Modern Alignment Strategies in Total Knee Arthroplasty and How to Best Achieve Them

➢ Adherence to accepted definitions of the various alternative total knee arthroplasty alignment strategies is important for research and communication between surgeons.➢ Technological advances, including robotics and navigation-assisted systems, have made precise execution of alternative alignment strategies feasible.➢ Modern studies have suggested that minor deviations (±3°) from neutral mechanical alignment do not significantly impact long-term total knee arthroplasty implant survivorship.➢ Individualized alignment strategies, such as kinematic, restricted kinematic, and functional alignment, aim to respect native anatomy and soft-tissue balance.➢ The majority of studies comparing intermediate-term outcomes of kinematic and mechanical alignment suggest noninferior outcomes with kinematic alignment; however, some studies have suggested superior outcomes with kinematic alignment.