Optimizing Limb Alignment in Total Knee Arthroplasty: Techniques, Outcomes, and Future Directions

Abstract Proper limb alignment during total knee arthroplasty (TKA) is critical for achieving optimal postoperative outcomes, influencing pain relief, functional recovery, and implant longevity. This review aims to explore the significance of limb alignment in TKA, evaluate various alignment techniques, and identify factors influencing alignment strategies. A comprehensive literature review was conducted using PubMed, Scopus, Embase, and Google Scholar to identify the relevant articles that were selected based on inclusion criteria focusing on alignment techniques in TKA. Key data were extracted and synthesized, considering study designs, sample sizes, alignment methods, and outcomes. The review discusses several alignment techniques: Mechanical alignment, kinematic alignment, functional alignment, computer-assisted navigation, and robotic-assisted surgery. Each technique’s advantages, such as simplicity and anatomical fidelity, and disadvantages, including reliance on surgeon experience and cost, were analyzed. Individual patient factors, including bone morphology and soft tissue conditions, were identified as crucial in determining the optimal alignment strategy. Proper limb alignment is essential for the success of TKA, impacting both immediate and long-term patient outcomes. Although traditional mechanical alignment remains standard, emerging methods such as kinematic- and robotic-assisted techniques offer promising alternatives that may better address individual anatomical variations. Future research should focus on developing personalized approaches to alignment, leveraging technological advancements, and enhancing clinical outcomes for TKA patients.