At the recent Knee Society meeting in New Orleans, Louisiana, from March 15, 2014, there are several papers relating to the question of what is the ideal alignment of a leg after knee replacement. There was no clear consensus on what ideal alignment is other than making sure that the leg is mechanically straight and the soft tissue is well balanced. There are several options for obtaining alignment during a knee replacement. These include conventional instruments, which are based on fixed points on the thigh bone and shin bone, computer-assisted surgery that uses computers to help with alignment, and patient-specific guides which are developed from preoperative CT scans or MRIs of the patient’s lower extremity and then custom or one-time use cutting guides are made for that particular surgical procedure. All of these options have enjoyed success, and there is no clearcut winner based on literature data from 2014. The custom cutting guides as well as computer-assisted surgery increase the cost and time associated with the replacement procedure. Studies will continue to help elucidate whether or not one form of alignment is more reliable for use in knee replacement surgery.