Robotic-Assisted Kinematically Aligned Total Knee Arthroplasty

The optimal alignment strategy in total knee arthroplasty (TKA) has yet to be elucidated. Mechanical alignment (MA), traditionally thought of as the gold-standard approach, positions implants perpendicular to the mechanical axes of the femur and tibia to achieve neutral limb alignment in the coronal plane. By contrast, kinematic alignment (KA) seeks to recreate the patient's pre-arthritic joint line, limb geometry, and soft-tissue balance by resurfacing the distal femur and proximal tibia. Although multiple studies have reported either equivocal or improved functional outcomes for KA compared to MA, most KA techniques have relied on cartilage thickness assumptions and caliper-guided instrumentation, which can be limited by the precision of manual bone resections and may necessitate intraoperative bony recuts when residual soft tissue imbalance persists. To address these limitations, robotic-assisted TKA offers enhanced accuracy and reproducibility of implant placement by facilitating patient-specific bony resection planning, objective assessment of soft tissue balance, and intraoperative mapping of intact cartilage. In this article, we present our surgical technique for robotic-assisted kinematically aligned TKA, which leverages a CT-based robotic platform to map cartilage intraoperatively and guide patient-specific component placement in accordance with traditional KA principles.