Five Quality Assurance Steps for Balancing a Kinematically Aligned Total Knee Arthroplasty

Kinematically aligned total knee arthroplasty (TKA) has gained interest because two randomized trials and a national multicenter study showed that patients treated with kinematic alignment reported significantly better pain relief, function, flexion, a more normal-feeling knee than mechanical alignment with a similar implant survivorship at 2, 3, and 6 years [1–5]. This chapter introduces the three goals of kinematically aligned TKA, which are to restore (1) the native tibial-femoral articular surfaces, (2) the native knee and limb alignments, and (3) the native laxities of the knee. Because kinematically aligned TKA is relatively new and not as well understood as mechanically aligned TKA, we present five Quality Assurance Steps that are used intraoperatively to verify both kinematic alignment of the femoral and tibial components to the native joint lines and correct balancing of the knee. Examples of patients with severe varus and valgus deformity and flexion contractures treated with kinematically aligned TKA are shown.