- SPECIALIST ORTHOPAEDIC SURGEON | MELBOURNE, VIC | ALBURY NSW |
- 03 9421 6133
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.
Around 2.1 million Australians (1 in 11 people) have osteoarthritis, with a 58% increase expected by 2032 due to population ageing and rising obesity rates
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.
- Match the implant positioning to your pre-arthritic joint
- Avoid unnecessary soft tissue releases
- Preserve the natural pivot and roll of your knee
- Uneven tension in surrounding ligaments
- A feeling of tightness or stiffness
- Less natural movement after surgery
Mechanical alignment: A “one-size-fits-all” approach
Mechanical alignment has been the traditional method used in knee replacement surgery. It involves aligning the knee implants to create a straight line from the hip, through the knee, to the ankle, often referred to as a neutral mechanical axis. While this technique can create a symmetrical leg shape, it may not take into account the patient’s natural anatomy and the way their knee originally moved.
In some patients, mechanical alignment can lead to:
Kinematic alignment: Restoring your natural joint motion
Kinematic alignment, on the other hand, aims to restore the original alignment and joint movement that was unique to you before arthritis. Rather than forcing a straight alignment, this technique carefully considers your natural joint lines, ligament tension, and bone shapes.
In conjunction with the kinematic alignment technique, Dr Hockings uses detailed 3D imaging and surgical planning software to:
The goal of kinematic alignment is to help your knee move and feel more like it used to, which may lead to a more natural walking pattern, faster recovery, and improved patient satisfaction. In short, mechanical alignment standardises the knee, while kinematic alignment personalises it.
Alignment Method Goal Bone Cuts Soft Tissue Balance Feel of the Joint Suitability
Mechanical Alignment
- Standardise the joint to a neutral axis
- Based on generic angles and alignment lines
- Ligaments often need to be released
- May feel more artificial or constrained
- Long-established method for all knee types
Kinematic Alignment
- Restore original, pre-arthritic joint motion
- Based on individual patient’s anatomy
- Preserves natural soft tissue tension
- Aims for a more natural-feeling knee
- 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:
- Detailed pre-operative CT scan and 3D planning
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
- Minimally invasive subvastus surgical approach
Durning 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
- Precision-guided implant positioning
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 concerned about a painful or failing hip replacement, Dr Jason Hockings can provide clarity and expert guidance. A personalised consultation will help determine whether revision surgery is right for you, and what steps to take next.
If you’re living with hip pain or stiffness that’s affecting your quality of life, a thorough assessment can help determine the cause and guide the right treatment path.
