Mechanically aligned total knee arthroplasty (TKA) improves the quality of life of patients with knee arthritis; however, studies have shown that 10% to 20% of patients are dissatisfied with their results. Accordingly, kinematically aligned TKA was implemented in 2006 as an alternative alignment strategy, with the goal of reducing the prevalence of unexplained pain, stiffness, and instability, and improving the rate of recovery, kinematics, and contact forces. In this article, we review the history and principles of kinematically aligned TKA, and describe in detail the technique for performing a kinematically aligned TKA with modified conventional instruments and the use of simple intraoperative checkpoints to confirm correct component position prior to cementation. Case studies of challenging deformities treated with kinematically aligned TKA are also presented. Although the short-term results of kinematically aligned TKA have been promising, longer-term survivorship remains to be demonstrated.