Specific case consideration for implanting TKA with the Kinematic Alignment technique

The Kinematic Alignment (KA) technique for total knee arthroplasty (TKA) is an alternative surgical technique aiming to resurface knee articular surfaces.The restricted KA (rKA) technique for TKA applies boundaries to the KA technique in order to avoid reproducing extreme constitutional limb/knee anatomies.The vast majority of TKA cases are straightforward and can be performed with KA in a standard (unrestricted) fashion.There are some specific situations where performing KA TKA may be more challenging (complex KA TKA cases) and surgical technique adaptations should be included.To secure good clinical outcomes, complex KA TKA cases must be preoperatively recognized, and planned accordingly.The proposed classification system describes six specific issues that must be considered when aiming for a KA TKA implantation.Specific recommendations for each situation type should improve the reliability of the prosthetic implantation to the benefit of the patient.The proposed classification system could contribute to the adoption of a common language within our orthopaedic community that would ease inter-surgeon communication and could benefit the teaching of the KA technique. This proposed classification system is not exhaustive and will certainly be improved over time. Cite this article: EFORT Open Rev 2021;6:881-891. DOI: 10.1302/2058-5241.6.210042.