3D Knee Replacement with Custom Implants


Dr. Buch explains why he prefers custom knee implants for knee replacement

When considering knee replacement would you want your natural knee recreated or replaced? 

The majority of knee replacement in the United States is done with off the shelf implants. Off the shelf implants are mass produced with fixed angles and come in a variety of sizes to cover the majority of all patient's joint size. This traditional approach to knee replacement requires your surgeon to pick the implant that is the closest size to your natural knee and then work to make your knee fit the implant. When Dr. Buch utilizes the 3D technology for knee surgery each patients unique anatomy is imaged and then utilize to create a custom implant to exactly fit your natural knee. Just like our DNA, every knee joint is different as we all have slight nueances that can not be accounted for with traditional off the shelf implants. We have learned through many  studies examing knee replacement data that 20-25% of all traditional knee replacment patients have some issue with their new knee. The most common feedback in the 20-25% of traditional knee replacement patients is it just does not feel like my natural knee. 

What are the potential benefits of utilizing custom made knee implants versus off the shelf implants?
  • Reduced operating time
  • Reduced anesthesia time
  • Quicker recovery
  • Shorter length of hospital stay
  • More natural feeling knee
  • Preservation of your knee's natural shape, joint line, and kinematics
  • Less blood loss
  • Less bone removal 
  • Improved fit of your implant
  • Reduced risk of infection (reduced operating time & use of pre-steralized one time use patient specific instrumentation)

From image to implant. Learn how custom knee implants are made:




Frequently Asked Questions Regarding 3D Knee Replacement:


Why does Dr. Buch prefer customized knee implants versus off the shelf implants for his patients?

The primary reason is everyone's knee anatomy is different. Most knees look the same however the bones and angles that make your natural knee are all slightly different. If we create an implant utilizing the exact anatomy of your natural knee you should have a more natural feeling knee. With traditional off the shelf knee implants the surgeon has to select the implants from pre determined sizes that most closely fit your knee during surgery. With custom made knee implants for each patient we know the implant we utilize will be a precise fit prior to surgery. 

Why do I need a CT scan for custom knee implants and what does it allow you to see?

A CT scan or computed tomography scan is an advanced medical imaging technique used to non-invasively acquire detailed images of various anatomy within the body for diagnostic purposes. This CT scan allows us to capture the specific anatomy and variations in each knee joint to create a custom implant. This information is then sent to an engineer and uploaded to proprietary software that creates a digitial image that will serve as the blueprint for each custom knee implant. This 3D model is then sent to a 3D printer that develops the mold and custom instrumentation for each surgery. 

How does the recovery differ with a customized knee implant?

Recovery after knee replacement with off the shelf implants typically took three months. Knee replacement recovery today is quite different as there have been significant advancements in anesthesia, pain control, surgical techniques, and implant design. These factors have significantly reduced the recovery time following knee replacement as the majority of patients recover within three to six weeks. Another significant shift in the recovery of knee replacement patients is the hospital stay following knee replacement. Historically, knee replacement with off the shelf implants patients would stay in the hospital three to seven days. Today, knee replacement with customized implants ninety-five percent of our patients go home in one to two days. These advancements have also allowed the appropriate candidates to have knee replacement on an outpatient basis where patients will go home in hours following surgery.

Are there limitations on who is a candidate for knee replacement with custom implants?

Anybody with severe arthritis of the knee that has failed conservative treatment modalities is a candidate for knee replacement with custom implants. There are some minor limitations to utilizing a custom knee implant, if you have severe deformity of the knee joint we may not be able to make a knee to your anatomy. If you have a lot of bone loss, you have had significant trauma, or if you have a lot of hardware in the knee you may not be able to have a customized knee. 

How does customized knee replacement technology allow Dr. Buch to achieve natural mechanical ailgnment and how is this beneficial for patient outcomes?

By utilizing data obtained during your CT scan we know the knee is going to be a precise match resulting in a better fit and alignment. This will result in a better balanced knee which increases the range of motion and results in a more natural knee.   During knee replacement mechanical ailgnment is important because most people are born with their leg in a valgus alignment. As we age this can worsen moving toward a more neutral position or it can change to varus alignment which is the most common. A mistake that was historically made in knee replacement is that most patients walk around for 20 plus years with a varus ailgment and then surgeons would put their new knee in valgus alignment to represent the way their knee joint was before aging and wear and tear caused this change. It is best to put the knee implant in the position you are used to walking in or a neutral position. Patients will tolerate this ailgment better when they walk as it will feel like their own knee. A surgeon can do a great job with the surgical process of replacing your knee but if the ailgnment is off or changed it can result in pain or an unnatrual feeling knee.

What are the differences in patient satisfaction with a custom knee implant versus an off the shelf impant?

We conducted a study on patients who received bilateral (both knees) knee replacement. For patients to be in the study they had to have a knee replacement with an off the shelf implant and be a current candidate for knee replacement on the opposite side with a custom made knee implant. Every patient in the study reported higher satisfaction scores with the customized knee implant, they liked it better, reported they recovered quicker, and reported the custom knee implant felt better then their off the self implant. 

What is the difference between a 3D knee replacement with custom implant versus a robotic knee replacement?

First, there is a significant difference between the two. The potential issue with robotic knee replacement is you have to input data into the computer, dial in the robot, and use an off the shelf implant to match your knee to the implant. Some surgeons say the robot helps them put in the implant better, this may be true but the implant utilizes for robotic knee replacement is still not a perfect match to your knee like a custom made implant. Custom made implants are designed for your knee and your knee only resulting in less surgery then robotic surgery. Robotic surgery also requires additional incisions to make pin holes for the navigation component of the robot. The custom made implant system made by Conformis is a much simpler, straighforward system that allows surgeons to produce consistant results. 

How do I find out more information about customized knee implants and the company that produces them? 

We receive calls from across the United States about Conformis custom made knee implants from presentations Dr. Buch has given or patients find this website. The best thing to do for more information on custom made implants, Conformis, or the process of knee replacement is to contact our office at 469-443-0939 to schedule an appointment with Dr. Buch. Dr. Buch has been an early adopter of this technology and had first hand seen the benfit this technology provides to patients. Dr. Buch will explain knee replacement with custom implants in detail and you will have all the time you need to ask questions. If you are in a different state or unable to travel to our office locations near Dallas, Texas we would be happy to help make a recommendation on a good surgeon who utilizes this technology near you. Another option is to visit the Conformis website here to obtain additional information. 


Dr. Buch peformed bilateral 3D Knee Replacement on Don. Watch the video below to learn more about Don's experience with custom made implants:





Dr. Buch has been featured in numerous articles and interviews for his expertise and outcomes with 3D knee replacement:

Beckers ASC Review: Outpatient Total Knee Replacement: Critical factors enabling successful total knee replacement procedures in ASCs. 

Living Well Magazine: The Perfect Fit, Customizing Your Knee Replacement Surgery

Surgeon Experience Interview with Richard Buch, M.D.: Knee Replacement Instability

Richard Buch, M.D., Clinical Investegator: Clinical Study Demonstrates Conformis Customized Knee Implants Provide Superior Outcomes & Potential for Economic Savings

3D Printer Gives Patient New Knees, Ability to Run 


About Richard Buch, M.D.

Richard Buch, M.D. is the founder of The Dallas Limb Restoration which has become a national referral center for complex pathologies of the knee, shoulder, and hip. As a leader in his field and featured expert at countless national and international meetings Dr. Buch offers patients innovate technologies and treatment solutions for pain, injury, and degenerative conditions. Dr. Buch has over 25 years experience performing knee replacements and has done over 13,000 knee, hip, and shoulder surgeries. To schedule an appointment with Dr. Buch click here or call 469-443-0939.