Abstract Despite advances in surgical techniques and implant design, a significant number of patients remain dissatisfied after total knee arthroplasty (TKA), often because of factors unrelated to the arthroplasty itself. Among these, pelvic biomechanics play a vital yet frequently overlooked role in affecting knee alignment, load distribution, and functional outcomes. This review explores how pelvic orientation, tilt, and dynamics, as well as coronal asymmetries and spinopelvic mobility, influence knee biomechanics and TKA planning. By viewing the pelvis not as a static reference but as a dynamic biomechanical driver, this study discusses how sagittal imbalance, pelvic obliquity, and stiffness impact intraoperative assessment and postoperative knee function. Using an integrated, evidence-based approach, the present study advocates for a paradigm shift in knee arthroplasty that recognises the pelvis as a central factor for success in TKA and promotes personalised solutions grounded in whole-body biomechanics.
Migliorini et al. (Fri,) studied this question.