Kinematic Alignment for Total Knee Replacement

[@dv6701]

I am a candidate for tkr here in Sacramento, CA. I've just started researching the kinematic approach. My dr. wants to do robotic and when I asked him what the differences were he said this: Please comment: "Kinematic knee alignment is a controversial technique done by a minority of surgeons designed to change the bone cuts to optimize soft tissue balancing. Mako assisted knee replacement accomplishes this same end with more precision by using computer software to make adjustments to bone cuts in real time and optimize implant sizing, positioning and soft tissue balancing. Whatever potential benefit that is offered by kinematic surgery is accomplished with Mako assisted surgery with further benefits not achieved with kinematic alignment alone." He doesn't say how Mako provides further benefits not achieved with kinematic. I read on your website that most people spend 3 to 4 nights in the hospital. Here they get you out in one day or one overnight stay. How long does the surgery take with kinematic? THANK YOU!

[@orthopaedics360]

I won't go into the discussion and debate - but essentially the difference is this: Mechanical alignment aims to align the knee the SAME for every patient. The patients capsular structures, ligaments and sometimes tendons can be released to balance the knee. Many modalities have been created to achieve the same alignment for each patient (A perfectly straight leg with a 10 degree foot progression angle). But not all alignments are the same. Look at people walking around - some are bow legged, some are knock kneed. Most of those people don't have arthritis and it's their normal alignment. Kinematic alignment reproduces the normal alignment for that patients and therefore does not require ligament or soft tissue releases. Without matching the alignment of a patients own anatomy - the knee will require other soft tissue balancing operative techniques to balance the knee. I respect all surgeons preferences but I would also say that it is the fastest growing method around the work from an alignment perspective, and the results are phenomenal. I would advise you to read research performed by one of the godfathers of kinematic alignment - Dr Stephen Howell.

[@dv6701]

@@orthopaedics360 Hi Dr. Chien-Wein Liew, thank you so much for your response 🙂 I did call Dr. Howell's office and tried to make an appointment for consult but he does not accept my insurance plan. There are only 1 or 2 other surgeons that use the kinematic alignment technique here. Since Dr. Howell is one of the godfathers of kinematic alignment, I would've thought there would be more doctors using this approach here in Sacramento. In any event, I appreciate your response. (I will be looking into changing my insurance plan during open enrollment.) Thank you.

[@bradcorrea9963]

Question how do you know or figure out how the knee was prior to needing a replacement.

[@devinthomas4866]

Studies show that most arthritic knees have about a 2.2 mm loss of cartilage on the femur and tibia in the affected area. Simply putting implant back into the space of the original joint. Resurfacing the joint. Like a retread without changing alignment.