Kinematic Alignment Knee Replacement
What Is Kinematic Alignment?
For decades, most knee replacements were performed using a philosophy called mechanical alignment.
The basic idea was straightforward: position every knee replacement so the leg is as close to perfectly straight as possible. Regardless of how a patient’s knee was naturally shaped before arthritis developed, the goal was to create a neutral mechanical axis when going from the hip to the ankle.
That approach has worked well for millions of patients and remains widely used today.
However, it turns out that most people are not naturally built perfectly straight.
Some people are naturally a little bow-legged. Others are naturally a little knock-kneed. Most fall somewhere in between.
In other words, the knee you were born with probably wasn’t perfectly neutral.
Kinematic alignment is a philosophy that takes a different approach.
Instead of forcing every patient into the same alignment target, kinematic alignment attempts to restore the knee to its native, pre-arthritic position while still creating a stable and durable knee replacement.
Think of it this way – if you bought a custom-tailored suit, you would expect it to fit your body—not somebody else’s.
Dr. Tauchen believes knee replacement should follow the same principle.
The goal is not to make every knee look identical.
The goal is to make the replacement feel as natural as possible for the individual patient.
Historically, surgeons believed that placing every knee replacement into a perfectly neutral position would maximize implant durability and reduce wear over time.
As a result, surgeons often removed bone and adjusted soft tissues to create a straight mechanical axis regardless of a patient’s native anatomy.
Again, this strategy has been successful for many patients and there is still nothing “wrong” with it.
However, it may not always recreate the way that patient’s knee functioned before arthritis developed.
One of the criticisms of traditional knee replacement has been that some patients report their knee feels “artificial” despite technically successful surgery.
The X-rays look great. The implants are well positioned. The knee functions well.
Yet some patients still say:
“It just doesn’t feel like my knee.”
Kinematic alignment seeks to address that concern.
The philosophy is simple:
Restore the anatomy the patient naturally had before arthritis developed whenever safely possible.
Every knee is unique.
Some patients naturally have a slight bow-legged alignment.
Others naturally have a slight knock-kneed alignment.
Some have a tilted joint line.
Some do not.
Kinematic alignment recognizes these differences rather than attempting to eliminate them.
Instead of making every knee perfectly straight, the goal is to restore the patient’s natural anatomy while balancing the knee throughout its range of motion.
The result is a knee replacement that more closely resembles the patient’s original knee.
Dr. Tauchen often explains it this way:
“If you’ve spent 65 years walking with a certain knee shape, why would we automatically assume your body wants a completely different shape after surgery?”
The goal is not perfection on an X-ray. The goal is restoring natural function.
One of the challenges with kinematic alignment is that it requires an extremely high degree of precision.
Small differences in implant position can significantly affect the final result.
That is where robotic technology becomes incredibly valuable.
Dr. Tauchen utilizes the Mako robotic system, a CT-based robotic platform that allows detailed preoperative planning and highly accurate execution during surgery.
Before surgery, a CT scan is used to create a three-dimensional model of the patient’s knee.
This allows Dr. Tauchen to carefully analyze:
- Native anatomy
- Joint line orientation
- Bone wear patterns
- Alignment characteristics
- Implant positioning options
During surgery, the robotic system helps execute that plan with a level of precision that would be difficult to consistently achieve using traditional instruments alone.
Think of it like using GPS instead of a paper map.
You can reach the destination either way.
One method simply provides far more information along the journey.
Dr. Tauchen was the first surgeon in the Chicago area to utilize a CT-based robotic platform to consistently perform kinematic alignment total knee replacement.
Early in his experience with robotic surgery, he recognized that the technology offered a unique opportunity to personalize knee replacement in ways that had previously been difficult to achieve.
Rather than simply applying traditional mechanical or “functional” alignment principles through a robot, he developed his own workflow focused on restoring native anatomy through robotic-assisted kinematic alignment.
Over time, that experience has grown into one of the largest robotic kinematic alignment practices in the region.
Today, Dr. Tauchen has performed hundreds of robotic kinematic alignment knee replacements and continues to refine and advance the technique.
As his experience with robotic kinematic alignment expanded, Dr. Tauchen began working closely with Stryker to help educate other surgeons interested in the technique.
He now serves as a consultant for Stryker and participates in the development of educational programs focused on robotic kinematic alignment knee replacement.
Surgeons from around the country can visit his operating room to observe the procedure and learn the workflow firsthand.
In addition, as a pioneer of this technique, Dr. Tauchen travels to teach courses, participate in surgeon education programs, and help train other orthopedic surgeons on robotic-assisted kinematic alignment techniques.
For patients, this involvement provides reassurance that they are being treated by a surgeon who is not simply following emerging trends, but helping shape how those techniques are taught and implemented nationwide.
Research continues to evolve, but the goal of kinematic alignment is straightforward:
Create a knee replacement that functions more like the patient’s natural knee.
Potential advantages may include:
- More natural knee motion
- Improved patient satisfaction
- Less need for extensive ligament releases
- Restoration of native anatomy
- Improved soft tissue balance
- Enhanced functional recovery
Perhaps most importantly, kinematic alignment reflects a broader shift occurring throughout medicine.
Healthcare is increasingly moving away from one-size-fits-all solutions and toward personalized treatment strategies.
Dr. Tauchen believes knee replacement should be no different.
Not necessarily.
Every patient presents unique anatomy, goals, and surgical considerations.
The good news is that modern robotic technology allows surgeons to individualize treatment based on the specific needs of each patient.
Dr. Tauchen believes the future of knee replacement is personalization.
After all, patients are not identical and their knees are not identical.
And their knee replacements should not necessarily be identical either.
The goal of kinematic alignment is not simply to place implants.
The goal is to recreate a knee that feels stable, natural, and functional.
Whether that means returning to golf, cycling, pickleball, travel, long walks, or simply getting through the day without knee pain, every decision is centered around helping patients get back to the activities they enjoy most.
Because the best knee replacement is not the one that looks perfect on an X-ray.
It’s the one that helps patients forget they ever needed a knee replacement in the first place.
At a Glance
Dr. Alex Tauchen
- Board-certified orthopedic surgeon
- Fellowship-trained joint replacement specialist
- Specializing in hip and knee replacement surgery
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