The Kellgren-Lawrence classification system was used to classify knee OA for each case [21]. Patients with KL grade III or grade IV in the tibiofemoral joint as well as patients with ≤ 5 degrees varus of the proximal tibia (medial proximal tibial angle ≥ 85 degrees), ≤ 5 degrees of valgus deformity were considered for KA-TKA. Exclusion criteria included inflammatory arthritis, previous intra-articular fracture, previous collateral ligament or posterior cruciate ligament rupture, genu recurvatum, and fixed flexion contracture greater than 20 degrees. Given that trochlear dysplasia may have unknown impacts on this study, patients with trochlear dysplasia found preoperatively or intraoperatively were also excluded from this retrospective study.

From May 2018 to August 2020, a total of 55 patients underwent KA-TKA in our institution. After excluding three patients diagnosed with trochlear dysplasia and seven patients with missing intraoperative measurement data of lateral trochlear resection exposure, 45 patients (52 knees) were finally included in this study. Eleven patients were men, and 34 patients were women. The mean age was 69.5 ± 6.7 years (56–85 years), and the mean body mass index was 28.6 ± 4.2 kg/m2 (26–34 kg/m2). The preoperative radiographic changes of 1 knee were in accordance with Kellgren-Lawrence grade III, and the other 51 knees were in compliance with grade IV. Fifty patients had varus knees, and 2 patients had valgus knees. Among them, 16 patients (16 knees) underwent KA-TKA with the assistance of patient-specific instrumentation (PSI-KA), and 29 patients (36 knees) underwent KA-TKA using conventional instruments with measurement tools (Calipered kinematically aligned instrumentation, Calipered-KA). All bilateral KA-TKAs (seven patients) were performed using the Calipered-KA technique.

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