Kinematically Aligned Total Knee Replacement Surgery
Precision Alignment for Optimal Joint Function
Your knee is a complex joint that can be severely affected by arthritis, injuries, or other conditions, resulting in pain and limited mobility.A total knee replacement, or total knee arthroplasty, is a surgical option that aims to relieve this pain and restore functionality.
When you choose to undergo a total knee replacement with Dr Anthony Keeley, the procedure is performed using advanced techniques, including the kinematic alignment (KA) surgical approach. This technique is used totailor your knee replacement to your anatomy, which may help achieve optimal implant alignment and support natural knee movements, potentially leading to reduced postoperative discomfort and a faster recovery.
In the following sections, we’ll delve deeper into the kinematically aligned total knee replacement procedure, covering personalised alignment (kinematic alignment), modern implants, and the latest technologies used in the procedure.
THE KINEMATICALLY ALIGNED TOTAL KNEE REPLACEMENT
Unlike traditional knee replacements that often use standard measurements and techniques, a kinematically aligned total knee replacement is a highly personalised approach to knee surgery in which Dr Keeley customises every aspect of the procedure to match your unique anatomy.
Every person’s knee is different, and when a knee replacement is needed, it’s important that the implants are positioned and fitted as precisely as possible to your specific knee structure. Kinematic alignment (KA) takes into account the unique angles and movements of your knee joint, allowing the new implant to closely replicate your original knee.
This approach is designed to maintain the natural biomechanics of your knee, which may lead to a more natural feel, better function, and potentially a quicker recovery compared to traditional knee replacement methods.
Kinematic Alignment 3D Video animation showing the main steps of TKA Procedure
THE POTENTIAL BENEFITS OF A KINEMATICALLY ALIGNED KNEE REPLACEMENT
Natural Movement: Kinematic alignment aims to restore the natural motion of your knee, which may result in a more natural feel after surgery.
Faster Recovery: The precise placement and alignment of the implant may help reduce postoperative pain and support a quicker return to your normal activities.
Long-Term Success: By closely matching your knee’s natural anatomy, this approach is intended to improve long-term outcomes and patient satisfaction.
Dr Keeley’s use of the Kinematic technique reflects a leading approach in knee replacement surgery, combining advanced technology with personalised care to help achieve the best possible results for each patient.
PROSTHETIC IMPLANTS IN TOTAL KNEE REPLACEMENT SURGERY
Prosthetic implants play a pivotal role in Total Knee Replacement Surgery (TKA), as they are instrumental in restoring the function and stability of the knee joint. These meticulously designed artificial components are crucial to the success of the procedure, and typicallyconsist of the following components:
This medial pivot, metal component is designed to replace the end of the femur (thigh bone). It closely replicates the natural shape of the femur’s articular surface, which is essential for maintaining the knee’s natural movement and stability, especially on the medial (inner) side of the knee.
The tibial component replaces the top surface of the tibia (shin bone). It typically includes a metal baseplate and a plastic insert that acts as the cartilage, providing a smooth gliding surface.
In some cases, the undersurface of the patella (kneecap) may also be resurfaced with a plastic implant to improve patellar tracking and reduce friction within the joint.
The material used for the articular surfaces varies but commonly includes a combination of metals and plastic. The femoral component is often made of a metal alloy (e.g., cobalt-chromium), while the tibial component has a metal baseplate and a plastic insert made of ultra-high-molecular-weight polyethylene (UHMWPE). These materials are chosen for their durability and biocompatibility.
These prosthetic components can be secured to the bone using various fixation methods, including cemented fixation (using bone cement) or cementless fixation (relying on bone ingrowth into porous coatings on the implant).
The choice of fixation method depends on factors such as the patient’s bone quality and Dr Keeley’ssurgical preferences.
THE TOTAL KNEE REPLACEMENT SURGICAL PROCEDURE
Your total knee replacement surgical procedure begins when you are wheeled into the anaesthetic bay, where you’ll meet a member of the anaesthesia team. Most patients receive a combination of a low-dose spinal anaesthetic and a light general anaesthetic to ensure comfort during the surgery.
After you are completely anaesthetised, your leg will be prepped and cleaned, and Dr Keeley will make an incision on the side, or front of your knee (lateral skin incision). Dr Keeley uses the subvastus approach to access the joint, carefully avoiding cutting any muscle or tendon, and gently moving the kneecap (patella) to one side.
The arthritic portions of the thigh bone (femur) and shin bone (tibia) are then removed, and the surfaces are reshaped to accommodate the artificial components. If needed, the patella is resurfaced and replaced at this time also.
The new components are secured to the bone using bone cement, which contains antibiotics to reduce the risk of infection. A plastic (polyethylene) spacer of varying height is then inserted between the components to ensure smooth movement.
By the end of the procedure, your arthritis will have been removed and replaced with the new, smooth surfaces.
The incision is then closed with dissolvable sutures, and a small pump may be used to inject local anaesthetic for enhanced recovery.
Your hospital stay following knee replacement surgery is usually 3 nights but may be longer, depending on the complexity of the surgery, your overall health, and your individual circumstances.
POST-OP REHABILITATION GUIDELINES FOLLOWINGA KINEMATIC ALIGNED TOTAL KNEE ARTHROPLASTY
Post-operative rehabilitation following total knee replacement surgery is a critical phase that plays a pivotal role in ensuring optimal recovery, restoring function, and promoting your long-term joint health.
IMMEDIATE POST-OP PERIOD
Monitoring: In the initial hours after surgery, you’ll be closely monitored in the recovery room for any immediate post-operative concerns, including pain management and early signs of complications.
Movement: Based on Dr Keeley’s assessment, you may start walking and doing weight-bearing exercises with the help of crutches or a walker.
HOSPITAL STAY
Physiotherapy: A physiotherapist will work with you to initiate gentle knee mobility exercises and guide you through bed exercises to prevent stiffness.
Pain Management: Pain medications will be administered to keep you comfortable and is crucial for facilitating early mobility.
EARLY POST-DISCHARGE PERIOD -FIRST FEW WEEKS
Home Exercises: Your rehabilitation plan will include a set of prescribed home exercises focusing on knee mobility, gentle strengthening, and maintaining joint flexibility.
Ambulation Aid: You may continue using a walker or crutches as recommended by Dr Keeley until you regain sufficient strength and balance.
WEEKS 2-6
Physiotherapy Sessions: Regular physiotherapy sessions will continue to progress your exercises, incorporating more challenging activities to enhance strength and range of motion.
Gradual Weight-Bearing: Depending on your progress, Dr Keeley may advise a gradual increase in weight-bearing activities.
WEEKS 6-12
Advanced Strengthening: As your knee continues to heal, emphasis will be placed on more advanced strengthening exercises. These may include stationary biking, leg presses, and other controlled resistance exercises.
Functional Activities: Physiotherapy will shift towards incorporating functional activities such as stairs, getting in and out of chairs, and simulating real-world movements.
BEYOND 12 WEEKS
Return to Normal Activities: With the guidance of your physiotherapist and Dr Keeley, you’ll gradually resume normal activities. This may include low-impact exercises, recreational walking, and light recreational sports.
Monitoring and Follow-ups: Regular follow-up appointments with Dr Keeley will continue to monitor your progress, address any concerns, and make adjustments to your rehabilitation plan as needed.