Stephen M. Howell, M.D.

Total Knee Replacement

An innovator in the field of total knee replacement (TKR), Dr. Howell’s preferred surgical method for TKR is ‘kinematic alignment’, a technique he developed in 2005 to improve placement of the orthopaedic implants that form the new knee. Kinematic alignment ‘customizes’ the placement of the implants to the unique anatomy of each patient’s knee, which quickens recovery, and provides better satisfaction, pain relief, function, and flexion than traditional or mechanically aligned TKR.

Mechanical alignment places the implants in an ‘average’ position for all patients that changes the natural alignment of the limb and knee and causes uncorrectable knee instabilities. The orthopaedic literature has shown that 20-25% of patients with mechanically aligned TKR continue to complain of pain, stiffness, and instability despite the surgical intervention. These undesirable consequence are lessened by customizing the position of the implants with kinematic alignment.

Dr Howell has performed more than 3800 kinematically aligned TKR as of July 2017 since he performed the first one in January 2006. The surgical technique for performing kinematic alignment  are detailed in a Youtube video, book chapter entitled ‘Kinematic Alignment in Total Knee Arthroplasty‘,  and in a published study entitled ‘Accurate alignment and high function after kinematically aligned TKR performed with generic instruments’. We wrote a free animation for practicing the surgical steps for TouchSurgery, which and can be viewed by downloading the application on your mobile phone and tablet.

Kinematic alignment has caused a paradigm shift in TKR. Surgeons, patients, and their physical therapists all quickly notice that a patient with a kinematically aligned TKR report less pain, a quicker recovery, better function, better flexion, and a more natural feeling knee when compared to mechanically aligned TKR. Even more impressive are reports from patients who are dissatisfied with a previous mechanically aligned TKR and who undergo kinematically aligned TKR in their opposite knee. These patients report greater satisfaction, less pain, better motion and a quicker and less painful recovery with their kinematically aligned TKR. Randomized clinical trials from the United States, Germany, and Japan independently confirmed that the kinematic alignment technique provided better pain relief and restored better function, more flexion, and more normal alignment than the mechanical alignment technique.

Patients and surgeons frequently ask whether kinematic alignment has a positive affect on long-term implant survival and function. A three-year follow-up study by Dr. Howell showed the revision rate is lower and function is higher after kinematically aligned TKA than after mechanically aligned TKR. More recently, a six-year follow-up study of different patients concluded that kinematically aligned TKR has a comparable revision rate and higher function than mechanically aligned TKR.

Kinematic alignment has improved  the patient experience and recovery including reductions in the length of hospital stay, 30-day readmission rate, and major complication rate. The average length of stay is 1.3 days, 30-day readmission rate is 1.5%, and major complication rate is 1%, each of which are substantially better than national standards for mechanically aligned TKR (3.1 days, 2.5%, and 2.7%, respectively).

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 of kinematic alignment TKR for use by patients, surgeons, and physical therapists. For those patients considering a TKR, download the Patient and Family Guidebook On Kinematically Aligned Total Knee Replacement with answers to frequently asked questions (FAQ) and share with family and friends.

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