Alignment strategy does not confer clinically meaningful advantages in medial pivot total knee arthroplasty: a systematic review and meta-analysis

Both kinematic and mechanical alignment in medial pivot TKA yielded reliable improvements in clinical and functional outcomes, with only minor differences in motion and joint awareness that did not reach thresholds of clinical relevance. Surgical decision-making should therefore prioritise intraoperative soft tissue balance, implant-specific design, and surgeon expertise rather than the expectation of meaningful superiority of one alignment philosophy over the other.