Trial results This proposed clinical trial will have a direct impact on patient care if it demonstrates that anatomical alignment TKA provides better clinical results than mechanical alignment TKA and similar migration patterns measured by RSA. Then the use of anatomic alignment may become the gold standard for TKA procedures. Lacking accurate investigation and surgical tools, anatomical alignment was abandoned in the early TKA era. Mechanical alignment was selected to minimize errors and secondary failures. With novel technologies (personalized instruments built on MRI), anatomical alignment might be the best way to replicate knee biomechanics and improve patient outcomes after TKA. The proposed study will allow us to establish the real value of anatomical alignment and its safety.