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Kinematic Alignment Surgery: Innovation in Total Knee Replacement Surgery

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When we hear the phrase “alignment and balance,” our thoughts often make the connection to automobiles. Although a four-wheeled mode of transportation is important in the daily lives of adults, another means of getting from Point A to Point B that is critical to our health and wellbeing is our own bodies.

The human body is a complex network of blood, bones, tissue, nerves and joints that work in harmony with each other to keep bodies upright and moving. When parts of the body begin to break down or are compromised, it causes friction, discomfort and reduced mobility. One common “breakdown” area of the human body is the knee. The knee joint is the largest and most complex and therefore the most stressed joint in the body; having healthy knees is required to perform most everyday activities.

Unfortunately, the knee is also the most easily injured joint and frequently is a source of painful arthritis in adults. Knee pain, swelling, catching, locking and grinding are common signs of knee arthritis, and for many patients surgical correction may provide relief and restore their ability to enjoy life again. But when it comes to knee replacement surgery, physicians in the past have subscribed to a one-alignment-fits-all methodology called mechanical alignment that, for one-third of the population, leads to stiffness and instability when the position of their “new knee” doesn’t agree with their body type.

A Better Technique
One particular surgeon was not satisfied with the statistics and a seemingly cookie cutter approach to total knee replacement, or TKR. Fueled by a determination to find a better way for patients who were frustrated with their current TKR, Dr. Stephen Howell delved into years of translational research, patient consulting and extensive lab work to find answers. His dedication paid off and by 2005 he had developed kinematic alignment, or KA, a 3D technique for TKR that improved the native placement of the orthopedic implants that formed the new knee.

By understanding and perfecting a simple algorithm using ten precise caliper measurements that guide the surgeon where to make precise cuts, kinematic alignment surgery has successfully proven to be the answer for patients who were not able to get relief and healing from traditional knee replacement surgeries. These patients also enjoyed shorter lengths of stay in the hospital, less blood loss, a quicker return to prior function and a return to the mobility and knee function they desire. To date, Dr. Howell has performed his patented kinematic alignment surgery approach on nearly 4,000 patients with the lowest complication and readmission rate on record.

Unique Placement
“Much like people, no two knee joints are alike,” Dr. Howell noted. “So when a knee replacement is needed, the position and fit of implants should be as precise and individual as it can be. My research gave me a chance to look at knee surgery through a new lens and develop something simple that can help those patients who have not found success with conventional TKR.

“Imagine your knee is like a door in a doorframe. If the alignment of the frame is thrown off, the door will never shut right even if the door is replaced. With mechanical alignment knee surgery the position of the new parts may not fit the frame formed by the patient’s ligaments, so the ligaments are cut to enable the knee to move. Also with mechanical alignment, the implants can loosen over time and make the knee feel weak and unstable. With kinematic alignment surgery no ligaments are cut, allowing for the millimeter adjustments that ultimately balance the knee better. With the KA process, precise and simple adjustments are made to ensure that the bone, joint and ligaments all work together in a way that fits the patient’s body perfectly. The result is a custom-positioned knee replacement with a higher success rate and quicker recovery time.”

A Consummate Educator
When he’s not performing 500 total knee replacements each year at Adventist Health Lodi Memorial, Dr. Howell extends his knowledge well beyond the walls of the renowned medical facility. As a board-certified orthopedic surgeon, he works tirelessly to use his three decades of experience as a clinician, researcher, and innovator in total knee replacement, anterior cruciate ligament reconstruction and meniscal surgery to teach others. As a result, he has trained physicians all over the world including Europe, France, Australia, Japan, China and Canada. He is also a professor at UC Davis and has published more than 140 scientific articles that have advanced the understanding of arthritis of the knee and treatment.

“I am honored to be working with Adventist Health Lodi Memorial and thrilled to bring innovative orthopedic care to the residents of San Joaquin County,” Dr. Howell concluded. “Our mission is to restore the native function of the knee and give our patients their lives back.” ■

To learn more about Dr. Howell and kinematic alignment, visit