AUGUST 202419the patient's weight-bearing axis of their leg. It is the most employed (and studied) approach globally. The technique has many variances through soft tissue balancing and bone resection to ensure the patient achieves a neutral HKA axis (180°). It is important to note that this technique sometimes requires surgeons to perform soft tissue releases, elevating or gently cutting medial or lateral ligament fibers to ensure equal tension in both knee compartments. As such, thepatient leaves the operating room with a straight leg, an optimal X-ray standard, and objective positioning marks. Kinematic Alignment: The Fastest Growing Technique in TKA TodayTo diagnose the root cause of lower satisfaction levels, we must investigate all the variables affecting patient satisfaction. Some surgeons have recognized that mechanical alignment could be part of the root cause. This approach, not technology or implant design, has historically been the common denominator in knee replacement. Many modified approaches have been published over the past 50 years, but none have grown as exponentially as the kinematic alignment (KA) technique. The idea is simple: resurface the patient's bony anatomy and minimize soft tissue releases. The technique's rationale comes from the fact that every patient has a different knee anatomy. Are the patient's legs slightly bowed or knock-kneed? Kinematic alignment will ensure that their leg would be restored to their native angle, whereas mechanical alignment forces each leg into a neutral stance. Proponents of the KA technique say that each patient's anatomy is restored, which should theoretically also restore native joint forces, ligament tensions, and kinematics. A novel concept, this technique essentially places each component in a personalized alignment instead of a `standardized' position. Industry focus on kinematic alignment has continued to surge in popularity, particularly in the past five years. A key reason for the surge is improved forgotten joint scores (the golden metric) and positive surgeon feedback. Perhaps nothing has spread the concept of kinematic alignment faster than peer discussions among surgeons. More and more studies are published each year demonstrating that kinematic alignment deserves consideration in a surgeon's practice.The bottom line? The knee replacement industry is facing a critical moment: we may be witnessing a transition to personalized arthroplasty. What Does the Future Look Like?Is kinematic alignment the watershed moment for TKA? Time will tell. The most interesting aspect of this rising trend is that surgeons are beginning to question the wisdom of conventional knee replacement. That may be just the start ­the KA technique was developed using implants and instrumentation specifically designed for Mechanical Alignment. There are some promising opportunities for manufacturers to create KA-specific instrumentation to simplify the technique and make it even more reproducible for every surgeon. Since KA requires positioning implants to each patient's individual anatomy, there is also a significant opportunity to refine the implant designsand further reinforce the concept of patient-specific knee replacement.The Watershed Moment: Personalizing Patient's Knee ReplacementsThe watershed moment for knee replacement is not robotics,software, or other technology that enhances precision. The industry has already accomplished significant achievements in precision.The watershed moment is improving the accuracy of each surgery by changing the target. kinematic alignment represents a shift of thinking; reproduce the patient's native anatomy and kinematics, instead of focusing on an arbitrary standard (MA). The data looks promising: early and mid-term studiesarealready demonstrating improved forgotten joint scores.In turn, more and more surgeons are switching their techniques, further reinforcing the trend. The concept represents a substantial opportunity to improve patient outcomes with zero additional costs to the healthcare system, which is a victory for every party involved in the patient's continuum of care. Kinematic alignment represents a shift of thinking; reproduce the patient's native anatomy and kinematics, instead of focusing on an arbitrary standard (MA)
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