Total Knee Replacement
In the field of total knee replacement, Dr Howell designed a new alignment method called ‘kinematic alignment’ in 2005 in response to registry data in England and Canada showing that 1 of 5 patients are not satisfied with their total knee replacement because of stiffness, instability, and pain. Kinematic alignment improves the rate of recovery, function, and patient satisfaction when compared to the traditional mechanically aligned total knee replacement.
The first application of kinematic alignment was with the Custom Fit OtisKnee in January 2006, which is manufactured by OtisMed, Inc and is a company cofounded by Dr Howell, which is now owned by Stryker Orthopaedics. The OtisKnee uses Shape-Matching technology to kinematically align a total knee replacement to an individual’s anatomy. The OtisKnee has been used in 23,000 knees in the United States and is currently in use in Europe, Canada, and Australia and pending FDA approval in the US.
After performing 1100 kinematically aligned OtisKnee operations with custom-fit patient-specific guides, Dr Howell modified conventional instruments and has used them to perform kinematic alignment in over 1000 patients between Oct 2009 and Jan 2012. The advantages of kinematic alignment with modified conventional instruments are detailed in a chapter he wrote entitled ’Kinematic Alignment in Total Knee Arthroplasty‘ in the new, 5th edition of ‘Insall Scott Surgery of the Knee‘.
A recent publication entitled ‘Kinematic Versus Mechanically Aligned Total Knee Arthroplasty: A Prospective Randomized Double Blind Study’ by Dr Gene Dossett from the Department of Orthopaedics at the Veterans Administration Hospital in Phoenix, AZ has independently confirmed Dr Howell’s early experiences. Dr Dossett’s study showed that the kinematically aligned total knee replacement had better function and motion than the traditional technique of mechanically aligning the total knee replacement. Of equal importance was that kinematic alignment restored the same limb and knee alignment as mechanical alignment, which is reassuring because alignment is an important predictor of early wear, loosening, and survivorship.
This website contains a series of informational videos and scientific publications by Dr Howell that show the principles, surgical techniques, rapid recovery, patient satisfaction, and advantages and disadvantages of kinematic aligning a total knee replacement for viewing and reading by interested surgeons, patients, and physical therapists. He has also written a comprehensive reference entitled ‘Patient and Family Information Handout for Kinematically-Aligned Total Knee Replacement Surgery’ for those interested in total knee replacement.
