In this presentation orthopaedic surgeon, Savya Thakkar, discusses his approach to Kinematic Alignment (KA) principles and the restorative benefits it has for patients suffering from arthritic knee conditions.
Good morning. My name is Sylvia Tucker. I'm a hip and knee reconstructive surgeon at Johns Hopkins Orthopedics, specifically at Howard County General Hospital. Today, I'm going to be discussing some advances in Ni Arthur plastic and the management of me arthritis. Specifically thinking about custom Kinnah Matic cuts versus Smart Kid, a Matic implants Which one of these is the key to restore an atomic function for the arthritic need? Mhm. The question I'd like to ask my peers and the audience is. Would you treat these three patients the same way? On the Left is a patient with by compartmentalize arthritis in the media and patella femoral compartments. In the middle is an athletic patient with try compartmentalize arthritis that has some degree of constitutional various. And finally, in the end, is a patient with a windswept deformity with a Val Ghous on the right and a variously on the left. Our current choices are between various different alignment options and various different smart implant options. The alignment options, specifically of interest, is Kinnah Matic alignment. This is Charles Review. Charles is a French trained surgeon who now practices in the United Kingdom, and he has written a wonderful review about various different alignment options available for the total knee patient. So think about a patient that has constitutional various as shown in the picture. Now on the extreme right is a systematic method off aligning these patients back to their neutral mechanical access and on the left arm or patient specific guides such as Uni Compartment, will knees and kidney magically aligned total niece. So as we know, mechanical and an atomic alignment aligns them back to their neutral mechanical access. For the most part, what is kill a Matic alignment is a bony procedure, a ligament sparing in a soft tissue sparing procedure, which then allows you to customize various different alignment options. The way to think about this is assume. You have a long length radiograph of a patient on the right knee. There is a neutral mechanical axis, and this is what a mechanically aligned total knee would look like on the left knee. That is a slight degree of various, and this is what a Kinnah, magically aligned knee would look like. Kinnah Matic Alignment has an interesting history at Johns Hopkins with David Hungerford and can crack out. They both came up with this concept off measured resection and an atomic alignment, which was the precursor to Kinnah Matic alignment. Along with the alignment philosophy, they also developed the poorest coated, an atomic implant, using striker How America instrumentation, which was groundbreaking at that time. In modern terms, it's important to make an analogy to hip resurfacing can dramatically aligned means just like hip resurfacing Zara bony resurfacing procedure, in which the thickness off the cuts that you make varies with the wear that you see in various different compartments. It's a ligament staring and a patient specific procedure, for the most part, and there are new landmarks for implant positioning. These landmarks include various Kinnah Matic axes. In green is the transfers access through the femur for tibial flexion and extension. In purple is the transfers. Access for patellar, flexion and extension, and in yellow is the longitudinal access for tibial rotation in relation to the FEMA. The goal off cinematic alignment is to maintain the natural asymmetry that exists between extension and flexion in normal lease, as compared to a more mechanically aligned model in which you want equal flexion and extension gaps. To reduce that a symmetry. Newer implants also exist in order to try and preserve telematics, rotating platform designs, medial pivot designs and asymmetric designs or some off them. In addition to that, we also have designs that can maintain both the cruciate ligaments and multi compartment tal or unique um, parte mental Arthur plastic. So what has changed for the surgeon? Initially, we would only think about the continuum of constraint from the least to the most constraint prosthesis. But now we also have the ability to think about Kinnah Matic options in addition to constraint options for patients. My algorithm is very simple. I like to think of knee arthritis as a compartment specific disease. I then like to obtain long length radiographs to understand which compartment is affected and which surgical treatment to plan for the patient, along with which ligaments to release. And then I'd like to temper this with patient expectations and treatment options. Long length radiographs Allow me to assess the varying degrees of deformity, assess how much that deformity can be passively corrected or corrected by the implant and then planned for appropriate bone cuts and releases in the patient with a bike. Um, parte mental arthritis model. I'd like to do a simultaneous by compartmentalize Arthur plasticky in the medial or lateral compartments, coupled with the patella ephemeral compartment in a patient who is an athletic soccer player or any other athlete with constitutional various. I like to preserve that various by means of my implant, which achieves some degree of joint line of liquidity, and finally, with a patient with a windswept deformity, I like to preserve the mechanics by bringing them back to their mechanical alignment. As you can see, this is a patient who initially came to me with a bad, windswept deformity and finally the outcome at three years of follow with an excellent restoration off her gate and function. With that, I'd like to thank you very much for your attention, and this is my contact information for further questions or concerns, Thank you very much.