Kinematic Total Knee Replacement

Knee arthritis can really limit your daily life and activities. If more conservative arthritis treatments do not offer sufficient relief, knee replacement surgery may be an option.

Dr. Kenneth Sands offers a unique approach to total knee replacement called kinematic total knee replacement. This procedure restores function and kinematic alignment to the knee, which feels more like a natural knee after surgery.

Dr. Sands is a board certified orthopaedic surgeon with over 20 years of experience in total knee replacements. Additionally, he has helped design total knee implants and served as a consultant to multiple companies for knee implants, and educates other surgeons on total knee replacement techniques.

When to Consider Total Knee Replacement

As an elective procedure, the decision to proceed with total knee replacement is a personal one.

Dr. Sands typically advises patients to consider total knee replacement if they are experiencing loss of knee function or excessive pain from arthritis after a failed course of conservative treatment. Ultimately, the decision is based on the patient’s desire to have a good quality of life.

Symptoms that may indicate a patient would benefit from total knee replacement include:

• Severe knee pain and stiffness that limits everyday activities and mobility
• Pain that continues while at rest (potentially affecting sleep at night)
• Inflammation and swelling in the knee that does not improve with medication
• Deformity of the knee, such as bowing in or out, due to degeneration of the joint
• Conservative treatments like medications, injections, and physical therapy do not improve pain and function

What is a Kinematic Total Knee Replacement?

Dr. Sands’ philosophy on total knee replacement is to restore function and kinematic alignment of the knee.

Kinematic Total Knee Replacement (TKR) is a surgical technique for knee replacement that aims to restore the patient’s natural knee anatomy and movement as closely as possible. It differs from the traditional knee replacement method of mechanical alignment, which aims for a standardized joint alignment based on average anatomical angles rather than the patient’s unique anatomy.

With the mechanical alignment method, the goal is to create a straight leg (with a hip-knee-ankle alignment of 180°), regardless of the patient’s natural alignment pre-surgery. The bone cuts and implant positioning are standardized. However, most patients do not naturally have a 180 degree alignment. This standardized approach can lead to muscle strain and joint stiffness because the patient’s body has to compensate for the new unnatural alignment.

With a Kinematic Alignment, Dr. Sands’ goal is to replicate the patient’s original (pre-arthritis) joint lines, ligament tension, and natural kinematics--how the knee actually moved and felt before arthritis developed. This creates a better environment for the patient’s new knee to recover and function more naturally long-term.

Benefits of Kinematic Total Knee Replacement

There are several benefits to kinematic total knee replacement over the traditional mechanical alignment method, including:

• Improved patient satisfaction
• Faster recovery
• Less stiffness or need for manipulations to improve range of motion
• A more natural-feeling knee replacement

Kinematic Total Knee Replacement Procedure

Dr. Sands uses the Medacta SpheriKA total knee system. It is a medial pivot total knee implant designed specifically to work with the Kinematic alignment technique. Medial pivot knee designs have been shown to help reproduce the sensation of having an intact ACL, which helps with creating a more natural feel to the new knee.

The surgical procedure takes approximately one hour. During the procedure, Dr. Sands assesses cartilage loss and makes resections based on millimeters of cartilage loss. This typically allows for less removal of bone when compared to the mechanical alignment technique.

In most cases, the kinematic total knee replacement procedure is outpatient, allowing patients to return home the same day. However, patients with certain preexisting medical issues may be admitted to the hospital for overnight observation.

Recovering from Kinematic Total Knee Replacement

Each patient will have a slightly different experience in recovery. Dr. Sands and his team will give specific instructions based on individual needs, but these are some general guidelines for the recovery process.

Managing Pain after Surgery

Dr. Sands uses an intraoperative pain cocktail injection and preoperative medications to reduce pain after surgery. Most of his surgeries are done under a regional anesthetic, which helps to reduce pain immediately after surgery and reduces certain complications from anesthesia.

Pain is very subjective. Often, patients feel a slight increase in pain on the third day after surgery, and then feel like they have turned the corner on the 10th day. Most patients take a narcotic pain medication for the first week and then start to transition to extra strength Tylenol during the day, sometimes continuing narcotic pain medication at night if needed.

Wound Dressing

Most of Dr. Sands’ patients receive a waterproof dressing, which allows them to shower immediately following surgery.

However, some patients are not eligible to receive a waterproof dressing if they have a history of being on Eliquis or high dose Xarelto. These patients receive a more traditional dressing and are allowed to shower after one week.

Mobility & Physical Therapy

Patients are able to walk starting on the day of surgery. Generally, they will begin with a walker and then advance to a cane at their own pace. Once patients feel comfortable without the cane, they can transition to walking independently. The process to move from a walker to independent walking typically ranges from 3 to 6 weeks.

Dr. Sands typically recommends that patients participate in physical therapy for 4 to 6 weeks after a total knee replacement. Physical therapy is available at our facility, and there are also several physical therapy providers throughout Brevard County and surrounding counties that can be utilized, depending on the patient’s preference.

Return to Activity & Full Recovery

Patients can return to basic everyday activities at their own pace. Some activities can be resumed within a couple of days of surgery, while more involved activities may take 3 to 6 weeks to safely resume. Swimming or submerging in water is restricted until the wound is completely healed.

Generally, patients are able to fully return to work and perform more strenuous activities within about 6 to 8 weeks of surgery. Patients who have jobs that are less physically demanding can typically return to work sooner. Ultimately, full recovery takes about one year.

Long-term, Dr. Sands advises patients to avoid high-impact activities like prolonged running or jumping. Walking, hiking, swimming, biking, tennis, baseball/softball are all possible after full recovery. Kneeling is possible, but a knee pad or pillow is recommended for comfort. Dr. Sands also discourages sitting in the figure four position with the leg that has been operated on.

Kinematic Total Knee Replacement in Melbourne, FL

Dr. Kenneth Sands is a board certified orthopaedic surgeon specializing in joint replacement surgery, including total knee replacement. He has over 20 years of experience. Dr. Sands utilizes the kinematic total knee replacement technique to provide a more natural-feeling knee replacement to patients, which allows for better long-term results.

If you would like to learn more about kinematic total knee replacement or schedule an appointment with Dr. Sands, please call our office at (407) 643-1234.