Neutral mechanical alignment: Stickin' with the one that brung ya-Opposes

Total knee arthroplasty is a safe and reproducible procedure for the treatment of arthritis. Despite increased use and modern techniques, there remains up to a 20% rate of patient dissatisfaction for reasons unexplained in the literature. One hypothesis is that universally targeting a neutral, mechanical alignment rather than taking a more individualized approach to patient alignment may contribute to patient dissatisfaction. Constitutional varus and kinematic alignment techniques aim to match patient anatomy more closely in total knee arthroplasty and are discussed in detail in this review.