Draft:Stephen M. Howell
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Stephen M. Howell | |
|---|---|
| Born | Stephen Miller Howell |
| Education | Northwestern University Feinberg School of Medicine (MD) |
| Occupation | Orthopedic surgeon |
| Known for | Kinematic alignment in total knee arthroplasty; tibial tunnel placement in anterior cruciate ligament reconstruction |
| Spouse | Lydia Pleotis Howell |
| Medical career | |
| Profession | Surgeon |
| Field | Orthopedic surgery, biomedical engineering |
| Institutions | University of California, Davis Adventist Health Lodi Memorial Methodist Hospital of Sacramento |
Stephen Miller Howell is an American orthopedic surgeon and biomedical engineering researcher. He is credited with introducing kinematic alignment, a patient-specific method of positioning the components in total knee arthroplasty that restores the patient's pre-arthritic joint line rather than aligning the limb to a neutral mechanical axis.[1][2][3] He was for many years an adjunct professor of biomedical engineering at the University of California, Davis, where he collaborated with the engineer Maury L. Hull.[4][5]
Education and early career
[edit]Howell attended medical school at Northwestern University on a United States Air Force scholarship and completed his orthopedic residency at Thomas Jefferson University.[6][4] After residency he was assigned to Travis Air Force Base in Fairfield, California.[4] He later practiced at Methodist Hospital of Sacramento and, from about 2017, at Adventist Health Lodi Memorial in Lodi, California.[7][8]
Research
[edit]Anterior cruciate ligament reconstruction
[edit]Howell's early research concerned graft placement in anterior cruciate ligament reconstruction. With Hull he described how an anteriorly placed tibial tunnel causes the graft to impinge on the roof of the femoral intercondylar notch,[9][10] a concept later authors say he popularized.[11] The 65° tibial drill guide he designed to avoid roof impingement is known as the Howell guide.[12] He and colleagues also reported that a tibial tunnel drilled too vertically in the coronal plane causes the graft to impinge on the posterior cruciate ligament, producing loss of flexion and anterior laxity, and recommended a coronal tunnel angle of 65° to 70°.[13][14][15][16]
Kinematic alignment
[edit]Howell first used kinematic alignment clinically in January 2006.[17] The technique was initially performed with patient-specific cutting guides made from magnetic resonance imaging models; Howell is a co-inventor on the patent for these guides, which were developed by OtisMed Corporation of Alameda, California, and marketed as the OtisKnee.[18][17] OtisMed's assets were acquired by Stryker Corporation in 2009.[19] Howell subsequently developed a manual-instrument version of the technique in which each bone resection is verified with a caliper,[20] and reported that it could be performed accurately with generic instruments.[21]
His 2013 report that kinematically aligned knees functioned well regardless of the resulting limb alignment category,[22] and a 2018 report of implant survival and function at 10 years,[23] are among the most cited publications on alignment in knee arthroplasty.[24] Howell's unrestricted form of kinematic alignment places no limits on the patient's native anatomy or the final alignment; later variants such as restricted kinematic alignment, inverse kinematic alignment and functional alignment were proposed as modifications of it.[1][20][3][25]
Howell worked with Medacta International on kinematic alignment instrumentation, which received Food and Drug Administration clearance in 2018,[26] and is the surgeon developer of the company's GMK SpheriKA femoral component, launched in 2023.[27] By 2019 he had hosted surgeons from the United States and 9 other countries at Lodi to observe the technique.[8]
He is the lead editor of Calipered Kinematically Aligned Total Knee Arthroplasty: Theory, Surgical Techniques and Perspectives (Elsevier, 2021)[28] and, with Hull, wrote the chapters on kinematic alignment in the 5th and 6th editions of Insall & Scott Surgery of the Knee.[29]
Honors
[edit]In December 2018 Howell was made an honorary member of the German Arthroplasty Society (Deutsche Gesellschaft für Endoprothetik).[6][30] In September 2026 he delivered the keynote lecture, "My Journey Personalizing Knee Replacement Surgery", at the annual meeting of the Personalized Arthroplasty Society in Montreal.[31]
Personal life
[edit]Howell is married to Lydia Pleotis Howell, a pathologist who chaired the Department of Pathology and Laboratory Medicine at the UC Davis School of Medicine from 2010 to 2023. In 2023 the couple made a $2 million estate gift establishing an endowed chair in that department.[4]
Selected publications
[edit]- Howell SM, Hull ML. Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res. 1992;(283):187–195. doi:10.1097/00003086-199210000-00026
- Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med. 2001;29(5):567–574. doi:10.1177/03635465010290050801
- Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res. 2013;471(3):1000–1007. doi:10.1007/s11999-012-2613-z
- Howell SM, Papadopoulos S, Kuznik KT, Hull ML. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc. 2013;21(10):2271–2280. doi:10.1007/s00167-013-2621-x
- Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty. 2018;33(12):3678–3684. doi:10.1016/j.arth.2018.07.020
References
[edit]- 1 2 Lustig, Sébastien; Sappey-Marinier, Elliot; Fary, Camdon; Servien, Elvire; Parratte, Sébastien; Batailler, Cécile (2021). "Personalized alignment in total knee arthroplasty: current concepts". SICOT-J. 7: 19. doi:10.1051/sicotj/2021021. PMC 8019550. PMID 33812467.
Kinematic alignment (KA), described by Howell et al. in 2006, is an "individualized" or patient-specific technique.
- ↑ Yang, Hong-Yeol; Seon, Jong-Keun; Ayob, Khairul Anwar (2026). "Evolving philosophies of alignment in total knee arthroplasty: from mechanical uniformity to personalised harmony". Medicina. 62 (2): 307. doi:10.3390/medicina62020307. PMC 12941868. PMID 41752706.
- 1 2 Indelli, Pier Francesco; Salvi, Andrea Giorgio; Petralia, Gianluca (2023). "Editorial: Alignment options and robotics in total knee arthroplasty". Frontiers in Surgery. 10. doi:10.3389/fsurg.2023.1247759. PMC 10368122. PMID 37496717.
Howell et al. introduced the "kinematic alignment" (KA).
- 1 2 3 4 "Surprise retirement gift". University of California, Davis. Retrieved 2026-09-19.
- ↑ "Hull Lab". UC Davis Health, Department of Orthopaedic Surgery. Retrieved 2026-09-19.
- 1 2 Drees, Jackie (2019). "Dr. Stephen Howell receives honor from German Arthroplasty Society: 4 notes". Becker's Spine Review. Retrieved 2026-09-19.
- ↑ "Surgeon Scorecard: Methodist Hospital of Sacramento". ProPublica. 2015. Retrieved 2026-09-19.
- 1 2 "Australian surgeon visits Lodi to study under total joint replacement expert". Lodi News-Sentinel. August 2019. Retrieved 2026-09-19.
- ↑ Howell, Stephen M.; Hull, Maury L. (1992). "Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement". Clinical Orthopaedics and Related Research. 283 (283): 187–195. doi:10.1097/00003086-199210000-00026.
- ↑ Howell, Stephen M.; Taylor, Mark A. (1993). "Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof". The Journal of Bone and Joint Surgery. American Volume. 75 (7): 1044–1055. doi:10.2106/00004623-199307000-00011. PMID 8335664.
- ↑ Tanksley, John A.; Werner, Brian C.; Conte, Evan J.; Lustenberger, David P.; Nye, Nicholas L.; Hart, Joseph M.; Miller, Mark D. (2017). "ACL roof impingement revisited: does the independent femoral drilling technique avoid roof impingement with anteriorly placed tibial tunnels?". Orthopaedic Journal of Sports Medicine. 5 (5) 2325967117704152. doi:10.1177/2325967117704152. PMC 5439652. PMID 28567428.
Howell popularized the concept of roof impingement in transtibial (TT) ACL reconstructions with anterior tibial tunnels.
- ↑ Cuomo, Pierluigi; Edwards, Andrew; Giron, Francesco; Bull, Anthony M. J.; Amis, Andrew A.; Aglietti, Paolo (2006). "Validation of the 65° Howell guide for anterior cruciate ligament reconstruction". Arthroscopy. 22 (1): 70–75. doi:10.1016/j.arthro.2005.10.016. PMID 16399464.
- ↑ Howell, Stephen M.; Gittins, Mark E.; Gottlieb, Jeffrey E.; Traina, Steven M.; Zoellner, Timothy M. (2001). "The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction". The American Journal of Sports Medicine. 29 (5): 567–574. doi:10.1177/03635465010290050801. PMID 11573914.
- ↑ Simmons, Richard; Howell, Stephen M.; Hull, Maury L. (2003). "Effect of the angle of the femoral and tibial tunnels in the coronal plane and incremental excision of the posterior cruciate ligament on tension of an anterior cruciate ligament graft: an in vitro study". The Journal of Bone and Joint Surgery. American Volume. 85 (6): 1018–1029. doi:10.2106/00004623-200306000-00006. PMID 12783997.
- ↑ Kraeutler, Matthew J.; Wolsky, Rachel M.; Vidal, Armando F.; Bravman, Jonathan T. (2017). "Anatomy and biomechanics of the native and reconstructed anterior cruciate ligament: surgical implications". The Journal of Bone and Joint Surgery. American Volume. 99 (5): 438–445. doi:10.2106/JBJS.16.00754. PMID 28244915.
Howell et al. suggested that the ideal angle for the tibial tunnel was between 65° and 69° from the medial joint line in the coronal plane.
- ↑ Nishimori, Makoto; Sumen, Yoshio; Sakaridani, Kazuhiko; Nakamura, Masahiro (2007). "An evaluation of reconstructed ACL impingement on PCL using MRI". Magnetic Resonance Imaging. 25 (5): 722–726. doi:10.1016/j.mri.2006.10.002. PMID 17540284.
- 1 2 Jackson, Douglas W. (15 October 2010). "Kinematic vs. mechanical alignment: What is the difference?". Orthopedics Today. Retrieved 2026-09-19.
- ↑ US 9017336, Ilwhan Park, Stephen M. Howell, Charlie W. Chi, "Arthroplasty devices and related methods", issued 2015-04-28, assigned to OtisMed Corporation
- ↑ "Stryker Corporation announces agreements to acquire assets of OtisMed Corporation" (Press release). Stryker Corporation. 11 November 2009. Retrieved 2026-09-19 – via BioSpace.
- 1 2 Vendittoli, Pascal-André; Martinov, Sergio; Blakeney, William G. (2021). "Restricted kinematic alignment, the fundamentals, and clinical applications". Frontiers in Surgery. 8 697020. doi:10.3389/fsurg.2021.697020. PMC 8329359. PMID 34355018.
- ↑ Howell, Stephen M.; Papadopoulos, Stacey; Kuznik, Kyle T.; Hull, Maury L. (2013). "Accurate alignment and high function after kinematically aligned TKA performed with generic instruments". Knee Surgery, Sports Traumatology, Arthroscopy. 21 (10): 2271–2280. doi:10.1007/s00167-013-2621-x. PMID 23948721.
- ↑ Howell, Stephen M.; Howell, Stacey J.; Kuznik, Kyle T.; Cohen, Joshua; Hull, Maury L. (2013). "Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category?". Clinical Orthopaedics and Related Research. 471 (3): 1000–1007. doi:10.1007/s11999-012-2613-z. PMC 3563808. PMID 22996362.
- ↑ Howell, Stephen M.; Shelton, Trevor J.; Hull, Maury L. (2018). "Implant survival and function ten years after kinematically aligned total knee arthroplasty". The Journal of Arthroplasty. 33 (12): 3678–3684. doi:10.1016/j.arth.2018.07.020. PMID 30122435.
- ↑ Micicoi, Grégoire; Sculco, Peter K.; Parker, David A.; Hirschmann, Michael T.; Lustig, Sébastien (2026). "The 100 most cited publications on alignment in total knee arthroplasty". Journal of ISAKOS. 20. doi:10.1016/j.jisako.2026.101180. PMID 42462972.
This current was driven most prominently by Howell and colleagues, whose kinematic alignment series established both the technique and its functional rationale.
- ↑ Mancuso, Francesco; Al-Mohamadi, Khaled; Kleinert, Christian; Cornelissen, Stijn; Pandit, Hemant; Jeremic, Dragan (2026). "Unrestricted kinematic alignment for total knee arthroplasty: a mid- to long-term follow-up non-designer single surgeon study". Bone & Joint Open. 7 (5): 627–635. doi:10.1302/2633-1462.75.BJO-2025-0399.R1. PMC 13161791. PMID 42116731.
- ↑ "Medacta receives FDA clearance for kinematic alignment instrumentation for total knee replacement". Orthopedics Today. 1 November 2018. Retrieved 2026-09-19.
- ↑ Brusco, Sam (30 October 2023). "Medacta to debut GMK SpheriKA femoral implant". Orthopedic Design & Technology. Retrieved 2026-09-19.
- ↑ Howell, Stephen M.; Bini, Stefano A.; Steele, G. Daxton, eds. (2021). Calipered Kinematically Aligned Total Knee Arthroplasty: Theory, Surgical Techniques and Perspectives. Elsevier. ISBN 978-0-323-75626-6.
- ↑ Howell, Stephen M.; Hull, Maury L.; Mahfouz, Mohamed R. (2017). "Kinematically aligned total knee arthroplasty". In Scott, W. Norman (ed.). Insall & Scott Surgery of the Knee (6th ed.). Elsevier. ISBN 978-0-323-40046-6.
- ↑ "Drs. Stephen Howell, Kandice Beenken & more: 18 orthopedic surgeons making headlines". Becker's Spine Review. 16 January 2019. Retrieved 2026-09-19.
- ↑ "PAS 2026 Annual Meeting". Personalized Arthroplasty Society. Retrieved 2026-09-20.
Keynote — Stephen Howell: My Journey Personalizing Knee Replacement Surgery
External links
[edit]- Stephen M. Howell publications indexed by Google Scholar
Category:Living people Category:American orthopedic surgeons Category:Feinberg School of Medicine alumni Category:University of California, Davis faculty Category:United States Air Force Medical Corps officers Category:Physicians from California
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