Following training in Belgium in May 2024, Dr. Ackermann began performing the procedure with remarkable success. Patients feel little pain and do not require as much pain medication after surgery.

Kinematic alignment (KA) is a modern approach to knee replacement surgery that seeks to improve the performance of total knee arthroplasty (TKA). Unlike traditional methods used for the past 40 years, KA focusses on positioning the knee prosthesis more naturally, employing different reference points based on recent research into knee anatomy.

Traditional knee replacement methods typically use a mechanical alignment approach, which aligns the knee joint perpendicular to the leg’s mechanical axis. However, this does not always correspond to the natural anatomy of each patient. Hungerford and Krackow’s 1980s research introduced the concept of anatomical alignment, which takes into account the knee joint’s natural orientation. Over time, research has revealed that not everyone’s knees align in the same way, with some people naturally having a slight varus (inward) or valgus (outward) alignment.

Bellemans conducted a key study in 2012 and discovered that approximately 32% of men and 17% of women have “constitutional varus,” which means their knees naturally align inward. This suggests that a one-size-fits-all knee replacement strategy may not be the best option for everyone.

Kinematic alignment solves this problem by customising the knee replacement to each patient’s unique anatomy. The goal is to return the knee joint to its pre-arthritic state while preserving the natural alignment and ligament tension. This differs from mechanical alignment, which frequently requires non-anatomic bone cuts and can lead to patient dissatisfaction.

Research has shown that KA can improve outcomes for many patients. For example, a 2017 study by Parratte examined various TKA alignment methods and discovered that KA frequently results in faster recovery, less residual pain, and better overall function than mechanical alignment. However, it is important to note that KA may not be appropriate for everyone, particularly those with specific anatomical variations.

Another important aspect of KA is preserving the knee’s natural motion. Matsuda’s 2015 study found that KA can result in more natural knee movement than mechanical alignment. Still, there are concerns about increased stress on specific parts of the knee joint over time.

In some cases, a modified approach known as restricted kinematic alignment (rKA) is used. This method, discussed by Vendittoli in 2020, provides a compromise by slightly adjusting the alignment to avoid extreme angles that may cause issues in some patients.