An Evidence-based Review of Challenges Faced in Personalized Alignment Strategies in Total Knee Arthroplasty

Restoring knee alignment is critical to total knee arthroplasty (TKA) success. Mechanical alignment offers reliable outcomes by standardizing component positioning, but it may neglect individual anatomy. In response, personalized alignment techniques—such as kinematic, inverse kinematic, and functional alignment—aim to replicate native biomechanics using technologies like robotics and patient-specific instrumentation. While promising, these approaches raise concerns about alignment precision, long-term outcomes, and technique selection. As personalized alignment techniques gain traction, evidence is needed to determine optimal patient-specific strategies and implant compatibility. Long-term data will clarify the clinical value and durability of these individualized techniques in TKA.