Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction

Bone Joint J. 2014 Jul;96-B(7):857-62. doi: 10.1302/0301-620X.96B7.33946.


Substantial healthcare resources have been devoted to computer navigation and patient-specific instrumentation systems that improve the reproducibility with which neutral mechanical alignment can be achieved following total knee replacement (TKR). This choice of alignment is based on the long-held tenet that the alignment of the limb post-operatively should be within 3° of a neutral mechanical axis. Several recent studies have demonstrated no significant difference in survivorship when comparing well aligned versus malaligned TKRs. Our aim was to review the anatomical alignment of the knee, the historical and contemporary data on a neutral mechanical axis in TKR, and the feasibility of kinematically-aligned TKRs. Review of the literature suggests that a neutral mechanical axis remains the optimal guide to alignment.

Keywords: Total knee replacement; Coronal alignment; Neutral mechanical alignment; Anatomic alignment; Kinematically aligned total knee replacement.

Publication types

  • Review

MeSH terms

  • Arthroplasty, Replacement, Knee* / standards
  • Biomechanical Phenomena
  • Bone Malalignment / prevention & control
  • Humans
  • Knee Joint / physiopathology*
  • Osteoarthritis, Knee / surgery
  • Prosthesis Fitting
  • Rotation
  • Surgery, Computer-Assisted