Custom Knee Replacement


Custom knee replacements are an option for the vast majority of patients who are candidates for a normal type of knee replacement.

The indications for custom knee replacement are no different than the indications for a total knee replacement of a normal type – the patient must have symptoms relating to underlying osteoarthritis that has been radiographically demonstrated and confirmed with physical examination.

Custom knee replacement is a breakthrough in the treatment of arthritis, and can be particularly useful for patients who have previously undergone knee replacement surgery. A custom knee replacement is designed using computer-aided design and built from metal shapes that precisely fit the patient’s joint morphology. This technique allows surgeons to tailor the prosthesis to each person’s specific anatomy.

Knee arthritis symptoms

Symptoms from knee arthritis must be sufficiently debilitating and frequent to warrant surgical intervention and ideally, the patient should also have attempted to control these symptoms with the nonsurgical interventions and treatments for osteoarthritis before proceeding to surgery.

Custom Knee Replacement Materials and Equipment

The way custom knee replacements differ from normal knee replacements are that a scan is necessary of the knee prior to the surgery being performed. The scan is completed in the same way as any other CT or MRI scan. This scan is then sent off to the custom knee replacement manufacturer who will then likely construct computer-based 3D model of the knee joint. They will then make calculations as to exactly where cuts need to be made in the bone, so that the arthritis is cut out of the knee in its entirety whilst leaving as much of the patient’s own healthy bone behind as possible.

Based on these scans and calculations, the company then creates custom cutting guides for the surgeon to use during the procedure as well as matching these custom cutting guides to the inner surface of the knee replacement component.

Customized knee replacement templates and

Customized knee replacement templates and cutting jigs

These cutting guides are prepared alongside the normal instruments for a total knee arthroplasty and when the time comes for the patient to have surgery, the surgeon uses the custom cutting guides instead of the stock cutting guides that he or she would, otherwise, have used in a normal knee replacement. This essentially means that the patient has a customized or patient-specific surgery that matches their own unique knee anatomy.

Custom Knee Replacement Treatment Options

As previously mentioned, patients will ideally have had osteoarthritis previously diagnosed and attempted some form of nonsurgical management of their arthritis before reaching the stage of requiring a knee replacement. The four main strategies for management an arthritic knee without surgery are anti-inflammatory medications (if the patient can tolerate taking these), physical therapy, bracing and intra articular knee injections of corticosteroid or in some cases hyaluronic acid analogs.

Not all patients will respond favorably to all nonsurgical managements and some patients will be so far along in the knee arthritis process at the time of diagnosis that even if they work to try nonsurgical managements of their arthritis, it is unlikely that they will be successful. For a definitive opinion on how severe patient’s arthritis is, they should first consult with an appropriate medical professional or orthopedic surgeon and they can be advised as to what stage of the arthritic process their knee is currently in and whether they would be candidates to trial nonsurgical management or whether surgery is likely the only option left for them.

Who is a good candidate of Custom Knee Replacement Surgery?

The patients who have reached a stage in their arthritis where their symptoms are frequent and so severe that they have become quite debilitated by their arthritis (and have also failed nonsurgical management strategies) are considered good candidates for any kind of knee replacement. The vast majority of these patients will be candidates for custom knee replacement surgery as the only contraindication to performing a custom knee replacement would be if there is significantly abnormal anatomy or major deformity that precludes the use of primary arthroplasty components.

This is likely to be a very small subset of patients and if you feel that you may be a candidate for a custom knee replacement surgery, consulting with one of our orthopedic surgeons is the best option to have a full assessment and appraisal as to whether you would be a good candidate or, if you are indeed one of the small subset of patients that are unable to have a custom knee replacement.

Custom Knee Replacement Surgery Procedure

Custom knee replacement surgery is almost identical to any other type of knee replacement surgery that uses non-custom components. The only difference in the entire process is that rather than the stock cutting guides that the implant companies prepare for use in normal total knee arthroplasties, the cutting guides are instead built in a custom fashion to the patient’s native knee anatomy. As a result, they are made of 3D-printed plastic and not metal.

Custom femoral component on a 3D constructed bone model.

Custom tibial component and 3D constructed tibial bone model.

The images above show 3D printed customized total knee components along with 3D printed bone models. The customized components allow accurate bone cuts and ensure snugly fit implants which are not subjected to undue stress on movement. The accurate bone cuts also aid in preserving bone.

They are usually disposable and the process of placing the custom guides in the appropriate position is slightly different than it would be for a normal total knee cutting guide which is usually made of metal and has to be manually placed into what the surgeon estimates to be the appropriate position for the cutting guide. This is essentially the only step that is any different from a normal total knee replacement and as such, the surgical dissection, tissue disruption and subsequent overall recovery would be largely the same (although there are numerous reports that custom knee replacement surgery patients recover quicker than non-custom knee replacement patients).

Custom Knee Replacement Surgery Success Rate

Custom knee replacement surgery is still, at its core, knee replacement surgery and as such has demonstrated broadly similar success rates to normal total knee arthroplasty. There are some studies published that suggest patients with custom knee replacements function biomechanically much more closely to their presurgery knee biomechanics and as such seem to recover slightly quicker than other knee replacement patients, but this is still controversial and some surgeons argue as to whether this difference is clinically significant.

In any case, at the very least, custom knee replacement surgery approaches between 85% and 90% success rate with around 5% to 10% of patients experiencing the same sort of symptoms preoperatively as they did postoperatively and a small subset of patients (usually less than 5%) reporting that their knee is worse after surgery.

Custom Knee Replacement Surgery Risks

The risks of custom knee replacement surgery are broadly similar to the risks of any knee replacement surgery, as the anesthetic that you will receive for the surgery will likely be the same and the procedure generally lasts about as long as the normal knee replacement would also. As previously mentioned, tissue dissection and surgical approach will likely be the same and, as such, the risks of having such surgery are identical to the risks of having a non-custom knee replacement surgery. These include periprosthetic infection, neurovascular injury, heart attack, blood clot, stroke, intraoperative fracture and postoperative knee stiffness.

Custom Knee Replacement Recovery and Timeframe

The immediate postoperative recovery from a custom knee replacement will involve the same process of performing exercises with the physical therapist and being assisted with ambulation in order to allow the patient to be up and walking as soon as possible after surgery. Once the patient has demonstrated a degree of independence with mobilization and is able to ascend 2 to 3 steps unassisted, this is usually the final physiotherapy goal prior to discharge. The knee will experience soreness and this will be controlled with opioid and non-opioid analgesics.

The primary goal in the early postoperative period is to work on range of motion exercises and there are a great number of these that you can perform. Your physical therapist will advise you on the best exercises for you specifically. It is also important to work on quadriceps strengthening and overall gait training too.

By around 3 to 6 months post surgery, most patients have achieved recovery to their approximate baseline, although some patients, particularly patients who are more elderly, may take a little longer than this and this is perfectly normal.

Custom Knee Replacement Exercises that help

Although physical therapists tend to tailor the treatment regimens to the individual patient based on their lifestyle and their immediate home environment, there are a series of exercises that most patients can perform that improve range of motion as well as quad strength and overall gait quality. Straight leg raises will improve quad strength without working on range of motion and assisted knee flexion with a blanket around the heel in bed is one of the first exercises that your physical therapy will likely have you perform and can be continued into the recovery process indefinitely.

Later on in the recovery process being able to sit on a stationary bicycle and use the nonoperative leg to help propel the pedals around is an excellent exercise that helps to work on the range of motion in the operative leg without putting too much strain across the knee. It is also an excellent exercise for general cardiovascular health and can be continued well after the patient has fully recovered from the knee replacement surgery.

Custom Knee Replacement Exercises to Avoid

Generally, we advise that the patient to avoid exercises that put a great deal of strain across the knee or to work too heavily on the quadriceps too early on the process. A good example of this would be resisted leg extension exercises particularly on gym weight machines. These put a great deal of strain across the patellofemoral joint and will also cause tension on the arthrotomy closure, which in the early postoperative period should be avoided.

Resisted or heavy barbell squatting should also be avoided as for the same reasons. Squatting can be a very good way to recovery from a knee replacement surgery, but usually beginning with bodyweight squats and usually using a wall to aid in the squatting motion is a good place to start. Once strength has been gained back in the knee through other exercises then resisted squats with barbells can be begun should the patient be very keen on pursuing this particular exercises, but we would not recommend performing heavy resisted squats until at least 6 months after the surgery.

Custom Knee Replacement Surgery Cost

For the most part, custom knee arthroplasty is more expensive than standard non-custom knee arthroplasty. This is for a number of reasons; the extra scan required for the process of 3D printing the custom cutting guides, and the process of manufacturing the guides themselves. However, there are a number of insurance plans that will cover, at the very least, part of the cost of a custom total knee arthroplasty. If you are unsure if this is the case, you can either talk to your plan provider directly or come and see one of our orthopedic surgeons in consultation who will be able to discuss the options with you and work with you to achieve a desirable solution if custom knee replacement is something that you are very knee on pursuing.


Custom total knee arthroplasty is available for the vast majority of patients who are candidates for a knee replacement surgery and although the benefit of these is controversial amongst many orthopedic surgeons, there is some research to suggest that it is beneficial and there is also plenty of research to suggest that custom knee replacement patients knees perform biomechanically more similarly to what we would consider “normal” knee biomechanics.

If custom knee arthroplasty is something that you are interested in pursuing, come and see one of our orthopedic surgeons as we will be to able to discuss your options with you and we will be happy to provide you with the information necessary to make a decision as to whether you wish to pursue custom knee arthroplasty or indeed whether you wish to proceed knee replacement at all.

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Based on 116 reviews
I had an extremely friendly and personalized medical consult with Dr Karkare. Dr Karkare was very knowledgeable and very professional. His communication skills was extremely good and explained my medical condition in very simple words. The office visit was very helpful in understanding my medical condition. Thank you Dr Karkare
Padmanabhan Nagaraj
20:49 25 Sep 23
Dr. Karlkare and his staff were excellent. Dr. Karkare explained everything clearly and took his time getting to know my Dad.
Anna Acker
22:46 07 Sep 23
Dr Vedant Vaksha had done emergency surgery in 2020 after a traumatic injury.His office at Complete Orthopedics handled the continued care thereafter.Dr V and his staff had been Professional and friendly throughout the process, taking the time to explain all the questions on how to proceed and what to expect.Whenever I needed to speak with Dr V or the office they were a phone call away, without waiting or calling several numbers like in so many other medical offices.The office was accommodating to scheduling to my needs at all times. Dr Vedant Vaksha earned the following5 out of 5 stars, highly recommended.
John Kuey
20:58 05 Sep 23
Dr. Vaksha helped me recover from an injury. I am very thankful that he took the time to explain the best treatment for my injury. Also thankful for the wonderful office staff!
Joseph Castelli
22:30 02 Aug 23
The office is wonderful!… Dr Paresh was very helpful and attentive and made my sister in laws recovery so much better.. Thank you for everything
Jazz Lorenzo
17:48 14 Jul 23
The ladies are very welcoming, the service is great, the doctor is very professional and caring and the building is super clean. I really like to come here, the atmosphere is very friendly... Come and you will love it too.
Joan Carasco
14:41 30 Jun 23
Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
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.
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.
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

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.