Michael Harvey, MD
If you’re considering total knee replacement, you’ve likely heard terms like “mechanical alignment” and “kinematic alignment” thrown around. These are surgical strategies for how we position and balance the new components in your knee during total knee arthroplasty (TKA). While they may sound technical, they can have a real impact on how your knee feels and functions after surgery.
Today, I want to focus on kinematic alignment—a technique that I increasingly recommend for many of my patients—and explain why it may be a more natural fit for your body.
What Is Kinematic Alignment?
Traditionally, most knee replacements have used a technique called mechanical alignment, where we aim to create a straight line from the center of your hip to your ankle, placing the components at right angles to that line. This works well in many cases, but it's not how everyone's knee is naturally aligned.
In contrast, kinematic alignment (KA) is a more personalized approach. Instead of making everyone’s knee look the same on an X-ray, we aim to restore the knee to the way it was before arthritis set in—to your own unique anatomy.
We achieve this by using precise imaging and instruments to match the placement of the implants to your native joint lines and ligament tension, rather than forcing them into a standardized position.
Why Does This Matter?
Imagine you’ve been walking your whole life with a slight natural bow in your legs, and now, after knee replacement, that alignment is suddenly corrected to perfectly straight. For some patients, that change can feel unnatural. It may even affect how your muscles and ligaments function.
Kinematic alignment avoids overcorrecting your anatomy. Instead, it seeks to work with your body, not against it. The goal is to recreate the knee’s natural rotation and motion, which may lead to a knee that feels more like your own.
The Benefits of Kinematic Alignment
While every patient is different, research and experience suggest several potential advantages of kinematic alignment for the right candidates:
- More Natural Knee Feel
Because KA aims to reproduce your pre-arthritic alignment, many patients report that their knee feels more "normal" after surgery. That includes smoother bending, less stiffness, and a better overall sense of stability during movement.
- Faster Recovery and Function
Some studies show that patients recover faster with kinematic alignment, regaining range of motion and walking ability sooner. This might be because the knee doesn’t need to adapt to an artificially imposed alignment.
- Less Soft Tissue Trauma
With KA, we generally don’t need to release as many ligaments or adjust surrounding structures, which can mean less pain, swelling, and trauma postoperatively.
- Higher Patient Satisfaction
Several studies report improved satisfaction scores among patients who received kinematically aligned TKAs compared to mechanically aligned ones. Simply put, patients tend to feel happier with the way their knee functions and feels.
Is Kinematic Alignment Right for Everyone?
Not necessarily. While it offers many benefits, KA isn’t suitable for all patients. People with severe deformities, significant ligament instability, or certain bone abnormalities might still benefit more from traditional techniques.
That’s why we always begin with a detailed assessment, including X-rays, 3D imaging, and physical examination, to determine the best alignment strategy for your specific anatomy and lifestyle goals.
What About Long-Term Outcomes?
Kinematic alignment is a relatively newer technique compared to mechanical alignment, which has decades of long-term data. That said, growing evidence shows that well-performed KA can offer comparable implant longevity, with potential for greater patient satisfaction and function in the medium term.
We continue to track outcomes closely, and as more data becomes available, we’re seeing increasing confidence in the durability of this technique.
Final Thoughts
As an orthopedic surgeon, my goal isn’t just to give you a pain-free knee—it’s to give you a knee that feels natural, stable, and allows you to return to the activities you love. For many patients, kinematic alignment is a powerful way to achieve that.
If you're considering knee replacement surgery, let’s have a conversation about your goals, your anatomy, and whether this personalized approach might be the best fit for you.
Your knee has been uniquely yours for decades. I believe your knee replacement should be too.
