Most of the population has different degrees of natural varus or valgus knee. Mechanical alignment, the most widely used in total knee arthroplasty, however, does not fully follow this physiological variation. Neutral alignment in coronal plane is considered as goal in mechanical alignment. Some authors speculated that this may have something to do with the lower satisfaction rate after total knee replacement. Kinematic alignment, which focuses more on the articular topography of the natural knee joint, emerged in this context. As this method may reduce soft tissue release, improve knee function and patient satisfaction. Therefore, it has received widespread attention in recent years. The author’s hospital is one of the earliestinstitutions in China to perform kinematic alignment in total knee replacement using patient-specific instrumentation. This review summarized the technology’s preoperative planning, pearls and pitfalls in surgical techniques, relevant basic theories, and clinical evidences, so as to help readers fully understand kinematic alignment.