Introduction: Correct prosthesis alignment and joint line reproduction in total knee replacement (TKR) is vital for a successful clinical outcome. It is acknowledged that the ideal coronal alignment of the knee following TKR should be between 4–10 degrees of valgus. A neutral or varus knee is associated with a higher failure rate. Previous studies have shown that ideal alignment is achieved in only around two-thirds of cases.

Joint line elevation > 8mm has been associated with inferior clinical outcome, and depression associated with retropatellar pain and increased risk of patella subluxation.

Recently, modifications have been made to the Kine-max-Plus Total Knee System instrumentation, theoretically providing better internal fixation to prevent a varus cut and a 12 mm measured resection from the “normal” tibial plateau. This study aims to examine whether these changes result in an improvement in alignment, and a more reliable restoration of joint line.

Materials and Methods: Two consecutive series, each of 75 patients who had undergone TKR using either the old (Group A) or the new (Group B) instrumentation were included in the study. Antero-posterior and lateral preoperative and postoperative knee radiographs were assessed using the American knee society radiographic analysis for prosthesis postionoing by 2 independent observers. The Tibial and Femoral Component Angles in the coronal plane (cTCA and cFCA) and in the sagittal plane (sTCA and sFCA) were measured, as was the change in joint line height.

Conclusion: Our results suggest that use of the new instrumentation is associated with better restoration of joint line, and is more effective in preventing implantation of the tibial component in varus. These figures relating to a modern instrumentation system provide a yardstick against which computer assisted and robotic surgery can be judged. Long-term follow-up will be required to assess the clinical significance of these results.