PURPOSE: This study aimed to evaluate the 2-year post-operative results of the unrestricted kinematic alignment technique in total knee arthroplasty (TKA) among Japanese patients and understand the potential benefits of this technique. METHODS: In total, 207 patients who underwent kinematic alignment in TKA for knee osteoarthritis between 2019 and 2021 were retrospectively reviewed. After applying the exclusion criteria, 164 knees remained for analysis (130 and 34 knees from female and male patients, respectively). The average age and body mass index were 74.5 ± 8.0 years and 26.4 ± 4.1 kg/m RESULTS: After surgery, statistically significant improvements were observed in both knee extension and flexion angles, as well as muscle strength ( CONCLUSION: In Japanese patients, kinematic alignment in TKA demonstrated significant improvements and promising outcomes over 2 years. Although alignment characteristics prior to arthritis may vary due to ethnic differences, this method-designed to replicate patient-specific alignments-is considered to have achieved favourable outcomes by tailoring to individual alignments. Further research comparing kinematic alignment with conventional alignment techniques could provide more valuable insights. LEVEL OF EVIDENCE: Level III.