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Kinematic alignment (KA) aims to restore the pre-arthritic geometry of the joint and has been shown to produce similar or improved outcomes compared to mechanical alignment (MA). However, there are significant challenges when attempting to restore outlier joint anatomy. This study sought to investigate how achieved TKA alignment correlates with 12 month patient outcomes. The study considered three categories of achieved TKA alignments: KA, MA, or conservative KA (restricting coronal component alignments to within 5° and combined coronal alignment to within 3° of neutral). 369 patients were analysed; each patient had preand post-operative CT scans and a 12-month postoperative Knee Osteoarthritis & Outcome Score (KOOS). From CT scans, component positions were measured, and patients were categorized to one of the three categories. The conservative KA group were least likely (76%) to reach the threshold KOOS Pain score set by the Patient Acceptable State Score (PASS); the full KA group was most likely (95%) to reach the threshold, whilst the MA group was in between these two groups (88%). These results demonstrated an increase in pain when the achieved alignment formed a compromise between a restorative and a reconstructive approach, and further suggests that conservative approaches to kinematic alignment may require a high level of discretion. Health Sciences EPiC Series in Health Sciences Volume 3, 2019, Pages 418–421 CAOS 2019. The 19th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery P. Meere and F. Rodriguez Y Baena (eds.), CAOS 2019 (EPiC Series in Health Sciences, vol. 3), pp. 418–421

Conservative Kinematic Alignment Strategies Report Higher Incidence of Mid-Term Pain Following TKA: a Retrospective Study