Knee Replacement philosophy & alignment
The Role of Kinematic Alignment & Functional alignment
Knee replacement surgery, also known as total knee arthroplasty (TKA), is one of the most successful procedures for relieving pain and restoring function in patients with severe knee arthritis. While implant design and materials have evolved, one of the biggest advancements in recent years is the concept of alignment strategy—specifically, the move from traditional mechanical alignment to kinematic alignment, as well as medial pivot prostheses.
Dr Collins aims to combine the positive benefits of all technologies and techniques to resurface the knee and achieve optimal outcomes and satisfaction.
Why Alignment Matters in Knee Replacement
The way a knee replacement is aligned directly impacts:
Joint stability
Implant longevity
Patient comfort and function
Traditionally, surgeons have aimed for a neutral mechanical alignment, where the hip, knee, and ankle are in a straight line. This was believed to ensure even load distribution across the implant.
However, not all knees are naturally straight. Many people are born with slight varus (inward angulation) or valgus (outward angulation) alignment, and their soft tissues have adapted to this.
What is Kinematic Alignment?
Kinematic alignment is a patient-specific approach to knee replacement. Instead of forcing every knee into a mechanically neutral position, kinematic alignment aims to restore the patient’s natural pre-arthritic anatomy—including their unique bone angles and soft tissue balance.
Key Principles of Kinematic Alignment:
Personalized cuts: Bone resections match the patient’s original joint lines.
Natural ligament tension: Soft tissues are preserved as much as possible, reducing the need for releases.
Recreating the original kinematics: The knee moves more like the patient’s native knee.
Benefits of Kinematic Alignment
Research and clinical experience suggest several potential advantages:
✅ Improved function: Patients often report a more natural feel during activities like walking or climbing stairs.
✅ Faster recovery: Less soft tissue disruption may lead to quicker rehabilitation.
✅ Higher satisfaction rates: Many patients prefer the more “normal” movement pattern compared to mechanically aligned knees.
Is Kinematic Alignment for Everyone?
Not all patients are ideal candidates. Factors such as severe deformity or ligament instability may require alternative alignment strategies. The decision is made after careful assessment, often with the help of computer navigation or robotic assistance for precision.
Functional Alignment?
Functional alignment in total knee replacement (TKA) is a surgical technique that aims to combine the benefits of kinematic alignment and mechanical alignment, while taking into account soft tissue balance and implant safety limits.
Dr Collins uses pre-operative CT 3d scanning to map your knee, and then restore or resurface your knee to it’s pre-arthritic condition whilst taking into account the soft tissue (ligament) balancing. He can very accurately do this with the aid to robotic-assistance that ensures accurate implant positioning and also objectively allows him to balance your knee prior to making any bony cuts. He aims for a personalised knee replacement that best suits your knee to maximise your satisfaction and outcomes.
Technology and Accuracy
Modern tools like robot-assisted surgery and patient-specific instrumentation help surgeons achieve accurate kinematic & functional alignment. These technologies improve precision and ensure that the implant replicates the patient’s natural alignment within safe limits.
Custom Knee Replacement
Dr Collins is happy to discuss the pros and cons of custom made knee replacement, and if appropriate can be utilised.
Final Thoughts
Kinematic and/or functional alignment represents a shift towards personalised knee replacement, focusing on restoring the patient’s native anatomy rather than applying a one-size-fits-all approach. For many patients, this can mean a more comfortable and functional knee after surgery.
If you’re considering knee replacement, discuss alignment options with your orthopaedic surgeon. The right strategy can make all the difference in your recovery and long-term results.
