Standardizing definitions of the total knee alignment techniques: recommendations by the Personalized Arthroplasty Society

Total knee arthroplasty is a highly effective intervention for end-stage osteoarthritis, yet nearly 20% of patients report dissatisfaction with clinical outcomes. This dissatisfaction is often linked to intraoperative parameters, particularly whole-leg alignment and component positioning, which might play a role in ensuring both satisfaction and long-term implant survival. Over the past two decades, alignment techniques have progressed from systematic, two-dimensional methods focused on the frontal plane to more personalized, three-dimensional approaches. This evolution has introduced inconsistencies and confusion among surgeons regarding alignment techniques, terminology, and application, underscoring the need for standardized definitions that can be universally adopted. This work provides standardized definitions for six main knee alignment techniques to enhance communication within the scientific community, particularly in clinical research. While not an exhaustive analysis of each method, this effort focuses on the foundational principles of these techniques, organized using a standardized framework to facilitate comparison and improve clarity in the field.