What Postoperative Kinematic Movement Patterns Correlate with Improved Patient-Reported Outcomes After Total Knee Arthroplasty?

This systematic review aimed to evaluate how postoperative kinematic pa!erns (i.e., range of motion, function during movement, and gait) measured through fluoroscopy, 3D motion analysis, and wearable/implanted devices were associated with patient-reported outcome measures (PROMs). Fourteen studies evaluating 771 knees were included. Two studies exploring post-surgery exercise kinematics with fluoroscopy showed that increased femoral rotation and adduction during deep kneeling, and greater internal rotation during step-up exercises were linked to be!er PROMs. Studies examining the association between postoperative gait and PROMs with 3D motion analysis found that walking speed, maximal knee flexion during gait, cadence, and vertical stride regularity were positively associated with improved PROMs. Studies utilizing wearable/implanted devices showed functional improvement following increases in PROMs. These findings may be used to guide future research on implant selection and implantation strategies as well as demonstrate the links between PROMs and more objective metrics. Level of Evidence: III. (Journal of Surgical Orthopaedic Advances 35(3):158–165, 2026)

Key words: total knee arthroplasty, kinematics, patient reported outcomes, gait, exercise