Total Knee Arthroplasty Using a Posterior-Stabilized Prosthesis During an Average Follow-Up of Five Years: A Prospective Randomized Clinical Trial

Background: This study aimed to investigate the differences in clinical outcomes between anatomical alignment and mechanical alignment in each knee, respectively, in patients who underwent bilateral total knee arthroplasty. Methods: Bilateral simultaneous total knee arthroplasty using a posterior-stabilized prosthesis was performed between June 2016 and May 2018, with one knee undergoing anatomical alignment and the contralateral knee undergoing mechanical alignment, which was randomized. There were 80 knees in 40 patients (mean age 75 years, range 60 to 87, with 4 men and 36 women) followed up for at least 2 years (mean follow-up 4.9 years, range 2 to 7 years). On the anatomical side, the distal femoral cut was set 2 degrees more valgus to the mechanical axis, and the tibial cut was set to 2 or 3 degrees varus using a specific guide. Implant position and lower extremity alignment were measured using postoperative radiographs and computed tomography images. The range of motion before and after surgery, Knee Society score, patient satisfaction, postoperative 2011 Knee Society questionnaire, and Knee Injury and Osteoarthritis Outcome Scores were evaluated. Results: A significant difference was observed in joint line orientation (0.6 versus 2.9 degrees, P < .001), but not in the postoperative hip-knee-ankle angle between 2 groups. There was one knee in the mechanical alignment group that required revision surgery at 5 years due to implant loosening. Before surgery, the anatomical alignment group had a significantly lower knee extension angle (-7.2 versus -6.0 degrees, P = .035) and Knee Society Score (46.1 versus 49.1, P = .046). No significant difference was observed between the groups except for the 2011 Knee Society Questionnaire satisfaction scores (26.7 versus 25.7, P = .035). More participants preferred the anatomical alignment side postoperatively. Conclusions: Anatomical and mechanical alignments had similar clinical outcomes in patients undergoing bilateral total knee arthroplasty at a mean of 4.9 years follow-up. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.