- SPECIALIST ORTHOPAEDIC SURGEON | MELBOURNE, VIC | ALBURY, NSW | MORNINGTON, VIC |
- 03 9421 6133
- Melbourne & Mornington VIC |
- Albury, NSW
Kinematic Alignment Total Knee Replacement
A surgical approach to relieve pain, restore movement, and help you return to the life you enjoy
Kinematic alignment total knee replacement is a modern surgical approach designed to restore the natural anatomy and movement of your knee. Unlike traditional techniques that aim to place implants in a standardised mechanical position, kinematic alignment focuses on recreating your individual, pre-arthritic joint function. This technique has gained growing popularity among orthopaedic surgeons and patients seeking a more natural-feeling knee replacement and quicker return to daily activity.
Orthopaedic surgeon Dr Jason Hockings is experienced in using this technique in combination with patient-specific instrumentation (PSI), advanced surgical technologies, and a minimally invasive subvastus approach to support greater precision, faster recovery, and long-term satisfaction.
Understanding kinematic alignment
Every person’s knee anatomy is different, with variations in the angles, rotation, and soft tissue balance that govern natural movement. In patients with osteoarthritis, these relationships can become distorted due to cartilage loss, deformity, and compensatory changes in the surrounding structures. Kinematic alignment seeks to restore the patient’s original, pre-arthritic joint orientation rather than forcing the knee into a neutral or “standardised” position. This involves:
- Preserving natural joint lines and bone angles
- Reproducing the three axes of knee motion (flexion-extension, internal-external rotation, and varus-valgus tilt)
- Maintaining soft tissue tension and ligament balance without extensive releases
- Optimising joint stability and comfort based on the patient’s natural biomechanics
How kinematic alignment differs from mechanical alignment
In total knee replacement surgery, the goal is to replace the damaged parts of your knee with prosthetic components that restore stability, movement, and comfort. There are different ways to align these implants, and the two main techniques are mechanical alignment and kinematic alignment.
Mechanical alignment: A “one-size-fits-all” approach
Mechanical alignment is the traditional technique used in knee replacement surgery. It positions the implants to form a straight line from the hip to the knee and down to the ankle, often called a neutral mechanical axis. Although this approach can create a symmetrical leg shape, it does not always reflect a person’s natural anatomy or the way their knee previously moved.
For some people, mechanical alignment may result in uneven ligament tension, a sense of tightness or stiffness, and knee movement that feels less natural after surgery.
Kinematic alignment: Restoring your natural joint motion
Kinematic alignment aims to restore the natural alignment and joint motion that were unique to your knee before arthritis developed. Instead of creating the same straight alignment for every patient, this technique works with your individual anatomy by respecting your original joint lines, ligament balance, and bone shape.
Using this approach, Dr Hockings incorporates detailed 3D imaging and surgical planning software to position the implants in a way that more closely reflects your pre-arthritic knee. This planning helps reduce the need for soft tissue releases and supports the natural pivot and glide of the joint.
The goal of kinematic alignment is to help the knee move in a way that feels closer to its natural pattern, which may support a smoother and more familiar walking style during recovery. While individual outcomes vary, kinematic alignment provides a more personalised approach compared with traditional mechanical alignment.
| Alignment Method | Mechanical Alignment | Kinematic Alignment |
|---|---|---|
|
Goal |
Standardise the joint to a neutral axis |
Restore original, pre-arthritic joint motion |
|
Bone Cuts |
Based on generic angles and alignment lines |
Based on individual patient’s anatomy |
|
Soft Tissue Balance |
Ligaments often need to be released |
Preserves natural soft tissue tension
|
|
Feel of the Joint |
May feel more artificial or constrained |
Aims for a more natural-feeling knee |
|
Suitability |
Long-established method for all knee types |
Suited to many patients, but not all cases |
Dr Hockings' kinematic alignment surgical process
Dr Hockings combines the principles of kinematic alignment with advanced tools and methods to deliver a highly personalised procedure:
You’ll receive a referral for a CT scan of your entire leg. This scan is used to construct a highly accurate 3D model of your knee. Using this model, Dr Hockings can:
- Map your natural alignment and joint contours
- Identify areas of joint wear or deformity
- Apply kinematic alignment principles to plan precise bone cuts
- Send the data to a specialist centre in Switzerland for the creation of patient-specific instrumentation (PSI) 3D-printed guides tailored to your knee
During your surgery, Dr Hockings uses the subvastus approach, which spares the quadriceps tendon by accessing the knee joint beneath the muscle. This approach supports:
- Faster return of muscle strength
- Reduced post-operative pain
- Improved mobility in the early stages of recovery
In surgery, your custom-made PSI guides are used to make bone cuts exactly as planned. These guides help achieve implant placement that:
- Aligns with your unique joint anatomy
- Restores your natural ligament balance
- Minimises soft tissue disruption
Advanced tools such as Augmented Reality (NextAR) or robotic-assisted technology may also be used in appropriate cases to further enhance surgical accuracy and real-time feedback.
Who is a good candidate for kinematic alignment?
Kinematic alignment is suitable for many patients undergoing primary total knee replacement, especially those with:
- Early to moderate osteoarthritis
- Preserved or restorable joint alignment
- Functional ligaments and minimal bone loss
- A desire for a more natural-feeling knee
Dr Hockings will carefully assess your imaging and clinical condition to determine whether this technique is suitable for your case.
If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.