Kinematic Knee Alignment

This open access book describes and illustrates the surgical techniques, implants, and technologies used for the purpose of personalized implantation of hip and knee components. This new and flourishing treatment philosophy offers important benefits over conventional systematic techniques, including component positioning appropriate to individual anatomy, improved surgical reproducibility and prosthetic performance, and a reduction in complications. The techniques described in the book aim to reproduce patients’ native anatomy and physiological joint laxity, thereby improving the prosthetic hip/knee kinematics and functional outcomes in the quest of the forgotten joint. They include kinematically aligned total knee/total hip arthroplasty, partial knee replacement, and hip resurfacing. The relevance of available and emerging technological tools for these personalized approaches is also explained, with coverage of, for example, robotics, computer-assisted surgery, and augmented reality. Contributions from surgeons who are considered world leaders in diverse fields of this novel surgical philosophy make this open access book will invaluable to a wide readership, from trainees at all levels to consultants practicing lower limb surgery

Calipered kinematic alignment was proposed by Dr. Stephen M. Howell to enable the accurate and individualized placement of total knee components coincident within ± 0.5 mm of the patient’s pre-arthritic alignment. The aim was to restore the patient's native joint kinematics and thereby address the well documented 20% dissatisfaction when total knee replacement is performed using traditional, or mechanical alignment techniques. With Dr. Stefano A. Bini and Dr. G. Daxton Steele as co-editors, Dr. Howell has curated an international team of expert surgeons and engineers to discuss various aspects of the calipered knee alignment technique in short, concise, and well-illustrated chapters. Each author provides clear, practical guidance for adopting and implementing calipered kinematic alignment covering manual, patient-specific, navigated, and robotic techniques. Chapters on component design tailored explicitly for kinematic alignment and showing the close relationship between knee biomechanics and the kinematically aligned TKA help the surgeon manage complex challenges associated with deformity and post-operative complications. Following the introduction of the calipered kinematic alignment technique for total knee arthroplasty, many international studies have shown consistently better patient satisfaction than the traditional mechanical alignment technique. Better function and high long-term implant survival have catalyzed a paradigm shift in total knee replacement philosophy that is being embraced by orthopedic surgeons and innovative implant companies around the world with excellent results. Calipered Kinematically Aligned Knee Arthroplasty is the definitive textbook on the subject and features: Thorough explanations of how the calipered kinematic alignment technique for total knee arthroplasty accurately sets total knee components coincident with the patient’s pre-arthritic alignment and coaligned with the three rotational axes of the native knee. A personalized approach to total knee surgery designed to reconstitute the patient’s native biomechanics in contrast with mechanical alignment that place all patients in the same standard alignment regardless of their constitutional anatomy. Detailed and well-illustrated descriptions of manual, navigated, robotic and patient-specific guide techniques that confirm kinematic alignment with a caliper. Clinical photos, radiographs, and line art throughout the book as well as helpful online technique videos. Key focus topics such as managing complex deformities, the expected post-operative recovery, and future trends in kinematic alignment. The shared experience and knowledge of international pioneers in the field. An emphasis on a personalized surgical philosophy which enables same-day discharge, reduces pain and opioid use, and promotes quicker recovery, better function, and a more natural feeling knee.

Calipered kinematic alignment was proposed by Dr. Stephen M. Howell to enable the accurate and individualized placement of total knee components coincident within ?± 0.5 mm of the patient's pre-arthritic alignment. The aim was to restore the patient's native joint kinematics and thereby address the well documented 20% dissatisfaction when total knee replacement is performed using traditional, or mechanical alignment techniques. With Dr. Stefano A. Bini and Dr. G. Daxton Steele as co-editors, Dr. Howell has curated an?international team of expert surgeons and engineers?to discuss various aspects of the calipered knee alignment technique in short, concise, and well-illustrated chapters.?Each author provides clear, practical guidance?for adopting and implementing calipered kinematic alignment covering manual, patient-specific, navigated, and robotic techniques.?Chapters on component design tailored explicitly for kinematic alignment and showing the close relationship between knee biomechanics and the kinematically aligned TKA help the surgeon manage complex challenges associated with deformity and post-operative complications. Following the introduction of the calipered kinematic alignment technique for total knee arthroplasty, many international studies have shown consistently better patient satisfaction than the traditional mechanical alignment technique. Better function and high long-term implant survival have catalyzed a paradigm shift in total knee replacement philosophy that is being embraced by orthopedic surgeons and innovative implant companies around the world with excellent results. Calipered Kinematically Aligned Knee Arthroplasty is the definitive textbook on the subject and features: Thorough explanations of how the calipered kinematic alignment technique for total knee arthroplasty accurately sets total knee components coincident with?the patient's pre-arthritic alignment and coaligned with the three rotational axes of the native knee. A personalized approach to total knee surgery designed to reconstitute the patient's native biomechanics in contrast?with mechanical alignment that places all patients in the same standard alignment regardless of their constitutional anatomy. Detailed and?well-illustrated descriptions?of manual, navigated, robotic, and patient-specific guide techniques that confirm kinematic alignment with a caliper. Clinical photos, radiographs, and line art throughout the book as well as helpful online technique videos. Key focus topics?such as managing complex deformities, the expected post-operative recovery, and future trends in kinematic alignment. The shared experience and knowledge of international pioneers in the field. An emphasis on a personalized surgical philosophy which enables same-day discharge, reduces pain and opioid use, and promotes quicker recovery, better function and a more natural feeling knee. An enhanced eBook version included with purchase?with access to the text, figures, videos, and references from the book on any desktop or mobile device.

Evidence-Based Orthopedics is an up-to-date review of the best evidence for the diagnosis, management, and treatment of orthopedic conditions. Covering orthopedic surgery as well as pre- and post-operative complications, this comprehensive guide provides recommendations for implementing evidence-based practice in the clinical setting. Chapters written by leading clinicians and researchers in the field are supported by tables of evidence that summarize systematic reviews and randomized controlled trials. In areas where evidence is insufficient to recommend a practice, summaries of the available research are provided to assist in decision-making. This fully revised new edition reflects the most recent evidence using the approved evidence-based medicine (EBM) guidelines and methodology. The text now places greater emphasis on GRADE—a transparent framework for developing and presenting summaries of evidence—to allow readers to easily evaluate the quality of evidence and the strength of recommendations. The second edition offers a streamlined presentation and an improved standardized format emphasizing how evidence in each chapter directly affects clinical decisions. Incorporating a vast amount of new evidence, Evidence-Based Orthopedics: Features thoroughly revised and updated content, including a new chapter on pediatric orthopedics and new X-ray images Provides the evidence base for orthopedic surgery as well as pediatric orthopedics and orthopedic conditions requiring medical treatment Covers the different methods for most orthopedic surgical procedures, such as hip replacements, arthroscopy, and knee replacements Helps surgeons and orthopedic specialists achieve a uniform optimum standard through a condition-based approach Aligns with internationally accepted guidelines and best health economic principles Evidence-Based Orthopedics is an invaluable resource for orthopedic specialists, surgeons, trauma surgeons, trainees, and medical students.

This comprehensive reference on total knee arthroplasty describes all surgical techniques and prosthetic designs for primary and revision arthroplasty, discusses every aspect of patient selection, preoperative planning, and intraoperative and postoperative care.

The modern field of total knee arthroplasty began over 50 years ago in the 1970s when the FDA approved cement for implant fixation, and durable plastic that replaced the meniscus became available. Simultaneously, alignment evolved into two opposing and contentious philosophies, the anatomic approach (forefather of kinematic alignment, ) and the 'cookie-cutter' or mechanical alignment. In 2006, the concept of personalized surgery initiated a paradigm shift away from the philosophy of mechanical alignment to calipered kinematic alignment total knee replacement. Dr. Howell, a professor of biomedical engineering and a sports medicine surgeon, developed the kinematic alignment technique. To perform the surgery, he created the first commercially made patient-specific guides designed to assist the surgeon in setting the components coincident to the patient's pre-arthritic joint lines, which is the kinematic alignment target.In 2007, early adopters' clinical experience, particularly Dr. Meade, persuaded over 300 surgeons to perform more than 20,000 kinematically aligned total knee replacements by 2011. Between 2011 and 2020, many worldwide studies reported that kinematic alignment improves patient satisfaction, function, ease of recovery, soft tissue balance, flexion, and joint-line and limb alignment compared with mechanical alignment. It is a winning approach.This primer uses the familiar concept of the Ten Commandments and selects ten topics for the surgeon to follow. The success of kinematic alignment requires caliper measurements of bone resections and intraoperative recording of verification steps. These recommendations reduce the risk of complications, a topic of great interest to the patient! Patients that research options in total knee replacement surgery will come across the kinematic and mechanical alignment philosophies. The mechanical alignment technique is a 'cookie-cutter' approach that places the components the same way in everybody regardless of their legs' shape. Because the method changes the patient's joint lines, the healthy ligaments are released, making the replaced knee feel unnatural. Kinematic alignment restores the patient's knee alignment before arthritis developed and preserves healthy ligaments, promoting patient satisfaction and high function.We hope this primer is useful for those investigating knee replacement surgery. Those who chose kinematic alignment, ask your surgeon whether they use the caliper and intraoperative verifications to position your new knee optimally!

Knee arthroplasty is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may also be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. Improving Accuracy in Knee Arthroplasty discusses new technology allowing the design of implants to be adapted for individual patients. Beginning with an introduction to knee alignment and misalignment, the following sections examine anatomical landmarks in the normal and arthritic knee, instruments, navigation in knee arthroplasty, robotics and soft tissue guided surgery. With contributions from a renowned author and editor team from the UK, USA and Europe, this comprehensive manual includes more than 400 colour images and illustrations. Key Features Comprehensive guide to improving accuracy in knee arthroplasty Discusses new technology allowing implant design to be adapted to individual patients Renowned author and editor team from the UK, USA and Europe More than 400 colour images and illustrations