This 2025 current-concepts review from Harris et al. defines and compares every major TKA alignment strategy — mechanical, anatomic, adjusted mechanical, kinematic, restricted kinematic, inverse kinematic, and functional — and evaluates the surgical technologies required to execute each. The central question: does departing from rigid mechanical alignment improve outcomes, and how do you do it accurately?
When planning TKA, recognize that your patient's CPAK phenotype may make strict neutral mechanical alignment an anatomically poor fit — individualized strategies (kinematic, restricted kinematic, or functional) are supported by Level I–II evidence for noninferior or superior outcomes, but require navigation or robotics to execute degree-specific cuts reliably.
Use the ±3° safe zone as your entry point when transitioning away from mechanical alignment, expanding thresholds as your familiarity grows.
This 2025 current-concepts review from Harris et al. defines and compares every major TKA alignment strategy — mechanical, anatomic, adjusted mechanical, kinematic, restricted kinematic, inverse kinematic, and functional — and evaluates the surgical technologies required to execute each. The central question: does departing from rigid mechanical alignment improve outcomes, and how do you do it accurately?
When planning TKA, recognize that your patient's CPAK phenotype may make strict neutral mechanical alignment an anatomically poor fit — individualized strategies (kinematic, restricted kinematic, or functional) are supported by Level I–II evidence for noninferior or superior outcomes, but require navigation or robotics to execute degree-specific cuts reliably.
Use the ±3° safe zone as your entry point when transitioning away from mechanical alignment, expanding thresholds as your familiarity grows.