Background: Kinematic alignment (KA) restores native limb alignment following total knee arthroplasty (TKA). The association of this technique with a medial pivot implant design attempts to re-establish the physiological kinematics of the knee. This study aims to analyze the clinical and radiological outcomes of patients undergoing MP-TKA with kinematic alignment and to assess the effect of limb alignment on the clinical outcomes. Methods: We retrospectively analyzed 55 patients who underwent kinematic aligned medial pivot TKA from September 2018 to January 2020. Patient-related outcomes (PROMs) were collected at baseline, 3, 12, and 24 months after surgery. Long-standing weight-bearing radiographs were performed three months after surgery. Results: We demonstrated a significant improvement in clinical outcomes from 3 months after surgery up to 24 months of follow-up. This clinical improvement was independent of limb alignment. The radiological analysis showed that the patient’s native limb alignment was restored and that their joint line orientation was parallel to the floor. Conclusion: The association of kinematic alignment and a medial pivot TKA implant allows for a fast recovery, with good clinical and functional outcomes up to a minimum of 2 years of follow-up, independent of the final limb alignment.

Background: Surgery remains the best option for more advanced stages of knee osteoarthritis (OA). Kinematic alignment (KA) is an innovative surgical technique that aims to co-align the rotational axes of the femoral, tibial, and patella components with the three kinematic axes of the knee. This study aims to evaluate and analyze short-term clinical, psychological, and functional outcomes in patients undergoing total knee replacement with the KA technique. Methods: Twelve patients who underwent total knee replacement surgery with kinematic alignment from May 2022 until July 2022 were prospectively followed and interviewed. Before surgery, the day after surgery, and postoperative day 14, the following tests were evaluated: VAS, SF-12 PS, SF-12 MS, KSS, KSS-F, PHQ-9, and KOOS-PS. Results: The mean BMI value of 30.4 (±3.4) Kg/m², mean age of 71.8 (±7.2) years. All the scores on the various tests administered consistently showed statistically significant improvement, not only immediately after surgery but also comparing the first to the fourteenth postoperative day. Conclusion: Kinematic alignment technique as a surgical treatment for KO allows the patient a fast postoperative recovery and good clinical, psychological, and functional results in a short time. Further studies are needed with a larger sample size, and prospective randomized studies are essential to compare these results with mechanical alignment.

Background: Hip osteoarthritis is a highly prevalent degenerative condition and a leading indication for total hip arthroplasty (THA). As anterior approaches have gained popularity, optimizing postoperative rehabilitation according to the muscles involved in recovery has become increasingly relevant. However, evidence regarding muscle-specific rehabilitation following the Anterior Minimally Invasive Surgery (AMIS) approach remains limited. Objectives: This study aimed to evaluate whether rehabilitation protocols specifically targeting the hip flexors or abductors could improve postoperative functional recovery compared with standard rehabilitation following AMIS THA. Methods: This retrospective single-center study included 29 patients aged 50–80 years with BMI < 30 kg/m² undergoing unilateral THA through the AMIS approach. The cohort included 14 men and 15 women. Patients were non-randomly allocated according to clinical and organizational factors to standard rehabilitation (ST; n = 10), a hip flexor-focused protocol (SP1; n = 10), or a hip abductor-focused protocol (SP2; n = 9). Postoperative recovery was evaluated using clinical, functional, and patient-reported outcome measures. Rehabilitation was supervised by physiotherapists. Outcomes included goniometric hip range of motion, dynamometer-measured hip flexor and abductor strength, Timed Up and Go (TUG), Visual Analogue Scale (VAS), Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), and SF-12. Longitudinal outcomes were analyzed using two-factor models assessing time, rehabilitation group, and their interaction, with post hoc comparisons where appropriate. Statistical significance was set at p < 0.05. Results: Of the 29 initially enrolled patients, 26 completed the study assessments and were included in the final analysis (ST, n = 9; SP1, n = 10; SP2, n = 7). Significant improvements over time were observed for hip flexion and internal rotation ROM, abductor strength, TUG, VAS, HOOS, and HHS. No consistent superiority of either targeted protocol over standard rehabilitation was identified. Postoperative improvements in hip range of motion, muscle strength, mobility, pain, and functional performance were observed over time across the study cohort. Although no protocol demonstrated statistically significant superiority in range of motion or functional outcomes, all three groups showed postoperative improvement over time following AMIS THA. Conclusions: All rehabilitation groups improved during postoperative recovery, but neither the flexor- nor abductor-focused protocol demonstrated superiority over standard rehabilitation. Given the small sample size and non-randomized design, these findings are preliminary and hypothesis-generating and require confirmation in adequately powered randomized studies. Because the targeted protocols also involved a greater overall number of prescribed exercises, the present design cannot distinguish the effects of muscle-specific targeting from those of greater exercise exposure.