Why Kinematic Alignment Is Right for You

Each time a patient’s knee joint is repaired during a total knee replacement, the surgeon aligns the new implant to match the angles of the skeleton. The technology of this process has developed over time, leading to a new approach, introduced in 2006, called kinematic alignment. The goal of this technique is to mimic the original anatomy of each patient’s knee. This can lead to drastically improved satisfaction with the results of the procedure. Moreover, only Dr. David Scott of Orthopaedic Speciality clinic offers kinematic alignment in the Spokane area. We welcome you to consult with us today to achieve a totally customized total knee replacement. 


radiographs of a kinematic alignment TKR implant

Kinematic Alignment radiographs. The bottom left shows how the implant mimics the natural angles of the other knee.

Since 1985, mechanical alignment had been the common practice for total knee replacements. This approach placed all knee implants in an average position (that is, in the same basic alignment for every patient, no matter their individual anatomy). Success rates were high, especially for patients with a posterior stabilized TKR. This form of knee implant replaces all the ligaments in the knee, as well as parts of the bone and cartilage. This makes it the most invasive form of the procedure. 

However, long-term patient satisfaction for this procedure and for others involving less invasive implants and techniques turned out  surprisingly low. This led Dr. Stephen Howell to develop a new approach in 2006. With this technique, he took into account each patient’s natural knee anatomy and alignment. Moreover, he prioritized preserving as much of the original knee structure as possible, which led to better balanced implants and a decreased need to restructure the original ligaments.

Due to the fact that the procedure is fairly recent in terms of medical history, medical professionals and researchers have not yet widely studied it. However, four meta-analyses, three randomized trials, and a national multicenter study have ascertained that patients whose total knee replacement followed the kinematic alignment approach experienced significantly better satisfaction than patients with mechanical alignment. On average, the former reported better pain relief, function, range of motion, and a more normal-feeling knee. 

We know you have questions:

Why is kinematic alignment not widely adopted?

Due to the fact that mechanical alignment is still the most common technique for total knee replacements, most implants and surgical instruments are optimized for this approach. For this reason, surgeons and clinics can feel ill-equipped to implement kinematic alignment in their procedures.

At OSC, however, Dr. David Scott believes that nothing should stand in the way of offering patients the best and most advanced joint care. This philosophy combined with his commitment to research and orthopaedic advancement means that he prioritizes kinematic alignment for all total knee replacements.

How does kinematic alignment work?

The human knee has three axes of alignment. One controls flexion-extension (bending and straightening); the next controls the motion of the patella (kneecap); the final controls the rotation of the tibia (shinbone) in relation to the femur (thighbone). Kinematic alignment takes all three of these axes into account. During the surgery, while the implant is tested range of motion, all three axes will be considered to ensure they are well-balanced. If the surgeon finds any tightness or looseness found, he or she will make adjustments to the bone and implant. This ensures that the fit of the implant perfectly mimics the patient’s native anatomy. 

Why should I choose Orthopaedic Specialty Clinic for my total knee replacement?

Dr. David Scott joined Dr. Stephen Howell in researching the benefits of kinematic alignment. He has helped prove that even with manual instrumentation and traditional implants, surgeons can still achieve a kinematic alignment for all patients. He hopes this discovery will allow all clinics to offer this superior procedure to patients in the future. For the moment, however, Orthopaedic Specialty Clinic of Spokane remains the only location in the Inland Northwest (and one of the few locations in the country) that offers this ground-breaking approach to total knee replacement surgery.

If you are excited to learn more about how kinematic alignment can improve your total knee replacement procedure, reach out to Orthopaedic Specialty Clinic and Dr. David Scott for a consultation today. 

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