Kinematic alignment yields a reduced knee adduction moment and better range of motion compared to mechanical alignment: biomechanical considerations of a staged, bilateral total knee arthroplasty case.

This technical note describes an intra-subject comparison between mechanical and kinematic alignment in total knee arthroplasty (TKA), based on gait analysis performed before and after staged bilateral procedures. Our quantitative assessment revealed differences in joint range of motion, moment profiles, and ground reaction forces between the two limbs. The kinematically aligned knee showed greater multi-planar mobility, higher sagittal moments, and a more physiological gait pattern. These findings highlight the added value of dynamic biomechanical analysis in evaluating the functional impact of alignment strategies, offering insights that go beyond static imaging and supporting more personalized approaches in TKA.