Anatomic alignment plays a crucial role in total knee arthroplasty (TKA) durability and long-term functional outcomes. This study examines postoperative changes in coronal plane alignment using the nine-type CPAK classification system and evaluates associations with PROMIS-10, KOOS Jr., and Modified SANE scores. Pre-operative CT measurements were used to determine arithmetic hip-knee-ankle angle and joint line obliquity, which were compared with postoperative values. Of 1,033 eligible TKA patients, 741 have completed CPAK classifications to date, with most categorized as Type I or II preoperatively. Remaining analyses will compare pre- and postoperative CPAK classifications to determine alignment shifts and their relationship with patient-reported outcomes at 1–2 years. This work aims to clarify whether maintaining a patient’s constitutional alignment confers superior function and satisfaction, and may help guide alignment strategy selection between mechanical and kinematic techniques.