Tibial Alignment

Total knee arthroplasty (TKA) is the best surgical modality for end-stage degenerative knee arthritis. Optimizing femoral and tibial alignment is critical to maximize implant survivorship and function. Malignment has been associated with eccentric implant loading, leading to early aseptic loosening and failure. Restoring the mechanical or kinematic axis has been shown to improve survivorship and clinical outcomes. This chapter discusses more traditional alignment techniques using intramedullary and extramedullary alignment systems, mechanical, and kinematic alignment aims, the utility of computer-assisted surgery and patient-specific instrumentation, and the potential integration of artificial intelligence and its applications in optimizing alignment in TKA recipients.