Calipered Kinematically aligned Total Knee Arthroplasty

Theory, Surgical Techniques and Perspectives

1st Edition - June 29, 2021
Imprint: Elsevier
Authors: Stephen M. Howell, Stefano A. Bini, G. Daxton Steele
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 5 6 2 6 - 6
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 5 6 2 7 - 3

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 th… Read more

Calipered Kinematically aligned Total Knee Arthroplasty

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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.

Cover Image
Title Page
Copyright
Contributors
Preface
Foreword
Acknowledgments
Dedication
Table of Contents
Video List
1 Mechanical Alignment Total Knee Arthroplasty: A Thoughtful Beginning With Unanticipated Limitations
References
2 Phenotypes of the Knee and Limb: Rationale for Transitioning Toward Personalized Alignment in Total Knee Arthroplasty
Abstract
Chapter Outline
Overview
Variability of the native knee alignment
Impact of alignment concepts on knee alignment
Summary
Acknowledgments
References
3 It Is Time to Consider a Philosophical Change From Mechanical to Kinematic Alignment
Abstract
Chapter Outline
Overview
Time for a change in alignment philosophy
Three axes of the knee make the case for changing to kinematic alignment
Mechanical alignment is incompatible with restoring the three axes and normal kinematics
Calipered kinematically aligned total knee arthroplasty optimizes implant survival, medial compartment loading, and patellofemoral kinematics
Summary
References
4 Preoperative Evaluation of the Patient for Treatment With a Calipered Kinematically Aligned Total Knee Arthroplasty
Abstract
Chapter Outline
Overview
Introduction
History
Physical Exam
Radiographs
Patient counseling
Summary
References
5 Calipered Kinematic Alignment Total Knee Arthroplasty Performed With Specific Manual Instrumentation, Verification Checks, and a Decision Tree
Abstract
Chapter Outline
Overview
Tips for Exposing the Knee to Perform Calipered Kinematically Aligned Total Knee Arthroplasty
Caliper Measurements and Verification Checks That Set the Femoral Component Coincident to the Patient’s Prearthritic Joint Lines With Minimal Flexion
Caliper Measurements and Verification Checks That Set the Tibial Component Coincident to the Patient’s Prearthritic Tibial Joint Line
Follow the Decision Tree to Restore the Native Tibial Compartment Forces, Ligament Lengths, and Laxities That Balance the Calipered Kinematically Aligned Total Knee Arthroplasty
Management of the Severe Fixed Valgus Deformity and Flexion Instability Caused by Incompetent Posterior Cruciate Ligament From Resection or Injury
Summary
References
6 Calipered Kinematic Alignment Using Patient-Specific Instrumentation
Abstract
Chapter Outline
Overview
History of patient-specific instrumentation
Design rationale of modern patient-specific instrumentation systems
Patient-specific instrumentation in the kinematic total knee arthroplasty: surgical technique
Results of modern patient-specific instrumentation
Conclusion
References
7 Calipered Kinematic Alignment With Navigation Instrumentation
Abstract
Chapter Outline
Introduction
Why Use Navigation?
Literature Review of Navigated Kinematically Aligned Total Knee Arthroplasty
The Soft Tissue Envelope of the Osteoarthritic Knee
Which Navigation System?
Kinematic Alignment Technique Using Navigation Instruments
Complex Deformity
Summary
References
8 Kinematic Alignment With Image-Based Robotic Instrumentation
Abstract
Chapter Outline
Overview
Introduction to Robotic-Assisted Technologies for Kinematically Aligned Total Knee Arthroplasty
Preoperative Image-Based Kinematic Alignment Planning
Bernese Surgical Workflow Robotic-Assisted Kinematically Aligned Total Knee Arthroplasty
Case 1
Case 2
Case 3
Summary
References
9 Strategies for Improving Implant Design Based on Differences in Tibiofemoral Kinematics of a Low-Conforming Total Knee Arthroplasty Implanted With Calipered Kinematic Alignment and the Native Knee
Abstract
Chapter Outline
Overview
In Vitro Differences in Laxities and Resting Positions Between a Low-Conforming Total Knee Arthroplasty Implanted With Calipered Kinematic Alignment and the Native Knee Analyzed in the Same Cadaveric Knee
In Vivo Loading of the Posterolateral Rim of the Insert by Using a Low-Conforming Total Knee Arthroplasty Implanted With Calipered Kinematic Alignment During a Deep Knee Bend and Step-Up
Strategies for Improving the Femoral and Tibial Component Design for Use With Calipered Kinematic Alignment
Summary
Acknowledgment
References
10 Strategies for Improving the Prosthetic Trochlea Design Based on Differences in Trochlea Morphology Between Femoral Components Set in Kinematic and Mechanical Alignment and the Native Knee
Abstract
Chapter Outline
Overview
Differences in Trochlear Morphology Between Four Femoral Components Set in Kinematic Alignment and the Native Knee
Differences in Trochlear Morphology Between Four Femoral Components Set in Kinematic Alignment and Mechanical Alignment
Strategies for Improving the Prosthetic Trochlear Design for Use With Kinematic Alignment
Summary
Acknowledgment
References
11 Advantages of Kinematically Aligned Total Knee Arthroplasty: A Biomechanical Perspective
Abstract
Chapter Outline
Overview
Gait analysis studies
Computer simulation studies
Cadaveric studies
Fluoroscopic two- and three-dimensional shape-matching analyses
Summary
References
13 Calipered Kinematically Aligned Total Knee Arthroplasty Closely Restores the Tibial Compartment Forces of the Native Knee
Abstract
Chapter Outline
Overview
In Vitro Tibial Compartment Forces During Passive Motion in the Calipered Kinematically Aligned Total Knee Arthroplasty and Native (i.e., healthy) Knee
Intraoperative Tibial Compartment Forces During Passive Motion in the Calipered Kinematically Aligned Total Knee Arthroplasty
Summary
Acknowledgment
References
13 Clinical Outcome, Postoperative Alignment, and Implant Survivorship After Kinematically Aligned Total Knee Arthroplasty
Abstract
Chapter Outline
Overview
Differences in Clinical Outcome Between Kinematically Aligned and Mechanically Aligned Total Knee Arthroplasty
Chronologic Review of the Author’s Experience and International Randomized Controlled Trials that Summarize the Effectiveness of Kinematically Aligned Total Knee Arthroplasty
International Meta-Analyses Summarizing the Effectiveness of Kinematically Aligned Total Knee Arthroplasty
Differences in Postoperative Alignment Between Kinematically Aligned and Mechanically Aligned Total Knee Arthroplasty
Implant Survival, Risk of Tibial Component Migration, and Revision Surgery After Kinematically Aligned Total Knee Arthroplasty
Summary
References
14 Managing Severe Deformities With Calipered Kinematic Alignment
Abstract
Chapter Outline
Overview
Calipered Kinematically Aligned Total Knee Arthroplasty (Linked) Technique Principles and Application to Treating Severe Deformities
Case 1: Kinematically Aligned Total Knee Arthroplasty for Severe Varus Deformity
Case 2: Kinematically Aligned Total Knee Arthroplasty for Severe Valgus Deformity
Case 3: Kinematically Aligned Total Knee Arthroplasty for Severe Posttraumatic Extraarticular Deformity
Case 4: Approach to the Treatment of Long-standing Extraarticular Deformities that are at a Distance from the Joint
Case 5: Posttraumatic Deformity Assisted by Patient-Specific Instruments Combined with Linked Kinematic Alignment Total Knee Arthroplasty
Case 6: Posttraumatic deformity
Summary
Acknowledgment
References
16 Kinematic Alignment Technique for Unicompartmental Knee Arthroplasty
Abstract
Chapter Outline
Overview
Definition
Rationale
Expected Benefits and Evidence
Surgical technique
Summary
Acknowledgments
References
16 Postoperative Management
Abstract
Chapter Outline
Overview
Immediate Postoperative Management
Long-term management
Summary
References
17 Reducing the Risk and Methods of Managing Stiffness After Calipered Kinematically Aligned Total Knee Arthroplasty
Abstract
Chapter Outline
Overview
Incidence of Stiffness After Calipered Kinematically Aligned Total Knee Replacement Declines With Use of Intraoperative Verification Checks
Calipered Kinematically Aligned Total Knee Replacement Restores Native Tibial Compartment Forces, Which Reduces the Risks of Stiffness and Loss of Motion
Calipered Kinematically Aligned Total Knee Replacement Restores the Native Ligament Lengths That Determine Knee Laxities, Which Reduces the Risks of Stiffness and Loss of Motion
Seven Intraoperative Verification Checks That Restore Native Tibial Compartment Forces and Laxities to the Kinematically Aligned Total Knee Replacement
Methods for Managing Stiffness and the Timing of Manipulation Under Anesthesia After Calipered Kinematically Aligned Total Knee Replacement
Summary
References
18 Reducing the Risk and Management of Early and Late Tibial Component Failure After Calipered Kinematically Aligned Total Knee Arthroplasty
Abstract
Chapter Outline
Outline
Incidence and Causes of Early and Late Tibial Component Failure After Calipered Kinematically Aligned Total Knee Arthroplasty With Posterior Cruciate Ligament–Retaining Implants
Verification Checks Restore the Native Slope and Laxities of the Flexion Space and Reduce the Risk of Early Tibial Component Failure
Medial Stabilized Implant Restores Anterior-Posterior Stability and Higher Function Than Anterior Cruciate Ligament–Deficient and Partial Meniscal–Deficient Designs
Revision of Just the Tibial Implant Often Manages the Tibial Component Failure After Kinematically Aligned Total Knee Arthroplasty
Summary
References
19 Reducing the Risk and Management of Patellofemoral Instability After Calipered Kinematically Aligned Total Knee Arthroplasty
Abstract
Chapter Outline
Overview
Incidence, Time of Onset, and Causes of Patellofemoral Instability after Calipered Kinematically Aligned Total Knee Arthroplasty
Use of Femoral Components Designed for Mechanical Alignment Does Not Explain Patellofemoral Instability after Kinematic Alignment
Use of an Intraoperative Verification Check and an Anatomic Patella Component Reduces the Risk of Patellofemoral Instability
A Femoral Component Redesigned for Kinematic Alignment Should Increase the Lateral Coverage of the Anterior Femur
Options for Managing Patellofemoral Instability after Calipered Kinematically Aligned Total Knee Arthroplasty
Summary
References
20 Retaining the Posterior Cruciate Ligament and Restoring the Prearthritic Tibial Joint Line Reduces the Risk of Early-Onset Tibiofemoral Instability After Calipered Kinematically Aligned Total Knee Arthroplasty
Abstract
Chapter Outline
Overview
Incidence and Causes of Early-Onset Flexion and Extension Space Tibiofemoral Instability After Calipered Kinematically Aligned Total Knee Arthroplasty
Retain the Posterior Cruciate Ligament and Use Verification Checks to Reduce the Risk of Early-Onset Tibiofemoral Instability After Calipered Kinematically Aligned Total Knee Arthroplasty
Three Intraoperative Methods That Compensate for Flexion Space Laxity When the Posterior Cruciate Ligament Is Excised or Inadvertently Injured
Options for Managing Early-Onset Flexion and Extension Space Tibiofemoral Instability After Calipered Kinematically Aligned Total Knee Arthroplasty
Summary
References
21 Revision Total Knee Arthroplasty Using Kinematic Alignment Principles
Abstract
Chapter Outline
Overview
How We Got Here: The Rationale for Mechanical Alignment and its Implications for Revision Total Knee Arthroplasty
Candidates for Kinematically Aligned Revision
Contraindications to kinematically aligned revision
Challenges to kinematically aligned revision/implant selection
Reverse engineering total knee arthroplasty alignment: The theory
Surgical technique
Case study
Last thoughts
Acknowledgment
References
Index

Stephen M. Howell

Stephen M. Howell, MD is a board-certified orthopedic surgeon practicing in Sacramento and Lodi. He joined Adventist Health Lodi Memorial with more than three decades of experience as a clinician, researcher, and innovator in total knee replacement (TKR), anterior cruciate ligament (ACL) reconstruction, and meniscal surgery. Dr. Howell’s clinical practice focuses on the treatment of degenerative processes and sports-related injuries to the knee. He performs more than 500 TKRs and 100 ACL reconstructions per year. Dr. Howell also created the kinematic alignment method, which caused a paradigm shift in TKR. His published experience demonstrates that patients report less pain, a quicker recovery, better pain relief, better function, better flexion, and a more natural feeling knee when treated with this method. Dr. Howell is also an Adjunct Professor of Biomedical Engineering at the University of California, Davis. He has published more than 140 scientific articles in peer-reviewed journals.

Stefano A. Bini

Stefano Bini, MD received his BA from Stanford University, his MD from Columbia University and completed Residency training at UCSF. He completed a Fellowship at the Rizzoli Orthopaedic Institute in Italy and obtained a second MD from the University of Florence. Prior to joining the faculty at UCSF, Dr. Bini worked at Kaiser Permanente as a joint replacement surgeon. Active in professional associations and academia, Stefano currently serves as the Chair of the International Committee for the AAHKS and sits on the Biomedical Engineering Committee for the AAOS. He is the Associate Editor of Arthroplasty Today and is a reviewer for 4 major orthopaedic journals. Over the past decade, Dr. Bini has organized over a dozen conferences and learning labs nationally and internationally, presented over 110 scientific papers and has authored 23 research papers, which focus on leveraging large databases to define best practice in adult reconstruction surgery.

G. Daxton Steele

G. Daxton Steele, MD is a highly skilled orthopaedic surgeon specializing in total joint surgery with The Andrews Institute, an affiliate of Baptist Health Care. Dr. Steele is an industry consultant and helped develop the first FDA approved technique for kinematic alignment.

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