At the Knee Society meeting in New Orleans, Louisiana, March 15, 2014, there were several papers presented that related to the question of what is the ideal alignment of a leg after knee replacement. There was no clear consensus on ideal alignment, other than making sure the leg is mechanically straight and the soft tissue is well-balanced.
There are several options for obtaining alignment during a knee replacement. These include conventional instruments, which are based on fixed points on the thigh bone and shin bone, computer-assisted surgery, which uses computers to help with alignment, and patient-specific guides, which are developed from preoperative CT scans or MRIs of the patient’s lower extremity and then custom or one-time use cutting guides are made for that particular surgical procedure. All of these options have been successful, and there is no clearcut winner based on literature data from 2014. The custom cutting guides, as well as computer-assisted surgery increase the cost and time associated with the replacement procedure. Studies will continue to help elucidate whether or not one form of alignment is more reliable for use in knee replacement surgery.