Adopting Kinematic Alignment: The Learning Curve of Fellowship-Trained Arthroplasty Surgeons.

Hanish, Stefan J; Crockarell, John R; Guyton, James L; Mihalko, Marc J; Mihalko, William M; Holland, Christopher T; Ford, Marcus C · Orthop Clin North Am · 2026

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Abstract

Kinematic alignment (KA) is emerging as an alternative to mechanical alignment (MA) in total knee arthroplasty and is designed to restore native prearthritic anatomy and minimize need for ligament releases. The learning curve remains poorly defined for fellowship-trained surgeons who were trained primarily in MA. Current evidence demonstrates that fellowship-trained MA surgeons can achieve proficiency comparable to experienced KA surgeons after 30 to 40 cases. Our institution documented the learning curve of a fellowship-trained MA surgeon's adoption of calipered KA using manual instrumentation along with 12 month patient-reported outcomes for comparison. Future studies can determine evidence-based guidelines.

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