Case Study: Custom Left Knee Replacement in a 40 year male

A 40 year old male presented to our office with complaints of left knee pain for the past 5 years. The patient stated he sustained a left knee injury playing soccer 11 years ago for which he was managed conservatively. He subsequently had multiple knee injections and underwent physical therapy but with only temporary relief.

The patient works as a welder in a construction firm. His work involves frequent bending, kneeling and twisting. Recently since the past 1 year the pain had limited his work output. He experienced moderate to severe pain on walking, standing for long and activities requiring him to bend or kneel.

Additionally, he was unable to play with kids and walk his dog since the past few months. The patient was a non smoker and had a past medical history of hypertension and depression, both well controlled with medications. His past surgical history included an appendectomy and laparoscopic cholecystectomy. He was currently taking hydrochlorothiazide 12.5 mg and sertraline. He had drug allergies to sulfamethoxazole and trimethoprim.

On his physician examination, his gait was found to be antalgic with reduced stance phase on the affected side. Patellar tap was positive on milking the suprapatellar pouch suggesting mild knee effusion. Medial joint line and medial patellar facet tenderness was positive. Anterior drawer, posterior drawer, lachman test, valgus and varus stress test were negative.

His imaging studies revealed osteoarthritic changes in the left knee. After careful consideration of lifestyle limiting knee pain and his medical condition, he was advised a custom left knee total replacement. Risks, benefits and alternatives were discussed at length with him. He was motivated to get back to his daily routine without knee pain.

Preoperative X-ray of the left knee showing AP and lateral viewsPreoperative X-ray of the left knee showing AP and lateral views
Preoperative X-ray of the left knee showing AP and lateral views

Several weeks before the surgery, a CT scan of the left knee was obtained. A unique 3D reconstruction was obtained from the data. This data was utilized to create unique patient specific implant. Additionally, disposable custom instruments unique for the patient’s knee were constructed. Custom implants and instruments ensured the best outcome of the procedure. A preoperative plan was made specific for the patient’s knee to preplan the bone cuts and offsets.

Complete Orthopedics patient specific surgical plan for a Custom Left Knee Replacement in a 40 year maleComplete Orthopedics patient specific surgical plan for a Custom Left Knee Replacement in a 40 year male - scan 2

Preoperative surgical plan outlining bone cuts and offsets

The patient underwent customized left knee arthroplasty

Implant used: Custom femur with a custom tibia and patella (38mmx8.5mm) with 10-mm polyethylene insert.

The patient was brought to the operating room after obtaining informed consent and signing the correct surgical site. The risks, benefits, alternatives were extensively discussed with the patient prior to the procedure. The anesthesia was obtained by the anesthesiologist. A tourniquet was placed over the left thigh, and the left lower extremity was prepped and draped in the usual sterile manner.

A straight incision was used for the arthrotomy. Skin and subcutaneous tissues were incised. Medial parapatellar arthrotomy was then performed. The tibial resection guide was then placed into position after exposure of the tibia, and the tibial resection was then made and was then checked. Attention was then turned towards the femur, and the distal cut was then performed using a jig.

The anterior-posterior chamfer cuts were then made using the respective cutting guides. The notch cut was then performed. The laminar spreaders were used medially and laterally, and the remainder of the meniscus and cruciate were then divided. The tibia was then prepared. A gap balancing was performed and was found to be perfect.

Attention was then turned to the patella. The patella was then resected, and drill holes were made in the patella. Trial patella was then placed into position. Trial femur was then placed into position followed by the trial tibia.

Poly was placed into position. The knee was then trialed through a full range of motion. The patellar stability was excellent. The full range of the knee was then obtained.

Trial components were then removed. The femur was cemented into position. Excess cement was then removed. The tibia was cemented into position. Excess cement was then removed. Poly was placed into position. The knee was then reduced and held in full extension with a bump under the ankle.

The patella was then cemented into position. Excess cement was removed and was held with a patellar clamp. The clamp was then removed after cement hardened. Thorough lavage was given.

The injection was given. Medial parapatellar arthrotomy was closed, and the remainder of the wound was closed in layers. Sterile dressing was applied over the wound. The tourniquet was deflated, and the patient was transferred to the postoperative care unit in stable condition.

Three months postoperative X-ray of the left knee showing AP and lateral imagesThree months postoperative X-ray of the left knee showing AP and lateral images - img 2
Three months postoperative X-ray of the left knee showing AP and lateral images.

The patient was able to walk the same day of the surgery with support. The pain was well controlled with medications. The staples were removed uneventful. He underwent a regime consisting of home exercise program and physical therapy. He was prescribed aspirin 325mg BID for three months for deep vein thrombosis prophylaxis.

After three months, the patient had successfully completed his physical therapy and discontinued aspirin. He was happily back to baseline activities. He was able to play with his kids and walk his dog without any discomfort. A week weeks later he was able to return to his work and reported no discomfort. The patient stated the results from surgery exceeded all his expectations.

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4.9
Based on 93 reviews
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.