The TEN COMMANDMENTS of Calipered Kinematically Aligned Total Knee Arthroplasty

By Stephen M. Howell, MD

Overview: Definition of calipered kinematic alignment and why follow ten commandments (9 min).

1. Thou shalt not perform kinematic alignment without recording caliper measurements of the bone resections, filling out a verification sheet, and following a decision-tree (9 min).
2. Thou shalt not leave a component proud or recessed from the pre-arthritic joint surface as the knee will feel tight or loose to the patient (7 min).
3. Thou shalt not make a straight leg instead straighten the leg to the patient’s pre-arthritic alignment (5 min).
4. Thou shalt not worry about varus failure of the tibial component as this is caused by mechanical alignment and alleviated by kinematic alignment (8 min).
5. Thou shalt not profess allegiance to the center of the femoral head and ankle (4min).
6. Thou shalt not deny treatment to knees with severe varus, valgus, and flexion deformities (7 min).
7. Thou shalt not commit to the first tibial cut instead use a recut guide to optimize varus-valgus stability in extension and restore native laxity in flexion (7 min).
8. Thou shalt not flex the femoral component more than a few of degrees or risk patello-femoral instability (6min).
9. Thou shalt not deviate from the patient’s pre-arthritic slope more than a few degrees or risk early-onset tibial component failure from posterior overload (5 min).
10. Thou shalt not intentionally remove the PCL, though when cut, reduce the posterior tibial slope to compensate for the increase in laxity in the flexion space (6 min).

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