Mechanical versus Kinematic Alignment in Total Knee Arthroplasty

This chapter presents a case scenario of a 65-year-old man with end-stage degenerative knee disease scheduled for total knee arthroplasty (TKA). A stable knee with a neutral mechanically aligned lower limb mechanical alignment (MA) has been one of the primary surgical aims of TKA, as it provides good long-term implant survivorship. A case-control study demonstrated that MA TKAs displayed several significant knee kinematic differences to a healthy group: less sagittal plane range of motion, decreased maximum flexion, increased adduction angle, and increased external tibial rotation. One of the concerns about performing knee-ankle (KA) TKA is that it might be associated with an increased risk of early failure and other complications. Longer follow-up is needed to assess survivorship and define the correct indications for KA techniques in TKA. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.