Alignment in total knee arthroplasty is slowly but steadily becoming difficult to follow, even for arthroplasty surgeons. The initial “culprit” is the advancement of kinematic alignment, which has fundamentally changed how we perceive knee arthroplasty. It has sprouted further, especially with advancement in assistive technologies, computer navigation, and robotics. We therefore now have mechanical, adjusted mechanical, unrestricted kinematic, restricted kinematic, inverse kinematic, and functional/personalized alignment strategies. Interestingly, all of these are only in the coronal plane, the sagittal plane is only coming. Since there are so many combinations, the evidence comparing these is not immense.

In a collaboration between two hospitals in Graz, Austria, AUVA and the University Hospital, each performing well over 400 knee arthroplasties yearly, our main goal was to add some evidence for some of the alignment strategies for both the coronal and the sagittal plane.

This special focus issue of Journal of Knee Surgery is demonstrating what can be achieved with conventional instruments, but is also questioning the value of robotics over computer navigation if the target remains the same—accuracy versus precision and vice versa.

I would like to thank all the authors who measured the X-rays multiple times, performed the analysis, and tried to make sense of what has been observed—some results were very unexpected!

The ultimate goal of this special issue is the advancement of outcomes for our patients. We sincerely hope that the readers will find useful information they can apply in their practice.

Article published online:
03 January 2024

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