Restricted Kinematic Alignment Improves Function, But Does Not Reduce Kinesiophobia After Total Knee Arthroplasty: A 3-Year Follow-Up Study.

BACKGROUND: Whether surgical alignment strategy influences postoperative kinesiophobia after total knee arthroplasty (TKA) remains unclear. This study aimed to compare the effects of restricted kinematic alignment (rKA) and mechanical alignment (MA) on postoperative kinesiophobia and functional recovery over a 3-year follow-up.

METHODS: This secondary analysis of a registered prospective randomized controlled trial included 183 patients undergoing TKA. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia-11 (TSK-11), and functional outcomes were evaluated using the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS) at multiple postoperative time points. Longitudinal outcomes were analyzed using mixed-effects models. Associations between 6-month changes in kinesiophobia and functional outcomes were evaluated using Spearman correlation analyses and Fisher's z-tests.

RESULTS: The TSK-11 scores did not differ significantly between groups at any follow-up time point, and the overall group effect was not significant (P = 0.153). Exploratory time-specific comparisons showed higher OKS scores in the rKA group at one year (P = 0.045) and higher FJS scores at six months (P = 0.026). Overall group effects were also significant for OKS (P = 0.004) and FJS (P = 0.007), with higher scores in the rKA group. Changes in TSK-11 were correlated with changes in OKS and FJS in both groups, without significant between-group differences in the correlation coefficients.

CONCLUSION: The rKA was associated with modest improvements in longitudinal functional outcomes, but did not reduce postoperative kinesiophobia. Kinesiophobia improvement was associated with functional recovery independent of alignment strategy, supporting targeted psychological and rehabilitation interventions.