|
1
|
Farid AR, Comtesse S, Sagi HC, Frosch KH, Weaver MJ, Yoon RS, von Keudell A. Enabling Technology in Fracture Surgery: State of the Art. J Bone Joint Surg Am 2025:00004623-990000000-01468. [PMID: 40424369 DOI: 10.2106/jbjs.24.00938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
Abstract
➢ Three-dimensional (3D) printing and virtual modeling, using computed tomographic (CT) scans as a base for the 3D-printed model, help surgeons to visualize relevant anatomy, may provide a better understanding of fracture planes, may help to plan surgical approaches, and can possibly simulate surgical fixation options.➢ Navigation systems create real-time 3D maps of patient anatomy intraoperatively, with most literature in orthopaedic trauma thus far demonstrating efficacy in percutaneous screw placement using preoperative imaging data or intraoperative markers.➢ Augmented reality and virtual reality are new applications in orthopaedic trauma, with the former in particular demonstrating the potential utility in intraoperative visualization of implant placement.➢ Use of 3D-printed metal implants has been studied in limited sample sizes thus far. However, early results have suggested that they may have good efficacy in improving intraoperative measures and postoperative outcomes.
Collapse
Affiliation(s)
- Alexander R Farid
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - Simon Comtesse
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - H Claude Sagi
- Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
| | - Michael J Weaver
- Harvard Orthopaedic Trauma Initiative, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard S Yoon
- Division of Orthopaedic Trauma and Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center/Saint Barnabas Medical Center-RWJBarnabas Health, Livingston/Jersey City, New Jersey
| | - Arvind von Keudell
- Harvard Orthopaedic Trauma Initiative, Boston, Massachusetts
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark
| |
Collapse
|
|
2
|
Scott DF, Horton EN. Femoral resection accuracy and precision in manual caliper-verified kinematic alignment total knee arthroplasty. J Exp Orthop 2025; 12:e70234. [PMID: 40256668 PMCID: PMC12006286 DOI: 10.1002/jeo2.70234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/03/2025] [Accepted: 03/07/2025] [Indexed: 04/22/2025] Open
Abstract
Introduction The accuracy and precision of bone resections in total knee arthroplasty (TKA) are essential to avoid poor implant positioning, which can lead to component wear, pain, and instability, reducing patient satisfaction and implant survivorship. Technology-assisted TKA techniques aim to improve accuracy but come with added costs, increased operative time, and varying success in clinical outcomes. Caliper-verified kinematic alignment (KA) attempts to restore the joint line by precisely measuring resections to equal implant thickness. We evaluated the accuracy and precision of caliper-verified KA-TKA performed with manual instruments. We hypothesised that this technique would achieve high accuracy and precision, with an average absolute difference between actual and target distal and posterior femoral resection measurements of ≤ 0.5 mm. Methods 385 consecutive patients underwent primary unrestricted caliper-verified KA-TKA with manual instrumentation. The thickness of the distal medial (DM), distal lateral (DL), posterior medial (PM) and posterior lateral (PL) femoral condyle resections were measured with a caliper and compared to a target determined by the degree of cartilage loss, saw blade kerf, and femoral component thickness. Results The mean differences between the resected and target thicknesses for DM, DL, PM and PL femoral resections were 0.1 ± 0.2 mm, 0.1 ± 0.3 mm, 0.3 ± 0.5 mm and 0.2 ± 0.4 mm, respectively (mean ± std. dev.). Most femoral resections were within 0.5 mm of the target-97.7%, 94.5%, 85.7% and 89.4% of DM, DL, PM and PL resections, respectively. Conclusion Manual caliper-verified KA-TKA achieved highly accurate and precise femoral resections with absolute differences from target that averaged 0.175 mm. This simple, logical, efficient, and reproducible surgical technique may be an option for surgeons contemplating the use of technology-assisted options, such as patient-specific instrumentation or robotic arm-assisted TKA, and surgeons without access to such technologies. Level of Evidence Level II.
Collapse
Affiliation(s)
- David Forrest Scott
- Spokane Joint Replacement Center, Inc.SpokaneWashingtonUSA
- Washington State University Elson S. Floyd College of MedicineSpokaneWashingtonUSA
| | - Emma N. Horton
- Spokane Joint Replacement Center, Inc.SpokaneWashingtonUSA
| |
Collapse
|
|
3
|
Stauss R, Savov P, Ettinger M. [New technologies in total knee arthroplasty : Current concepts and personalized treatment strategies]. ORTHOPADIE (HEIDELBERG, GERMANY) 2025; 54:190-198. [PMID: 39961906 DOI: 10.1007/s00132-025-04618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND In total knee arthroplasty (TKA), there is a trend towards personalized concepts. This includes the implementation of new technologies and the increasing popularity of individualized alignment strategies. TARGETS The purpose of personalized TKA is to restore the patient's bony anatomy and constitutional alignment, as well as the physiological soft tissue balance and joint kinematics. Modern technologies facilitate a thorough, three-dimensional analysis of the bony structures and the patient's constitutional alignment. Virtual planning enables a simulation component placement, gap balancing and postoperative alignment. After approval of the surgical plan, the technology-aided execution shows a greater accuracy, precision and reproducibility of implant alignment compared to conventional manual instrumentation. OVERVIEW This article focuses on novel technologies in total knee arthroplasty, including patient-specific instrumentation (PSI), custom implants, navigation and robotics. The purpose of this article is to summarize current evidence, including radiological and functional outcomes, as well as economic aspects. Furthermore, the implementation of novel technologies in the context of personalized alignment strategies will be discussed.
Collapse
Affiliation(s)
- Ricarda Stauss
- Universitätsklinik für Orthopädie im Pius Hospital, Carl von Ossietzky Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
| | - Peter Savov
- Universitätsklinik für Orthopädie im Pius Hospital, Carl von Ossietzky Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| | - Max Ettinger
- Universitätsklinik für Orthopädie im Pius Hospital, Carl von Ossietzky Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| |
Collapse
|
|
4
|
Laitinen MK. CORR Insights®: How Does Customized Cutting Guide Design Affect Accuracy and Ergonomics in Pelvic Tumor Resection? A Study in Cadavers. Clin Orthop Relat Res 2024; 482:1003-1005. [PMID: 38502816 PMCID: PMC11124704 DOI: 10.1097/corr.0000000000003048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Minna K Laitinen
- Head of the Orthopaedic and Traumatology Department, Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
|
5
|
Hiyama S, Takahashi T, Handa M, Takeshita K. Flexion contracture can cause component mismatch in the Prophecy ® preoperative patient-specific instrumentation for Evolution ® medial-pivot knee system. SICOT J 2024; 10:12. [PMID: 38592306 PMCID: PMC11003457 DOI: 10.1051/sicotj/2024009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Patient-specific instrumentation (PSI) systems are used to conduct total knee arthroplasty. PSI reduces operative time, is less invasive and easier to use, and minimizes the risk of errors by providing precise measurements and reducing operating room turnover time. However, a study on the accuracy of Prophecy Evolution PSI (Microport Inc., Arlington, TN, USA) reported that 94% were below the error margin of 1.5 mm and 90% had error margins of 1 mm. This study aimed to evaluate the accuracy of the Prophecy Evolution PSI system in terms of the thickness of "total" bony resection required to achieve adequate extension/flexion gaps and the component match ratio between preoperative planning and actual component size inserted. METHODS Comparisons were made between the sizes of femoral and tibial components planned with PSI and those inserted. The primary outcome was the average preoperative range of motion with and without matched femoral/tibial components. The study further analyzed the proportions of cases in which both the femoral and tibial components matched, neither matched, and only one of the femoral or tibial components matched. RESULTS The ratio of the same sizes between the PSI planning and those inserted was 50.8% (33 patients) for both the femoral and tibial components. For the femoral component alone, the ratio was 84.6% (55 patients), and for the tibial component, it was 58.4% (38 patients). A receiver-operating characteristic curve analysis indicated that flexion contracture greater than 20° was a significant prognostic factor for the PSI component match group versus the mismatch group. DISCUSSION Flexion contracture may cause PSI mismatch. Notably, flexion contracture greater than 20° was a significant risk factor for the PSI component match group versus the mismatch group. During preoperative planning for a patient with flexion contracture, surgeons should prepare for the possibility of inserting an undersized tibial component.
Collapse
Affiliation(s)
- Shuhei Hiyama
- Department of Orthopedics, Jichi Medical University 3311-1 Yakushiji Shimotsuke Tochigi 329-0498 Japan
| | - Tsuneari Takahashi
- Department of Orthopedics, Ishibashi General Hospital 1-15-4 Shimokoyama Shimotsuke 329-0502 Japan
| | - Mikiko Handa
- Department of Orthopedics, Jichi Medical University 3311-1 Yakushiji Shimotsuke Tochigi 329-0498 Japan
| | - Katsushi Takeshita
- Department of Orthopedics, Jichi Medical University 3311-1 Yakushiji Shimotsuke Tochigi 329-0498 Japan
| |
Collapse
|
|
6
|
Li S, Liu X, Chen X, Xu H, Zhang Y, Qian W. Development and Validation of an Artificial Intelligence Preoperative Planning and Patient-Specific Instrumentation System for Total Knee Arthroplasty. Bioengineering (Basel) 2023; 10:1417. [PMID: 38136008 PMCID: PMC10740483 DOI: 10.3390/bioengineering10121417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Accurate preoperative planning for total knee arthroplasty (TKA) is crucial. Computed tomography (CT)-based preoperative planning offers more comprehensive information and can also be used to design patient-specific instrumentation (PSI), but it requires well-reconstructed and segmented images, and the process is complex and time-consuming. This study aimed to develop an artificial intelligence (AI) preoperative planning and PSI system for TKA and to validate its time savings and accuracy in clinical applications. METHODS The 3D-UNet and modified HRNet neural network structures were used to develop the AI preoperative planning and PSI system (AIJOINT). Forty-two patients who were scheduled for TKA underwent both AI and manual CT processing and planning for component sizing, 20 of whom had their PSIs designed and applied intraoperatively. The time consumed and the size and orientation of the postoperative component were recorded. RESULTS The Dice similarity coefficient (DSC) and loss function indicated excellent performance of the neural network structure in CT image segmentation. AIJOINT was faster than conventional methods for CT segmentation (3.74 ± 0.82 vs. 128.88 ± 17.31 min, p < 0.05) and PSI design (35.10 ± 3.98 vs. 159.52 ± 17.14 min, p < 0.05) without increasing the time for size planning. The accuracy of AIJOINT in planning the size of both femoral and tibial components was 92.9%, while the accuracy of the conventional method in planning the size of the femoral and tibial components was 42.9% and 47.6%, respectively (p < 0.05). In addition, AI-based PSI improved the accuracy of the hip-knee-ankle angle and reduced postoperative blood loss (p < 0.05). CONCLUSION AIJOINT significantly reduces the time needed for CT processing and PSI design without increasing the time for size planning, accurately predicts the component size, and improves the accuracy of lower limb alignment in TKA patients, providing a meaningful supplement to the application of AI in orthopaedics.
Collapse
Affiliation(s)
- Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100010, China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing 100084, China
- Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen 518000, China
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Xi Chen
- Departments of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Hongjun Xu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100010, China
| | - Yiling Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100010, China
| |
Collapse
|
|
7
|
He M, Zhang H, Hu P, Jing L, Shan P. Micro Electromechanical System Navigation Assists Femoral Extramedullary Alignment Osteotomy in Total Knee Arthroplasty: A Single-Blind Randomizing Study. Orthop Surg 2023; 15:2786-2793. [PMID: 37580853 PMCID: PMC10622280 DOI: 10.1111/os.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE A micro-electromechanical system (MEMS) was developed based on spatial alignment and navigation technology to assist femoral extramedullary alignment osteotomy (FEAO) in total knee arthroplasty (TKA). The system can locate and adjust the femoral distal condylar osteotomy (FDCO) to obtain a better femoral prosthesis placement. It is a portable navigation device and provides an innovative approach for FDCO. METHODS Sixty patients who suffered from severe knee osteoarthritis who underwent unilateral TKA from May 14, 2021 to May 30, 2022 were randomly divided into a MEMS-FEAO group and a conventional femoral intramedullary alignment osteotomy (FIAO) group, with 30 cases in each group for a controlled retrospective study. The hip-knee-ankle angle (HKAA) of the lower limb was measured before and after surgery, the femoral valgus angle (FVA) was measured preoperatively, and the femoral prosthesis valgus angle (FPVA) and the femoral prosthesis flexion angle (FPFA) were measured postoperatively following computed tomography imaging protocols. Measurement data is statistically described as mean ± standard deviation c. The count data is described by frequency (constituent ratio) using the rank sum test. RESULT A total of 6.7% (2/30) of FEAO compared to 20.0% (6/30) of FIAO cases were postoperative deviations where the HKAA exceeded ±3° of neutral alignment (p < 0.05). The postoperative HKAA was 178.74° ± 1.56° versus 176.64° ± 3.39° (p < 0.05), the HKAA deviation was 1.25° ± 1.56° versus 3.36° ± 3.40° (p < 0.05), and the FPFA was 4.85° ± 2.46° versus 6.60° ± 1.86°(p < 0.05). Therefore, the differences were all statistically significant between the two groups. However, the FPVA was -0.59° ± 2.73° versus -0.80° ± 2.85° (p > 0.05), and there was no statistical significance between the two groups. CONCLUSION The MEMS-FEAO system can improve the accurate alignment and can be utilized as a locator to obtain the best femoral prosthesis placement in TKA and significantly reduce the rate of poor force line of the lower limb.
Collapse
Affiliation(s)
| | | | - Peiyan Hu
- Wangjing Hospital of CACMSBeijingChina
| | - Lin Jing
- Wangjing Hospital of CACMSBeijingChina
| | | |
Collapse
|
|
8
|
Keskinis A, Paraskevopoulos K, Diamantidis DE, Ververidis A, Fiska A, Tilkeridis K. The Role of 3D-Printed Patient-Specific Instrumentation in Total Knee Arthroplasty: A Literature Review. Cureus 2023; 15:e43321. [PMID: 37700954 PMCID: PMC10493459 DOI: 10.7759/cureus.43321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Total knee arthroplasty (TKA) is currently one of the most common orthopedic surgeries due to the ever-increasing average life expectancy. The constant need for effective and accurate techniques was contributed to the development of three-dimensional (3D) printing in that field, especially for patient-specific instrumentation (PSI) and custom-made implants fabrication. PSI may offer numerous benefits, such as resection accuracy, mechanical axis alignment, cost-effectiveness, and time economy. Nonetheless, the results of existing studies are controversial. For this purpose, a review article of the published articles was conducted to summarize the role of 3D-printed PSI in TKA.
Collapse
Affiliation(s)
- Anthimos Keskinis
- Orthopedic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GRC
| | - Konstantinos Paraskevopoulos
- Orthopedic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GRC
| | | | - Athanasios Ververidis
- Orthopedic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GRC
| | - Aliki Fiska
- Anatomy Laboratory, Democritus University of Thrace, Alexandroupolis, GRC
| | - Konstantinos Tilkeridis
- Orthopedic Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, GRC
| |
Collapse
|
|
9
|
Luan Y, Wang H, Fang C, Zhang M, Li J, Zhang N, Liu B, Su J, Cheng CK. Mechanical alignment tolerance of a cruciate-retaining knee prosthesis under gait loading—A finite element analysis. Front Bioeng Biotechnol 2023; 11:1148914. [PMID: 37064225 PMCID: PMC10098169 DOI: 10.3389/fbioe.2023.1148914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
Component alignment is one of the most crucial factors affecting total knee arthroplasty’s clinical outcome and survival. This study aimed to investigate how coronal, sagittal, and transverse malalignment affects the mechanical behavior of the tibial insert and to determine a suitable alignment tolerance on the coronal, sagittal, and transverse planes. A finite element model of a cruciate-retaining knee prosthesis was assembled with different joint alignments (−10°, −7°, −5°, −3°, 0°, 3°, 5°, 7°, 10°) to assess the effect of malalignment under gait loading. The results showed that varus or valgus, extension, internal rotation, and excessive external rotation malalignments increased the maximum Von Mises stress and contact pressure on the tibial insert. The mechanical alignment tolerance of the studied prosthesis on the coronal, sagittal, and transverse planes was 3° varus to 3° valgus, 0°–10° flexion, and 0°–5° external rotation, respectively. This study suggests that each prosthesis should include a tolerance range for the joint alignment angle on the three planes, which may be used during surgical planning.
Collapse
Affiliation(s)
- Yichao Luan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
| | - Chaohua Fang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- Department of Sport Medicine, Ningbo No 6 Hospital, Ningbo, China
| | - Min Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Junwei Li
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Ningze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Bolun Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jian Su
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- *Correspondence: Cheng-Kung Cheng,
| |
Collapse
|
|
10
|
Teissier V, Biau D, Hamadouche M, Talon D, Anract P. Time is Money! Influence on Operating Theater and Sterilization Times of Patient-specific Cutting Guides and Single-use Instrumentation for Total Knee Arthroplasty: A Full Factorial Design of 136 Patients. Arthroplast Today 2022; 18:95-102. [PMID: 36312884 PMCID: PMC9596960 DOI: 10.1016/j.artd.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background Patient-specific cutting guides (PSGs) and single-use disposable instrumentation (SUI) have emerged as potential beneficial innovations for total knee arthroplasty. The aim of this study was to evaluate the impact of PSG and SUI for total knee arthroplasty on operating room (OR) and sterilization times. Methods A monocentric, prospective, interventional, full factorial design study, including 136 patients, compared patient-specific (PSG, n = 68) to conventional cutting guides (n = 68) and SUI (n = 68) to conventional instrumentation (CVI, n = 68). In the OR, we recorded the number of instrument trays, operating time, and room occupancy time. In the central sterile services department, the total sterilization duration was assessed. The primary outcome was operating time and sterilization duration. Secondary outcomes were difference in the number of trays, Oxford Knee Score, and postoperative mechanical axis. Results The median operating time was 80 minutes (Q1-Q3: 73-90) and was significantly increased for SUI compared to that for CVI (+5 minutes, P = .0072). The median sterilization duration was 1261 minutes (Q1-Q3: 934-1603). It was significantly in favor of SUI (936 minutes) over CVI (1565 minutes) (+629 minutes, P < .0001). The total number of instrument trays was 404 for 136 patients: 252 for CVI and 152 for SUI (P < .0001) and 189 for PSG and 215 for conventional cutting guides (P = .0006). There was no significant difference in OKS (P = .86) nor in the postoperative alignment which was between 177° and 183° (75% patients, P = .24). Conclusions SUI lowers the number of instrument trays and sterilization duration. PSG is not associated with significant OR or sterilization time reduction. The use of SUI could reduce the risk of noncompliance of instrument trays.
Collapse
Affiliation(s)
- Victoria Teissier
- Department of Orthopaedic Surgery, Hopital Cochin, APHP, Université Paris, Paris, France
- Corresponding author. Cochin Teaching Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. Tel.: +33 6 89 21 58 27.
| | - David Biau
- Department of Orthopaedic Surgery, Hopital Cochin, APHP, Université Paris, Paris, France
| | - Moussa Hamadouche
- Department of Orthopaedic Surgery, Hopital Cochin, APHP, Université Paris, Paris, France
| | - Damien Talon
- Department of Pharmacy, Cochin Teaching Hospital, Paris, France
| | - Philippe Anract
- Department of Orthopaedic Surgery, Hopital Cochin, APHP, Université Paris, Paris, France
| |
Collapse
|
|
11
|
Song SJ, Lee HW, Kim YK, Park CH. Fixed distal femoral resection with a valgus cutting angle of 3° is more appropriate in intra-articular valgus deformity than juxta-articular valgus deformity in total knee arthroplasty: a retrospective single center study. ANNALS OF JOINT 2022; 7:35. [PMID: 38529156 PMCID: PMC10929302 DOI: 10.21037/aoj-22-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/06/2022] [Indexed: 03/27/2024]
Abstract
Background The traditionally recommended fixed valgus cutting angle (VCA) of 3° is used as the standard method in total knee arthroplasty (TKA) for valgus deformity. The accuracy of distal femur cutting can be affected by the type of valgus deformity because the intramedullary rod for distal femoral resection can become impinged on the femoral cortex. The purpose of this study is to analyze the accuracy and precision of a VCA of 3° in mechanical alignment in TKA for valgus deformity, based on the type of the deformity. Methods TKAs with a fixed VCA of 3° performed in 110 intra-articular and 102 juxta-articular valgus knees were retrospectively reviewed. The age (65.8 vs. 66.1 years), sex (female: male =78/32 vs. 70/32), body mass index (26.0 vs. 26.0), and severity of deformities (valgus 12.1 vs. valgus 12.5) were not significantly different (P>0.647). The mechanical-lateral-distal-femoral angle (mLDFA) and anatomical-mechanical-axis angle (AMA-A) were evaluated. The adjusted-VCA (aVCA) was defined as the maximum angle within the range without the intramedullary rod impinging on the femoral cortex. The proportion of well-aligned femoral component (mLDFA <90°±3°) was assessed. The correlation between AMA-A-3° or aVCA-3° and postoperative mLDFA-90° was analyzed. Results Despite the larger AMA-A in the juxta-articular group (6.2° vs. 6.8°, P<0.001), the aVCA was lesser in the juxta-articular group (5.4° vs. 4.1°, P<0.001). The mLDFA was more varus in the intra-articular group (91.7° vs. 90.6°, P<0.001) postoperatively. The proportion of well-aligned femoral component was higher in the juxta-articular group (85.3% vs. 70%, P=0.009). Postoperative mLDFA-90° was moderately correlated with aVCA-3° (r=0.301, r=387), but weakly correlated with AMA-A-3° (r=0.274, r=294) in both groups. Conclusions Although a fixed VCA of 3° is a reliable method in achieving mechanical alignment in valgus deformity, it can be more appropriate in juxta-articular deformity than in intra-articular deformity. The aVCA is a more reasonable predictor of femoral component alignment than the AMA-A, considering the femoral cortex impingement of the intramedullary rod.
Collapse
Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Kook Kim
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
|
12
|
Luan Y, Zhang M, Ran T, Wang H, Fang C, Nie M, Wang M, Cheng CK. Correlation between component alignment and short-term clinical outcomes after total knee arthroplasty. Front Surg 2022; 9:991476. [PMID: 36311927 PMCID: PMC9606652 DOI: 10.3389/fsurg.2022.991476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the correlation between component alignment and short-term clinical outcomes after total knee arthroplasty (TKA). METHODS 50 TKA patients from a regional hospital were enrolled in the study. The following component alignments were measured from radiological data acquired within 1 week after surgery: hip-knee-ankle angle (HKA), medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), femoral flexion-extension angle (FEA), tibial slope angle (TSA), femoral rotational angle (FRA) and tibial rotational angle (TRA). The Hospital for Special Surgery (HSS) knee scoring system was used to assess clinical outcomes after 1 year, with patients being divided into three groups (excellent, good and not good) according to the HSS scores. Difference analysis and linear correlation analysis were used for the statistical analysis. RESULTS The results showed significant differences in MDFA (p = 0.050) and FEA (p = 0.001) among the three patient groups. It was also found that the total HSS had only a moderate correlation with FEA (r = 0.572, p < 0.001), but FEA had a positive linear correlation with pain scores (r = 0.347, p = 0.013), function scores (r = 0.535, p = 0.000), ROM scores (r = 0.368, p = 0.009), muscle scores (r = 0.354, p = 0.012) and stability scores (r = 0.312, p = 0.028). A larger MDFA was associated with lower FE deformity scores (r = -0.289, p = 0.042) and the TSA had a positive influence on the ROM (r = 0.436, p = 0.002). Also, changes in FRA produced a consequent change in the FE deformity score (r = 0.312, p = 0.027), and the muscle strength scores increased as TRA increased (r = 0.402, p = 0.004). CONCLUSION The results show that the FEA plays a significant role in clinical outcomes after TKA. Surgical techniques and tools may need to be improved to accurately adjust the FEA to improve joint functionality and patient satisfaction.
Collapse
Affiliation(s)
- Yichao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Min Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Tianfei Ran
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Huizhi Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chaohua Fang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Department of Joint Surgery, Ningbo No.6 Hospital, Ningbo, China
| | - Maodan Nie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Min Wang
- Department of Orthopaedics, Xinqiao Hospital, Army Military Medical University, Chongqing, China,Correspondence: Min Wang Cheng-Kung Cheng
| | - Cheng-Kung Cheng
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Correspondence: Min Wang Cheng-Kung Cheng
| |
Collapse
|
|
13
|
Rouf S, Malik A, Raina A, Irfan Ul Haq M, Naveed N, Zolfagharian A, Bodaghi M. Functionally graded additive manufacturing for orthopedic applications. J Orthop 2022; 33:70-80. [PMID: 35874041 PMCID: PMC9304666 DOI: 10.1016/j.jor.2022.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Additive Manufacturing due to its benefits in developing parts with complex geometries and shapes, has evolved as an alternate manufacturing process to develop implants with desired properties. The structure of human bones being anisotropic in nature is biologically functionally graded i,e. The structure possesses different properties in different directions. Therefore, various orthopedic implants such as knee, hip and other bone plates, if functionally graded can perform better. In this context, the development of functionally graded (FG) parts for orthopedic application with tailored anisotropic properties has become easier through the use of additive manufacturing (AM). Objectives and Rationale: The current paper aims to study the various aspects of additively manufactured FG parts for orthopedic applications. It presents the details of various orthopedic implants such as knee, hip and other bone plates in a structured manner. A systematic literature review is conducted to study the various material and functional aspects of functionally graded parts for orthopedic applications. A section is also dedicated to discuss the mechanical properties of functionally graded parts. Conclusion The literature revealed that additive manufacturing can provide lot of opportunities for development of functionally graded orthopedic implants with improved properties and durability. Further, the effect of various FG parameters on the mechanical behavior of these implants needs to be studied in detail. Also, with the advent of various AM technologies, the functional grading can be achieved by various means e.g. density, porosity, microstructure, composition, etc. By varying the AM parameters. However, the current limitations of cost and material biocompatibility prevent the widespread exploitation of AM technologies for various orthopedic applications.
Collapse
Affiliation(s)
- Saquib Rouf
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Abrar Malik
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Ankush Raina
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Mir Irfan Ul Haq
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Nida Naveed
- Faculty of Technology, University of Sunderland, UK
| | | | - Mahdi Bodaghi
- School of Science and Technology, Nottingham Trent University, UK
| |
Collapse
|
|
14
|
Wen L, Wang Z, Ma D, Qu T. Surgeon Dominated Design Can Improve the Accuracy of Patient-Specific Instruments in Kinematically Aligned TKA. J Pers Med 2022; 12:jpm12081192. [PMID: 35893286 PMCID: PMC9332028 DOI: 10.3390/jpm12081192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
Precise bone resection is mandatory for kinematically aligned total knee arthroplasty (KA-TKA). This study is to investigate whether surgeon-dominated design can alter the accuracy of patient-specific instrumentation (PSI) in KA-TKA compared with the engineer design. A total of 24 patients (24 knees) who underwent KA-TKA in our institution were assigned to an engineer design group (10 knees) and surgeon design group (14 knees) chronologically. A novel portable medical-engineer interactive application can greatly enhance the surgeon’s participation in PSI design. The bone resection discrepancies were used to evaluate the accuracy of PSI in bone resection. The overall discrepancy of bone resection was reduced by surgeon-designed PSI compared to engineer-designed PSI by 0.33 mm. Surgeon-designed PSI seems to reduce the outliers in terms of relative discrepancies in bone resection as well, but it does not reach statistical significance. Moreover, surgeon-designed PSI could significantly improve the accuracy of PSI in the restoration of the joint line in terms of medial proximal tibial angle and mechanical lateral distal femoral angle. This study indicates that the dominance of surgeons in both PSI design and subsequent surgical operation should be emphasized in efforts to improve the accuracy of PSI.
Collapse
Affiliation(s)
- Liang Wen
- Department of Orthopeadics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; (L.W.); (D.M.)
| | - Zhiwei Wang
- Department of Orthopeadics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; (L.W.); (D.M.)
- Correspondence: ; Tel.: +86-10-85231228
| | - Desi Ma
- Department of Orthopeadics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; (L.W.); (D.M.)
| | - Tiebing Qu
- The Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Research Center, Beijing 100068, China;
| |
Collapse
|
|
15
|
Zeng X, Yang Y, Jia Z, Chen J, Shen H, Jin Y, Lu Y, Li P. The position of entry point in total knee arthroplasty is associate with femoral bowing both in coronal and sagittal planes. Front Surg 2022; 9:935840. [PMID: 35923443 PMCID: PMC9339686 DOI: 10.3389/fsurg.2022.935840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the femoral entry point of the intramedullary (IM) guiding rod applied to total knee arthroplasty (TKA) in Chinese subjects and the relationship with femoral bowing in the coronal and sagittal planes through three-dimensional (3D) validation methods. Methods Computed tomography (CT) images of 80 femurs in Chinese subjects were imported into Mimics 19.0 to construct 3D models. All operations were conducted by Rhinoceros software 5.0. The position of the IM rod entry point was assessed by calculating the distance between the entry point and the apex of the intercondylar notch (AIN) in the coronal and sagittal planes. The coronal femoral bowing angle (cFBA) and sagittal femoral bowing angle (sFBA) were also measured. Results The average optimal entry point was 0.17 mm medial and 12.37 mm anterior to the AIN in males, while it was 0.02 mm lateral and 16.13 mm anterior to the AIN in females. There was a significant difference between males and females in the sagittal plane (t = -6.570, p = 0.000). The mean cFBA was 1.68 ± 2.29°, and the mean sFBA was 12.66 ± 1.98°. The sFBA was strongly correlated with the anterior distance of the proper entry point, and the cFBA was moderately correlated with the lateral distance of the proper entry point. Conclusions There was a strong correlation between the position of the entry point and the femoral bowing angle in both the coronal and sagittal planes. Thus, to achieve better alignment, the position of the entry point should be measured individually based on femoral bowing.
Collapse
Affiliation(s)
- Xianli Zeng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yiming Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Zhenyu Jia
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Jiarong Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hongyuan Shen
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yan Jin
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yao Lu
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Department of Joint and Orthopedics, Orthopedic Center, Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Yao Lu Pingyue Li
| | - Pingyue Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Key Lab of Orthopedic Technology and Implant Materials, Department of Orthopedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China
- Correspondence: Yao Lu Pingyue Li
| |
Collapse
|
|
16
|
Correlation between Surface Area Ratio of Medial to Lateral Tibial Plateau and Knee Alignment in Adults. Curr Med Sci 2022; 42:577-583. [DOI: 10.1007/s11596-022-2590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/07/2022] [Indexed: 11/03/2022]
|
|
17
|
Gu W, Shah K, Knopf J, Josewski C, Unberath M. A calibration-free workflow for image-based mixed reality navigation of total shoulder arthroplasty. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2022. [DOI: 10.1080/21681163.2021.2009378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Wenhao Gu
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kinjal Shah
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Mathias Unberath
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
|
18
|
Raheem AA, Hameed P, Whenish R, Elsen RS, G A, Jaiswal AK, Prashanth KG, Manivasagam G. A Review on Development of Bio-Inspired Implants Using 3D Printing. Biomimetics (Basel) 2021; 6:65. [PMID: 34842628 PMCID: PMC8628669 DOI: 10.3390/biomimetics6040065] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 01/15/2023] Open
Abstract
Biomimetics is an emerging field of science that adapts the working principles from nature to fine-tune the engineering design aspects to mimic biological structure and functions. The application mainly focuses on the development of medical implants for hard and soft tissue replacements. Additive manufacturing or 3D printing is an established processing norm with a superior resolution and control over process parameters than conventional methods and has allowed the incessant amalgamation of biomimetics into material manufacturing, thereby improving the adaptation of biomaterials and implants into the human body. The conventional manufacturing practices had design restrictions that prevented mimicking the natural architecture of human tissues into material manufacturing. However, with additive manufacturing, the material construction happens layer-by-layer over multiple axes simultaneously, thus enabling finer control over material placement, thereby overcoming the design challenge that prevented developing complex human architectures. This review substantiates the dexterity of additive manufacturing in utilizing biomimetics to 3D print ceramic, polymer, and metal implants with excellent resemblance to natural tissue. It also cites some clinical references of experimental and commercial approaches employing biomimetic 3D printing of implants.
Collapse
Affiliation(s)
- Ansheed A. Raheem
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Pearlin Hameed
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Ruban Whenish
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Renold S. Elsen
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore 632014, India;
| | - Aswin G
- School of Advanced Sciences, Vellore Institute of Technology, Vellore 632014, India;
| | - Amit Kumar Jaiswal
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| | - Konda Gokuldoss Prashanth
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
- Department of Mechanical and Industrial Engineering, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia
- Erich Schmid Institute of Materials Science, Austrian Academy of Science, Jahnstrasse 12, 8700 Leoben, Austria
| | - Geetha Manivasagam
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology, Vellore 632014, India; (A.A.R.); (P.H.); (R.W.); (A.K.J.); (G.M.)
| |
Collapse
|
|
19
|
Halai M, Kooner S, Jamal B, McMillan J, Syme B, Holt G. The Relationships between the Rotational Axes of the Distal Femur in the Arthritic Caucasian Knee: A Magnetic Resonance Imaging Analysis. J Knee Surg 2021; 34:1436-1440. [PMID: 32356289 DOI: 10.1055/s-0040-1709676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Four distal femoral axes have been described to aid in the accuracy of transverse plane component alignment in total knee arthroplasty (TKA). These include the surgical epicondylar axis (SEA), the posterior condylar axis (PCA), and the anteroposterior (AP) axis. Therefore, the primary purpose of this study is to identify the axial femoral relationship with the least variation in a Caucasian population awaiting TKA for osteoarthritis. Secondarily, we further plan to determine if these femoral axis relationships differ with respect to sex or preoperative coronal alignment. These anatomic relationships were measured using preoperative magnetic resonance imaging, which was performed within 2 months of the planned operation date for patient specific instrumentation templating. In terms of our primary outcome, the mean SEA/AP angle was 92.8 degrees (standard deviation [SD]: 2.5 degrees), the mean PCA/AP angle was 95.7 degrees (SD: 2.8 degrees), and the mean PCA/SEA angle was 3.4 degrees (SD: 1.8 degrees). Overall, the PCA/SEA relationship had the smallest variance, while the PCA/AP had the most variance for all comparisons. In terms of our secondary outcome, there was no statistical difference between femoral axis relationships based on preoperative coronal plane alignment. In terms of sex differences, the PCA/SEA was significantly higher in female knees compared with males. Females had a PCA/SEA relationship of 4.7 degrees (SD: 1.3 degrees) compared with 2.6 degrees (SD: 1.2 degrees) for males (p < 0.05). By using the PCA/AP axes, the AP axis was externally rotated by 96.7 degrees (SD: 2.3 degrees) in females, compared with 93.2 degrees (SD: 2.1 degrees) in males, from the PCA. In conclusion, our results demonstrate that the PCA/SEA relationship should be used to determine axial rotation in TKA as it shows the least variation. When using the PCA, approximately 5 degrees of external rotation for Caucasian women and 3 degrees of external rotation for the Caucasian men should be dialed into the femoral cutting block to restore anatomic axial rotation. Further evaluation is needed to determine to role of preoperative coronal alignment on distal femoral axial alignment.
Collapse
Affiliation(s)
- Mansur Halai
- Department of Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock, Scotland, United Kingdom
| | - Sahil Kooner
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Bilal Jamal
- Department of Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock, Scotland, United Kingdom
| | - Jacquelyn McMillan
- Department of Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock, Scotland, United Kingdom
| | - Brian Syme
- Department of Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock, Scotland, United Kingdom
| | - Graeme Holt
- Department of Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock, Scotland, United Kingdom
| |
Collapse
|
|
20
|
Kumar P, Vatsya P, Rajnish RK, Hooda A, Dhillon MS. Application of 3D Printing in Hip and Knee Arthroplasty: A Narrative Review. Indian J Orthop 2021; 55:14-26. [PMID: 34122751 PMCID: PMC8149509 DOI: 10.1007/s43465-020-00263-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ideal surgical positioning and placement of implants during arthroplasty are crucial for long-term survival and optimal functional outcomes. Inadequate bone stock or defects, and anatomical variations can influence the outcomes. Three-dimensional printing (3DP) is an evolving technology that could provide patient-specific instrumentation and implants for arthroplasty, taking into account anatomical variations and defects. However, its application in this field is still not adequately studied and described. The present review was conceptualised to assess the practicality, the pros and cons and the current status of usage of 3DP in the field of hip and knee arthroplasties and joint reconstruction surgeries. METHODS A PubMed database search was conducted and a total number of 135 hits were obtained, out of which only 30 articles were relevant. These 30 studies were assessed to obtain the qualitative evidence of the applicability and the current status of 3D printing in arthroplasty. RESULTS Currently, 3DP is used for preoperative planning with 3D models, to assess bone defects and anatomy, to determine the appropriate cuts and to develop patient-specific instrumentation and implants (cages, liners, tibial base plates, femoral stem). Its models can be used for teaching and training young surgeons, as well as patient education regarding the surgical complexities. The outcomes of using customised instrumentations and implants have been promising and 3D printing can evolve into routine practice in the years to come. CONCLUSION 3D printing in arthroplasty is an evolving field with promising results; however, current evidence is insufficient to determine significant advantages that can be termed cost effective and readily available.
Collapse
Affiliation(s)
- Prasoon Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pulak Vatsya
- Department of Orthopaedics, All India Institute of Medical Science, New Delhi, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Hooda
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep S. Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
|
21
|
Patientenspezifische Instrumentierung und Totalendoprothesen am Knie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Hintergrund
Die patientenspezifische Instrumentierung (PSI) ist eine vielversprechende neue Technologie in der orthopädischen Chirurgie, die das Ziel verfolgt, die Implantationstechnik der Knietotalendoprothese (Knie-TEP) im Vergleich zur konventionellen Instrumentierung zu vereinfachen und präziser zu machen. Ziel dieses Artikels ist es, Vorteile und Grenzen der PSI für die primäre Knie-TEP zu beschreiben.
Material und Methoden
Es erfolgte eine umfassende Literaturrecherche zum Thema PSI in der Knieprothetik hinsichtlich Evidenz für Planung, Präzision, klinische Ergebnisse, intraoperative Parameter sowie Kosten und Effizienz.
Ergebnisse
Die dreidimensionale Computertomographie (CT) weist in der präoperativen Planung der Knie-TEP eine höhere Genauigkeit auf als 2‑D-Röntgenaufnahmen. Die meisten Arbeiten postulierten keine signifikanten Effekte zugunsten der Genauigkeit der PSI gegenüber der Standard-Knie-TEP. Aber sie berichteten auch nicht, dass die Genauigkeit mit PSI schlechter sei. Hinsichtlich des klinischen Outcomes gibt es genügend Konsens unter den veröffentlichten Studien, um festzuhalten, dass es kurz- und mittelfristig keinen Unterschied zwischen Patienten gibt, die mit PSI oder konventioneller Technik operiert wurden. Eine große Metaanalyse konnte weder eine kürzere Operationszeit noch eine geringere Komplikationsrate für die PSI-Knie-TEP feststellen. Lediglich der intraoperative Blutverlust erwies sich als niedriger im Vergleich zur Standardtechnik, jedoch mit unveränderter Transfusionsrate. Kosteneffektivitätsanalysen lassen schlussfolgern, dass die PSI aktuell (noch) nicht kosteneffektiv ist.
Diskussion
Obwohl die aktuell vorliegenden Studienergebnisse die PSI-Technologie hinsichtlich vieler messbaren Kriterien nicht eindeutig von der Standardtechnik abheben, zeigt die PSI viele theoretische und praktische Vorteile.
Collapse
|
|
22
|
León-Muñoz VJ, Parrinello A, Manca S, Galloni G, López-López M, Martínez-Martínez F, Santonja-Medina F. Patient-Specific Instrumentation Accuracy Evaluated with 3D Virtual Models. J Clin Med 2021; 10:jcm10071439. [PMID: 33916110 PMCID: PMC8036812 DOI: 10.3390/jcm10071439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
There have been remarkable advances in knee replacement surgery over the last few decades. One of the concerns continues to be the accuracy in achieving the desired alignment. Patient-specific instrumentation (PSI) was developed to increase component placement accuracy, but the available evidence is not conclusive. Our study aimed to determine a PSI system’s three-dimensional accuracy on 3D virtual models obtained by post-operative computed tomography. We compared the angular placement values of 35 total knee arthroplasties (TKAs) operated within a year obtained with the planned ones, and we analyzed the possible relationships between alignment and patient-reported outcomes. The mean (SD) discrepancies measured by two experienced engineers to the planned values observed were 1.64° (1.3°) for the hip–knee–ankle angle, 1.45° (1.06°) for the supplementary angle of the femoral lateral distal angle, 1.44° (0.97°) for the proximal medial tibial angle, 2.28° (1.78°) for tibial slope, 0.64° (1.09°) for femoral sagittal flexion, and 1.42° (1.06°) for femoral rotation. Neither variables related to post-operative alignment nor the proportion of change between pre-and post-operative alignment influenced the patient-reported outcomes. The evaluated PSI system’s three-dimensional alignment analysis showed a statistically significant difference between the angular values planned and those obtained. However, we did not find a relevant effect size, and this slight discrepancy did not impact the clinical outcome.
Collapse
Affiliation(s)
- Vicente J. León-Muñoz
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain; (F.M.-M.); (F.S.-M.)
- Correspondence:
| | - Andrea Parrinello
- Product Management Department, Medacta International SA, Strada Regina, 6874 Castel San Pietro, Switzerland;
| | - Silvio Manca
- Patient Matched Technology Department, Medacta International SA, Strada Regina, 6874 Castel San Pietro, Switzerland; (S.M.); (G.G.)
| | - Gianluca Galloni
- Patient Matched Technology Department, Medacta International SA, Strada Regina, 6874 Castel San Pietro, Switzerland; (S.M.); (G.G.)
| | - Mirian López-López
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, Avenida Central, 7, Edificio Habitamia, Espinardo, 30100 Murcia, Spain;
| | - Francisco Martínez-Martínez
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain; (F.M.-M.); (F.S.-M.)
- Department of Surgery, Pediatrics and Obstetrics & Gynecology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
| | - Fernando Santonja-Medina
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain; (F.M.-M.); (F.S.-M.)
- Department of Surgery, Pediatrics and Obstetrics & Gynecology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
| |
Collapse
|
|
23
|
Accuracy of empirical distal femoral valgus cut angle of 4° to 6° in total knee arthroplasty: a randomized controlled trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:175-181. [PMID: 33772375 DOI: 10.1007/s00590-021-02890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Currently, the best and simplest way that used to select the distal femoral valgus cut (DFVC) angle in total knee arthroplasty (TKA) is standing long leg radiograph. However, this kind of film is still not available in all hospitals. The purpose of this study is to compare the accuracy of different empirical DFVC angles in the restoration of the neutral mechanical alignment of the femoral component after TKA. METHOD 125 patients who diagnosed primary osteoarthritic knee and underwent unilateral TKA were randomly assigned into three groups: A, B, and C, according to the use of an intramedullary guide with the DFVC angle of 4°, 5°, and 6°, respectively. At three months after surgery, anteroposterior hip-to-ankle computed tomography (CT) scanograms were evaluated. Mechanical axis angle (MAA), mechanical lateral distal femoral angle (LDFA), femoral bowing, femoral neck-shaft angle (FNSA), and outliers of femoral component position were measured and compared among three groups. Independent influencing factors for the outliers > ±3° were determined using binary logistic regression analysis. RESULTS Group B was older than group A. There were no significant differences of postoperative MAA, LDFA, femoral bowing, and FNSA among three groups. Outliers > ±3° of femoral component position in each group were 14.6%, 19.0%, and 16.7%, respectively (p = 0.865). When considering the outliers > ±2°, group C (35.7%) had a trend to have fewer outliers than groups A and B (41.5 and 42.9%). However, this finding was not reached the statistical significance (p = 0.778). Femoral bowing was only significantly influencing factors that related to the outliers > ±3° (p = 0.003). CONCLUSION This study demonstrates that there are no significant differences in coronal femoral component alignment among using the DFVC angle of 4°, 5°, and 6°. The use of the DFVC angle of 6° had a trend to reduce the outliers. Nevertheless, femoral bowing is the crucial influencing factor for selecting the degree of DFVC angle.
Collapse
|
|
24
|
Lei K, Liu LM, Xiang Y, Chen X, Fan HQ, Peng Y, Luo JM, Guo L. Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis. J Orthop Surg Res 2020; 15:591. [PMID: 33298106 PMCID: PMC7724895 DOI: 10.1186/s13018-020-02123-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the operation and early clinical effect in primary total knee arthroplasty (TKA) about the novel combination of CT-based patient-specific three-dimensional (3D) preoperative design and conventional osteotomy instruments, compared with the conventional method. Methods After a 1:1 propensity score-matching (PSM), patients were matched to the novel technique group and the conventional group, 109 cases in each group. The conventional group adopted a preoperative design based on a full-length radiograph (FLX) and received TKA with conventional osteotomy instruments. The novel technique group used a CT-based patient-specific 3D preoperative design combined with conventional osteotomy instruments; during the surgery, the femoral entry point, femoral valgus osteotomy angle, the fix point of tibial plateau extramedullary guide pin, and the position of tibial extramedullary positioning rod were accurately selected according to the preoperative 3D design to ensure accurate intraoperative implementation. The lower limb alignment, component position, operation time, tourniquet time, hospital stay, blood loss volume, incidence of postoperative complications, visual analog scale (Vas) score, and New Knee Society Score System (NEW-KSS) at 1 day before operation and 1, 6, and 12 months after operation were recorded and compared. Results The novel technique group was significantly better than the conventional group in controlling lateral tibial component angle (LTC) (P < 0.001), and the novel technique group had lower percentages of hip-knee-ankle angle (HKA) outliers (P < 0.001) and overcorrection (P = 0.003). The operation time, tourniquet time, and hospital stay of the novel technique group was shorter (P < 0.05). In 1 month after the operation, the novel technique group achieved a significantly better VAS score (P < 0.05), but a similar NEW-KSS score (P > 0.05) when compared with the conventional group. But in 6 and 12 months after surgery, no statistical differences were seen in the above two scores (P > 0.05). Conclusion The novel technique of CT-based patient-specific 3D preoperative design combined with conventional instruments can improve the accuracy of osteotomy in primary total knee arthroplasty, with benefits of significantly reducing pain and rapid recovery during the early postoperative period, but having no obvious effect on outcome after a 1-year follow-up.
Collapse
Affiliation(s)
- Kai Lei
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Li Ming Liu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Yi Xiang
- Department of Orthopaedics, Logistic Support Forces of the Chinese PLA 985 Hospital, No. 30 Qiaodong Street, Taiyuan, 030001, Shanxi, China
| | - Xin Chen
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Hua Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Yang Peng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Jiang Ming Luo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China.
| |
Collapse
|
|
25
|
Are There Differences in Accuracy or Outcomes Scores Among Navigated, Robotic, Patient-specific Instruments or Standard Cutting Guides in TKA? A Network Meta-analysis. Clin Orthop Relat Res 2020; 478:2105-2116. [PMID: 32530896 PMCID: PMC7431275 DOI: 10.1097/corr.0000000000001324] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several kinds of cutting guides, including patient-specific instrumentation, navigation, standard cutting guides, accelerometer-based navigation, and robotic guidance, are available to restore a planned alignment during TKA. No previous study has simultaneously compared all of these devices; a network meta-analysis is an especially appealing method because it allows comparisons across approaches that were not compared head-to-head in individual randomized controlled trials. QUESTIONS/PURPOSES We performed a network meta-analysis to determine whether novel approaches to achieving implant alignment, such as patient-specific instrumentation, navigation, accelerometer-based navigation, and robotic guidance, provide any advantage over standard cutting guides in terms of: (1) hip-knee-ankle (HKA) alignment outliers greater than ± 3°, (2) outcome scores (1989 - Knee Society Score and WOMAC score) measured 6 months after surgery, or (3) femoral and tibial implant malalignment (greater than ± 3°), taken separately, in the frontal and sagittal plane, as well as other secondary outcomes including validated outcome scores 1 and 2 years after surgery. METHODS In our network meta-analysis, we included randomized controlled trials comparing the different cutting guides by using at least one of the previously specified criteria, without limitation on language or date of publication. We searched electronic databases, major orthopaedic journals, proceedings of major orthopaedic meetings, ClinicalTrials.gov, and the World Health Organization's International Clinical Trials Registry Platform until October 1, 2018. This led to the inclusion of 90 randomized controlled trials involving 9389 patients (mean age 68.8 years) with 10,336 TKAs. Two reviewers independently selected trials and extracted data. The primary outcomes were the proportion patients with malalignment of the HKA angle (defined as HKA > 3° from neutral) and the Knee Society Score and WOMAC scores at 6 months postoperatively. We combined direct and indirect comparisons using a Bayesian network meta-analysis framework to assess and compare the effect of different cutting guides on outcomes. Bayesian estimates are based on the posterior distribution of an endpoint and are called credible intervals. Usually the 95% credible interval, corresponding to a posterior probability of 0.95 that the endpoint lies in the interval, is computed. Unlike the frequentist approach, the Bayesian approach does not allow the calculation of the p value. RESULTS The proportion of HKA outliers was lower with navigation than with patient-specific instrumentation (risk ratio 0.46 [95% credible interval (CI) 0.34 to 0.63]) and standard cutting guides (risk ratio 0.45 [95% CI 0.37 to 0.53]); however, this corresponded to an actual difference of only 12% of patients for navigation versus 21% of patients for patient-specific instrumentation, and 12% of patients for navigation versus 25% for standard cutting guides. We found no differences for other comparisons between different cutting guides, including robotics and the accelerometer. We found no differences in the Knee Society Score or WOMAC score between the different cutting guides at 6 months. Regarding secondary outcomes, navigation reduced the risk of frontal and sagittal malalignments for femoral and tibial components compared with the standard cutting guides, but none of the other cutting guides showed superiority for the other secondary outcomes. CONCLUSIONS Navigation resulted in approximately 10% fewer patients having HKA outliers of more than 3°, without any corresponding improvement in validated outcomes scores. It is unknown whether this incremental reduction in the proportion of patients who have alignment outside a window that itself has been called into question will justify the increased costs and surgical time associated with the approach. We believe that until or unless these new approaches either (1) convincingly demonstrate superior survivorship, or (2) convincingly demonstrate superior outcomes, surgeons and hospitals should not use these approaches since they add cost, have a learning curve (during which some patients may be harmed), and have the risks associated with uncertainty of novel surgical approaches. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
|
|
26
|
Li Z, Yang Z, Liao W, Wang W, Zou Y, Pan Y, Feng Z. Fewer femoral rotational outliers produced with CT- than with MRI-based patient-specific instrumentation in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:2930-2941. [PMID: 31435705 DOI: 10.1007/s00167-019-05678-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/02/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Previous studies comparing the surgical accuracy between computed tomography (CT)- and magnetic resonance imaging (MRI)-based patient-specific instrumentation (PSI) methods have produced contradictory results. The aim of this study was to determine which is the more reliable imaging method (CT versus MRI) for patient-specific total knee arthroplasty (TKA). CT-based PSI is hypothesised to have an advantage regarding the number of outliers. METHODS A total of 22 randomised controlled trials (RCTs), including 1749 TKA cases, were eligible for the meta-analysis. RCTs, systematic reviews and meta-analyses on this topic published in databases before September 2018 were identified by a literature search. The primary outcome was the number of lower extremities with greater than 3° of difference in alignment angles between the postoperative outcomes and target outcomes. The parameters calculated from the meta-analysis included risk ratios (RRs) and 95% confidence intervals (CIs). Additionally, the publication bias and heterogeneity of the studies were assessed. RESULTS The risk of femoral rotational outliers in the PSI group (RR = 0.48; 95% CI 0.24-0.98) was significantly reduced. Furthermore, subgroup analysis showed that the accuracy in the CT-based PSI group was significantly higher than that in the MRI-based CSI group (RR = 0.31; 95% CI 0.10-0.92). CONCLUSION This meta-analysis shows that when performing TKA with PSI, preoperative CT is beneficial for the production of the PSI, resulting in a significantly lower proportion of outliers in femoral rotational alignment. CT should be the preferred choice for imaging when performing TKA surgery with PSI to obtain better femoral rotational alignment. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level I.
Collapse
Affiliation(s)
- Zhihao Li
- Guangzhou University of Traditional Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510403, Guangdong, People's Republic of China
- The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China
| | - Zhidong Yang
- The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China
| | - Wencui Liao
- The Liuzhou Hospital of Traditional Chinese Medicine, No. 32, Jiefang North Road, Chengzhong District, Liuzhou, 545000, Guangxi, People's Republic of China
| | - Weigang Wang
- The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China
| | - Yonggen Zou
- The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China
| | - Yaocheng Pan
- The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China
| | - Zongquan Feng
- Guangzhou University of Traditional Chinese Medicine, No. 12, Jichang Road, Baiyun District, Guangzhou, 510403, Guangdong, People's Republic of China.
- The Foshan Hospital of Traditional Chinese Medicine, No. 6, Qinren Road, Chancheng District, Foshan, 528000, Guangdong, People's Republic of China.
| |
Collapse
|
|
27
|
Thijs E, Theeuwen D, Boonen B, van Haaren E, Hendrickx R, Vos R, Borghans R, Kort N, Schotanus MGM. Comparable clinical outcome and implant longevity after CT- or MRI-based patient-specific instruments for total knee arthroplasty: a 2-year follow-up of a RCT. Knee Surg Sports Traumatol Arthrosc 2020; 28:1821-1826. [PMID: 31270591 DOI: 10.1007/s00167-019-05616-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient-specific instruments (PSI) are already widespread used in total knee arthroplasty (TKA). Either computed tomography (CT) scans or magnetic resonance imaging (MRI) scans are used pre-operatively to create jigs to guide resection during surgery. This study is a sequel of previous work that showed significantly more radiological outliers for posterior slope when CT-based guides were used. The aim of this study was to assess differences in revision rate and clinical outcome between the two groups at 2-year follow-up. METHODS At the 2-year follow-up, 124 patients were analysed in this prospective, randomised single-blind study. A survival analysis with revision of the TKA as endpoint was performed. Patients fulfilled four patient-reported outcome measurements (PROMs). Scores on the questionnaires were compared between both groups at the different follow-up visits. RESULTS At final follow-up, there was no significant difference in the survival rates of the CT- and MRI-based PSI surgery. Postoperatively, the PROMs significantly improved within each group compared with the pre-operative values. There were no significant differences for the PROMs between both groups at the 2-years follow-up. CONCLUSIONS Although previous results showed more outliers regarding posterior slope for CT-based PSIs, no difference in revision rate or the outcome of PROMs was found at 2-year follow-up. Further research to determine what the influence is of radiological outliers on implant survival and clinical outcomes is necessary. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Elke Thijs
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Dieuwertje Theeuwen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Bert Boonen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Emil van Haaren
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Roel Hendrickx
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob Borghans
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Martijn G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.
| |
Collapse
|
|
28
|
Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-Assisted Technologies in Arthroplasty: Navigating Your Way Today. JBJS Rev 2020; 8:e0157. [PMID: 32224641 DOI: 10.2106/jbjs.rvw.19.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Computer-assisted technologies that are used in arthroplasty include navigation, image-derived instrumentation (IDI), and robotics. Computer-assisted navigation improves accuracy and allows for real-time assessment of component positioning and soft-tissue tension. It is not clear whether the implementation of these technologies improves the clinical outcome of surgery. High cost and time demands have prevented the global implementation of computer-assisted technologies.
Collapse
Affiliation(s)
- Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia.,Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Sarah G Brereton
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Constantin E Dlaska
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mackay Hospital and Health Services, Mackay, Queensland, Australia
| |
Collapse
|
|
29
|
Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2164371. [PMID: 32258107 PMCID: PMC7085852 DOI: 10.1155/2020/2164371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 02/13/2020] [Indexed: 02/05/2023]
Abstract
Objective To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and Conclusion PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.
Collapse
|
|
30
|
Kang DG, Kim KI, Bae JK. MRI-based or CT-based patient-specific instrumentation in Total knee Arthroplasty: How do the two systems compare? ARTHROPLASTY 2020; 2:1. [PMID: 35236432 PMCID: PMC8796460 DOI: 10.1186/s42836-019-0020-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient-specific instrumentation (PSI) has been introduced into total knee arthroplasty (TKA) to improve accuracy in restoration of alignment. PSI in TKA refers to custom-made cutting jigs manufactured according to anatomic configuration of the patient’s bone based on preoperative magnetic resonance imaging (MRI) or computed tomography (CT) scans. The purpose of this study was to compare the MRI- or CT-based PSI to see if they could reproduce accurate bone resection and postoperative outcomes.
Methods
Seventy-one patients who received elective TKA using a PSI system for primary osteoarthritis with varus deformity were prospectively enrolled for this study. We randomly allocated those patients to MRI-based PSI group (36 patients) and CT-based PSI group (35 patients). The actual resection thickness and planned resection thickness by preoperative PSI electronic program were compared between the two groups. Radiographic findings of the postoperative limb alignment, three-dimensional position of the implants, and related complications were also evaluated. Clinical evaluation was also performed before and 2 years after the surgery.
Results
There were no significant differences in the resection thickness in femur and tibia between actual resection and planned resection in both groups. Furthermore, there were no significant differences between two groups in terms of coronal, sagittal and rotational alignment of the components. All clinical assessments revealed no differences between two groups 2 years after the operation. No specific complication related to PSI was observed.
Conclusions
Although MRI allows for visualization of cartilage, MRI-based PSI system did not show better accuracy in predicting the thickness of bone resection than CT-based PSI. Moreover, there were no differences in radiographic and clinical outcomes between the two groups.
Collapse
|
|
31
|
Jiang H, Xiang S, Guo Y, Wang Z. A Wireless Visualized Sensing System with Prosthesis Pose Reconstruction for Total Knee Arthroplasty. SENSORS 2019; 19:s19132909. [PMID: 31266162 PMCID: PMC6651251 DOI: 10.3390/s19132909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 12/04/2022]
Abstract
The surgery quality of the total knee arthroplasty (TKA) depends on how accurate the knee prosthesis is implanted. The knee prosthesis is composed of the femoral component, the plastic spacer and the tibia component. The instant and kinetic relative pose of the knee prosthesis is one key aspect for the surgery quality evaluation. In this work, a wireless visualized sensing system with the instant and kinetic prosthesis pose reconstruction has been proposed and implemented. The system consists of a multimodal sensing device, a wireless data receiver and a data processing workstation. The sensing device has the identical shape and size as the spacer. During the surgery, the sensing device temporarily replaces the spacer and captures the images and the contact force distribution inside the knee joint prosthesis. It is connected to the external data receiver wirelessly through a 432 MHz data link, and the data is then sent to the workstation for processing. The signal processing method to analyze the instant and kinetic prosthesis pose from the image data has been investigated. Experiments on the prototype system show that the absolute reconstruction errors of the flexion-extension rotation angle (the pitch rotation of the femoral component around the horizontal long axis of the spacer), the internal–external rotation (the yaw rotation of the femoral component around the spacer vertical axis) and the mediolateral translation displacement between the centers of the femoral component and the spacer based on the image data are less than 1.73°, 1.08° and 1.55 mm, respectively. It provides a force balance measurement with error less than ±5 N. The experiments also show that kinetic pose reconstruction can be used to detect the surgery defection that cannot be detected by the force measurement or instant pose reconstruction.
Collapse
Affiliation(s)
- Hanjun Jiang
- Institute of Microelectronics, Tsinghua University, Beijing 100084, China.
| | - Shaolin Xiang
- Institute of Microelectronics, Tsinghua University, Beijing 100084, China
| | - Yanshu Guo
- Institute of Microelectronics, Tsinghua University, Beijing 100084, China
| | - Zhihua Wang
- Institute of Microelectronics, Tsinghua University, Beijing 100084, China
| |
Collapse
|
|
32
|
Comparison of custom cutting guides based on three-dimensional computerized CT-scan planning and a conventional ancillary system based on two-dimensional planning in total knee arthroplasty: a randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2019; 43:2529-2538. [PMID: 31227853 DOI: 10.1007/s00264-019-04357-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Incorrect positioning of components during total knee arthroplasty (TKA) increases the risk of pain, instability, and early revision. The purpose of this study was to compare 3D planning-assisted and a conventional system for TKA positioning. We hypothesized that the use of three-dimensional CT-scan planning and custom cutting guides would increase the accuracy of component positioning. METHODS A randomized, controlled, prospective study of two groups was performed. In one group, patient-specific custom cutting guides (PSCG) were used for component positioning based on 3D CT-scan planning. In the control group, TKA was performed with a conventional ancillary system. The components' positioning angles were measured on 3D reconstructions. The main evaluation criterion was the percentage of outliers outside of a target zone of ± 3° for the coronal positioning of the femoral component. RESULTS Eighty patients were included. The percentage of outliers for the femoral component was significantly lower in the 3D-guided group (1 patient) compared to the control group (7 patients p = 0.02). The coronal femoral angle was restored with greater accuracy in the 3D-assisted group (- 0.1° ± 1.4°) compared to the control group (1.6° ± 2.5°). Surgery was significantly shorter in the 3D group. The clinical outcomes were better in the 3D group at the two year follow-up with fewer failures and a lower standard deviation in IKS scores. CONCLUSION The use of a 3D planning and custom guides can improve TKA component positioning by increasing the accuracy of implants alignment and reducing the percentage of outliers. The same benefit was not demonstrated for the global knee alignment and the clinical scores with no indisputable clinical advantage for the PSCG.
Collapse
|
|
33
|
León-Muñoz VJ, Martínez-Martínez F, López-López M, Santonja-Medina F. Patient-specific instrumentation in total knee arthroplasty. Expert Rev Med Devices 2019; 16:555-567. [PMID: 31154870 DOI: 10.1080/17434440.2019.1627197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures. During the past decade, patient-specific instrumentation (PSI) has been commercially introduced in order to simplify and make TKA surgery more effective, precise and efficient than conventional mechanical instrumentation (CI) and computer-assisted surgery (CAS). Nevertheless, there are critical arguments against PSI for routine use. The aim of the current manuscript is to describe advantages and limitations of PSI for primary TKA. AREAS COVERED By means of a description of the available literature different aspects are discussed (accuracy, clinical and functional outcomes, operative time, blood loss, efficiency and costs). EXPERT OPINION Most publications do not claim a significant increase in PSI accuracy over CI, but they also do not postulate PSIs accuracy is worse either. Regarding clinical aspects, PSI did not appear to give any advantage over standard techniques although, equally, it did not appear to show any disadvantages. PSI seems to reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room. Further studies will be required to more thoroughly assess all the advantages and disadvantages of this promising technology as an alternative to CI and CAS.
Collapse
Affiliation(s)
- Vicente J León-Muñoz
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain
| | - Francisco Martínez-Martínez
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain.,b Faculty of Medicine , University of Murcia , Murcia , Spain
| | - Mirian López-López
- c Subdirección General de Tecnologías de la Información. Servicio Murciano de Salud , Murcia , Spain
| | - Fernando Santonja-Medina
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain.,b Faculty of Medicine , University of Murcia , Murcia , Spain
| |
Collapse
|
|
34
|
Antoniadis A, Camenzind RS, Schär MO, Bergadano D, Helmy N. Accuracy of tibial cuts with patient-specific instrumentation is not influenced by the surgeon's level of experience. Knee Surg Sports Traumatol Arthrosc 2019; 27:1535-1543. [PMID: 29872869 DOI: 10.1007/s00167-018-4992-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE It was hypothesized that surgeon's experience as well as bone density play a significant role in achieving accurate cuts with patient-specific instrumentation (PSI). The aim of this study was to compare the accuracy of the tibial cuts in different bone densities made by a highly experienced orthopedic surgeon on one hand and a less experienced orthopedic surgeon on the other. METHODS Tibial models from three different sawbone densities were developed for this study. Each surgeon performed 21 cuts. A coordinate measuring machine was used to analyse the cuts. The K-Cohen test was performed to evaluate the results. The analyzed parameters were guide positioning and deviation from the guide cut to the tibial cut, including varus/valgus angle, the tibial slope, cut height, planarity (mm2), and rugosity (mm). RESULTS There was a significant difference in the positioning of the tibial cut guide between the two surgeons for the tibial slope (p < 0.05), while no difference was observed for the varus/valgus angle (n.s.) and the cut height (n.s.). No significant difference in the tibial cut was observed between the surgeons for the tibial slope angle (n.s.), varus/valgus angle (n.s.), planarity (n.s.), and rugosity (n.s.). In the different bone types, no significant difference was observed for the tibial slope (n.s.) and varus/valgus angle (n.s.), while planarity and rugosity showed significant differences (p < 0.05). Our study showed no significant difference in the tibial cuts for the tibial slope, varus/valgus angle, planarity, and rugosity between the two surgeons. CONCLUSIONS In the present study, it could be demonstrated that accuracy of the cuts is ensured by PSI not depending on the surgeon's experience and the bone mineral density. This speaks to its clinical significance: PSI might be suited for less experienced surgeons to reduce outliers in total knee arthroplasty (TKA).
Collapse
Affiliation(s)
- Alexander Antoniadis
- Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Roland S Camenzind
- Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | - Michael O Schär
- Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland
| | | | - Näder Helmy
- Department of Orthopedic Surgery, Bürgerspital Solothurn, Schöngrünstrasse 38, 4500, Solothurn, Switzerland. .,Orthopaedics and Traumatology, Burgerspital Solothurn, Schöngrünstrasse 42, 4500, Solothurn, Switzerland.
| |
Collapse
|
|
35
|
Cucchi D, Menon A, Aliprandi A, Soncini G, Zanini B, Ragone V, Compagnoni R, Ferrua P, Fossati C, Randelli P. Patient-specific Instrumentation Affects Rotational Alignment of the Femoral Component in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Orthop Surg 2019; 11:75-81. [PMID: 30834703 PMCID: PMC6430487 DOI: 10.1111/os.12420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 12/04/2022] Open
Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Monza, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Monza, Italy.,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Monza, Italy
| | | | | | - Beatrice Zanini
- IRCCS Policlinico San Donato, San Donato, Italy.,Department of Health Sciences, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy
| | - Vincenza Ragone
- IRCCS Policlinico San Donato, San Donato, Italy.,Department of Health Sciences, "Amedeo Avogadro" University of Eastern Piedmont, Novara, Italy
| | - Riccardo Compagnoni
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Monza, Italy
| | - Paolo Ferrua
- Department of Knee Surgery, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Monza, Italy.,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Monza, Italy
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Monza, Italy.,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Monza, Italy
| |
Collapse
|
|
36
|
McAuliffe MJ, Beer BR, Hatch JJ, Crawford RW, Cuthbert AR, Donnelly WJ. Impact of Image-Derived Instrumentation on Total Knee Arthroplasty Revision Rates: An Analysis of 83,823 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2019; 101:580-588. [PMID: 30946191 DOI: 10.2106/jbjs.18.00326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups. METHODS Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates. RESULTS IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the ≤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group. CONCLUSIONS IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients ≤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Michael J McAuliffe
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Benjamin R Beer
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Joshua J Hatch
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Ross W Crawford
- Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Alana R Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - William J Donnelly
- Department of Orthopaedics, Prince Charles Hospital, Chermside, Queensland, Australia
| |
Collapse
|
|
37
|
The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA. Knee Surg Sports Traumatol Arthrosc 2019; 27:1018-1027. [PMID: 30203197 DOI: 10.1007/s00167-018-5131-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is no present consensus on the most reliable anatomical landmarks or axes for tibial rotational alignment in total knee arthroplasty (TKA). The goal was therefore to review the literature and compare accuracy and repeatability of different axes for tibial baseplate rotation in TKA. METHODS Medline and Embase were searched for articles that reported accuracy in terms of error or discrepancy from the trans-epicondylar axes (TEA), and/or repeatability in terms of intraclass correlation coefficient, of one or more axes used for tibial baseplate rotation in TKA. Twenty-one articles met criteria, and their data were extracted and tabulated. RESULTS The selected articles evaluated 15 different axes, 13 for reliability, 12 for repeatability. The lowest errors or discrepancies from the projected TEA were reported for the original 'Akagi line' (posterior cruciate ligament posteriorly to medial border of tibial tuberosity), its variant using the sulcus of the tibial spines as anterior landmark, as well as the anterior tibial border and the curve-on-curve technique. The best inter-observer repeatabilities were reported for 'Akagi line' variants that use the geometric centre of the tibial plateau posteriorly and the medial border of the tibial tuberosity, or the medial sixth of the patellar tendon anteriorly. Considering accuracy and repeatability simultaneously, only two axes were found to satisfy both criteria consistently: the original 'Akagi line' and the anterior tibial border. CONCLUSIONS Because of the small number of studies found, the collected evidence remains insufficient to recommend reference axes for intra-operative rotational alignment of the tibial baseplate in TKA. A combination of two or more anatomical landmarks or projected axes could be used to ensure adequate tibial baseplate rotation, while considering individual patient morphology and implant design to optimize knee kinematics and prevent prosthetic overhang. LEVEL OF EVIDENCE Level IV, systematic review of level III and IV studies.
Collapse
|
|
38
|
Chanalithichai N, Tammachote N, Jitapunkul C, Kanitnate S. Rotational component alignment in patient-specific total knee arthroplasty compared with conventional cutting instrument. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1297-1304. [PMID: 30923964 DOI: 10.1007/s00590-019-02423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/22/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although many studies investigated the accuracy of customized cutting block (CCB), the data on rotational alignment are still lacking. The study aimed to assess whether CCB improved the component rotational position compared with conventional cutting instrument (CCI) using computed tomography scanning. METHODS Eighty-six of 102 total knee arthroplasties from the previous randomized study were analyzed. The outcomes were rotational position of the femoral and tibial components, frequency of outliers and intra-class correlation coefficient. RESULTS The mean femoral component rotation was not different between CCB versus CCI: 0.9° ± 0.8° versus 1.1° ± 1.1° (P = 0.29). Both groups had similar outlier frequencies: 2% (CCB) versus 2% (CCI) (P = 0.74). CCB had nearly 1° less mean tibial component deviation compared with CCI (P < 0.001): (1) dorsal tangent reference (DTR): 0.7° ± 0.8° versus 1.5° ± 1.0°, and (2) tibial trans-epicondylar reference (TTR): 0.5° ± 0.9° versus 1.4° ± 1.1°. Outlier frequencies were similar: (1) DTR: 0% CCB versus 5% CCI (P = 0.24), and (2) TTR: 5% in CCB versus 12% CCI (P = 0.20). Measurements based on tibial tubercle showed that CCB had ~ 1.4° less mean tibial component deviation compared with CCI: 0.3° ± 1.4° versus 1.7° ± 1.6° (P < 0.001) with a corresponding, less frequency of outliers: 0% versus 19% (P = 0.002). However, there was poor intra-observer reproducibility (0.61). CONCLUSIONS CCB did not improve femoral component rotational alignment compared with CCI nor affect outlier frequency, but it marginally improved the accuracy of tibial rotational alignment. The tibial tubercle reference point had poor intra-observer reproducibility.
Collapse
Affiliation(s)
- Nuttawut Chanalithichai
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| | - Nattapol Tammachote
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
| | - Chane Jitapunkul
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| |
Collapse
|
|
39
|
Gong S, Xu W, Wang R, Wang Z, Wang B, Han L, Chen G. Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1083-1095. [PMID: 30377714 PMCID: PMC6435625 DOI: 10.1007/s00167-018-5256-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3° from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance. METHODS A total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay. RESULTS There was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI - 0.71 to - 0.21, p = 0.0004, I2 = 48%). PSI resulted in approximately 0.4° less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI - 10.95 to - 3.75, p < 0.0001, I2 = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI - 146.65 to - 20.18, p = 0.01, I2 = 74%). We did not find any differences between PSI and SI with respect to any other parameters. CONCLUSIONS PSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level I.
Collapse
Affiliation(s)
- Song Gong
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Weihua Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ruoyu Wang
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zijian Wang
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Bo Wang
- 0000 0004 0368 7223grid.33199.31Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Lizhi Han
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Guo Chen
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| |
Collapse
|
|
40
|
Cucchi D, Menon A, Compagnoni R, Ferrua P, Fossati C, Randelli P. Significant differences between manufacturer and surgeon in the accuracy of final component size prediction with CT-based patient-specific instrumentation for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3317-3324. [PMID: 29453487 DOI: 10.1007/s00167-018-4876-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/12/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) may improve component sizing. Little has been reported about accuracy of the default plan created by the manufacturer, especially for CT-based PSI. The goal of this study was to evaluate the reliability of this plan and the impact of the surgeon's changes on the final accuracy of the guide sizes. METHODS Forty-five patients eligible for primary TKA were prospectively enrolled. The planned implant sizes were prospectively recorded from the initial manufacturer's proposal and from the final plan adjusted in light of the surgeon's evaluation; these two sizes where then compared to the actually implanted sizes. Fisher's exact test was used to test differences for categorical variables. Agreement between pre-operative plans and final implant was evaluated with the Bland-Altman method. RESULTS The manufacturer's proposal differed from the final implant in 9 (20.0%) femoral and 23 (51.1%) tibial components, while the surgeon's plan in 6 (13.3%, femoral) and 12 (26.7%, tibial). Modifications in the pre-operative plan were carried out for five (11.1%) femoral and 23 (51.1%) tibial components (p = 0.03). Appropriate modification occurred in 22 (88.0%) and 19 (76.0%) cases of femoral and tibial changes. The agreement between the manufacturer's and the surgeon's pre-operative plans was poor, especially with regard to tibial components. CONCLUSION The surgeon's accuracy in predicting the final component size was significantly different from that of the manufacturer and changes in the initial manufacturer's plan were necessary to get an accurate pre-operative plan of the implant sizes. CLINICAL RELEVANCE Careful evaluation of the initial manufacturer's plan by an experienced knee surgeon is mandatory when planning TKA with CT-based PSI. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Paolo Ferrua
- S.S.D. Chirurgia Articolare del Ginocchio, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| |
Collapse
|
|
41
|
Affiliation(s)
- Max Gordon
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden,
| |
Collapse
|
|
42
|
No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 2018; 26:2788-2796. [PMID: 29071356 DOI: 10.1007/s00167-017-4741-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/02/2017] [Indexed: 01/28/2023]
Abstract
PURPOSE AND HYPOTHESIS Patient-specific instrumentation (PSI) uses 3D preoperative imaging to produce individualized cutting blocks specific to patients' anatomy and according to the preoperative plan with the aim to reduce the number of mechanical leg alignment (MLA) outliers, to improve implant positioning and to decrease surgery time. The primary purpose of this study was to investigate the efficacy of a specific PSI in comparison with standard instrumentation (SI) in reducing the number of MLA outliers. It was hypothesized that the number of MLA outliers would be significantly lower in the PSI group. METHODS A multicenter randomized controlled trial was implemented. There were 59 patients in the PSI group and 66 in the SI group. The absolute number of outliers outside the ± 3° target neutral MLA was compared between the groups with a Chi-square test. As secondary outcomes, the Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were compared between the groups preoperatively and at 90-day follow-up. RESULTS There were 15 (26.3%) MLA outliers in the PSI group and 8 (12.3%) in the SI group. The number of outliers was not independent from the group ( X2 (1) = 3.8, p = 0.04; Relative risk = 1.5). Preoperatively, there were no significant differences between the groups when comparing their KSS and KOOS sub-scores. At 90 days postoperatively, the patients in the SI group showed better KOOS-Quality of Life (KOSS-QOL) in comparison with the PSI group (p < 0.0001). CONCLUSION The use of PSI did not significantly reduce the number of MLA outliers in comparison with SI. There were no differences when comparing the achieved mean MLA of both groups. LEVEL OF EVIDENCE Level I, prospective randomized controlled trial.
Collapse
|
|
43
|
Schotanus MGM, Thijs E, Heijmans M, Vos R, Kort NP. Favourable alignment outcomes with MRI-based patient-specific instruments in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:2659-2668. [PMID: 28698929 DOI: 10.1007/s00167-017-4637-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/06/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE Patient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty (TKA) with conventional instrumentation. PSI use requires a preoperative MRI scan, CT scan, or a combination of MRI and a long-leg standing radiograph. However, there is no consensus as to which of these modalities, MRI or CT, is the preferred imaging modality when performing TKA with PSIs. METHODS This systematic literature review and meta-analysis studied the differences in alignment outliers between CT- and MRI-based PSI for TKA. A search of the Cochrane Database of Systematic Reviews, MEDLINE/PubMed and Embase was conducted, without restriction on date of publication. Only level I evidence studies written in English that included TKA with the use of MRI- and CT-based PSI were selected. A meta-analysis was then performed of the rate of outliers in the biomechanical axis and individual femoral and tibial component alignment. Where considerable heterogeneity among studies was present or the data did not provide sufficient information for performing the meta-analysis, a qualitative synthesis was undertaken. RESULTS Twelve randomized controlled trials, studying 841 knees, were eligible for data extraction and meta-analysis. MRI-based PSI resulted in a significantly lower proportion of coronal plane outliers with regard to the lateral femoral component (OR 0.52, 95% CI 0.30-0.89, P = 0.02), without significant heterogeneity (n.s.). There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment. CONCLUSION This systematic review and meta-analysis demonstrate that alignment with MRI-based PSI is at least as good as, if not better than, that with CT-based PSI. To prevent for malalignment, MRI should be the imaging modality of choice when performing TKA surgery with PSI. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Martijn G M Schotanus
- Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
| | - Elke Thijs
- Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands
| | - Marion Heijmans
- Zuyderland Academy, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nanne P Kort
- Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands
| |
Collapse
|
|
44
|
Liu D, Li Y, Cai G, Jia D, Mao J, Meng X, Wang G, He C. [Short-term effectiveness of total knee arthroplasty assisted by three-dimensional printing osteotomy navigation template]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:899-905. [PMID: 30129315 DOI: 10.7507/1002-1892.201802013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short-term effectiveness of total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing osteotomy navigation template. Methods A retrospective study was performed on 60 patients with osteoarthritis bewteen January 2016 and June 2017. Thirty cases underwent TKA assisted by 3D printing osteotomy navigation template (3D printing group) and 30 cases underwent the conventional TKA (conventional TKA group). There was no significant difference in gender, age, body mass index, surgical side, and disease duration between 2 groups ( P>0.05). The operation time, the pre- and post-operative hemoglobin values, the amount of drainage, the Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) of knee joint before operation and at 3 months after operation were observed. And 6 freedom degrees of knee (the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement, the flexion and extension angle, and the internal and external displacement) before operation and at 3 months after operation were recorded by Opti-Knee (the knee 3D motion analysis system). The values of 2 groups were compared with 30 healthy adults (<60 years). Results The operation time was shorter in 3D printing group than that in conventional TKA group ( t=5.833， P=0.000). The hemoglobin values at 1 and 3 days after operation were higher in 3D printing group than those in conventional TKA group ( P<0.05). The amount of drainage was less in 3D printing group than that in conventional TKA group ( t=5.468， P=0.000). All patients were followed up 6-9 months (mean, 7.3 months). There was no significant difference in pre- and post-operative HSS score and KSS clinical score between 2 groups ( P>0.05). There was no significant difference in preoperative KSS function score between 2 groups ( P>0.05), but the KSS function score of 3D printing group at 3 months after operation was higher than that of conventional TKA group ( P<0.05). Before operation, the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement of 3D printing group and conventional TKA group were larger than that of the healthy adults ( P<0.05); there was no significant difference in the flexion and extension angle and the internal and external displacement between 2 groups and healthy adults ( P>0.05). At 3 months after operation, compared with healthy adults, the varus and valgus angle of conventional TKA group was increased, the flexion and extension angle of conventional TKA group was decreased ( P<0.05); the proximal-distal displacement and the internal and external displacement of 2 groups were decreased ( P<0.05); there was no significant difference in other freedom degrees between groups ( P>0.05). No sign of prosthesis loosening was observed by X-ray examination. Conclusion Compared with the traditional TKA, TKA assisted by the 3D printing osteotomy navigation template had such advantages as shorter operation time, less postoperative blood loss, and well postoperative recovery.
Collapse
Affiliation(s)
- Dejian Liu
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Yanlin Li
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032,
| | - Guofeng Cai
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Di Jia
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Jianyu Mao
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Xuhan Meng
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Guoliang Wang
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Chuan He
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| |
Collapse
|
|
45
|
Abane L, Zaoui A, Anract P, Lefevre N, Herman S, Hamadouche M. Can a Single-Use and Patient-Specific Instrumentation Be Reliably Used in Primary Total Knee Arthroplasty? A Multicenter Controlled Study. J Arthroplasty 2018; 33:2111-2118. [PMID: 29576488 DOI: 10.1016/j.arth.2018.02.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/25/2018] [Accepted: 02/07/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this controlled multicenter study is to evaluate the clinical and radiologic outcomes of primary total knee arthroplasty (TKA) using single-use fully disposable and patient-specific cutting guides (SU) and compare the results to those obtained with traditional patient-specific cutting guides (PSI) vs conventional instrumentation (CI). METHODS Seventy consecutive patients had their TKA performed using SU. They were compared to 140 historical patients requiring TKA that were randomized to have the procedure performed using PSI vs CI. The primary measure outcome was mechanical axis as measured on a standing long-leg radiograph using the hip-knee-ankle angle. Secondary outcome measures were Knee Society and Oxford knee scores, operative time, need for postoperative transfusion, and length of hospital stay. RESULTS The mean hip-knee-ankle value was 179.8° (standard deviation [SD] 3.1°), 179.2° (SD 2.9°), and 178.3° (SD 2.5°) in the CI, PSI and SU groups, respectively (P = .0082). Outliers were identified in 16 of 65 (24.6%), 15 of 67 (22.4%), and 14 of 70 (20.0%) knees in the CI, PSI, and SU group, respectively (P = .81). There was no significant difference in the clinical results (P = .29 and .19, respectively). Operative time, number of unit transfusion, and length of hospital stay were not significantly different between the 3 groups (P = .45, .31, and 0.98, respectively). CONCLUSION The use of an SU in TKA provided similar clinical and radiologic results to those obtained with traditional PSI and CI. The potential economic advantages of single-use instrumentation in primary TKA require further investigation.
Collapse
Affiliation(s)
- Laurent Abane
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| | - Amine Zaoui
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| | - Philippe Anract
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| | | | | | - Moussa Hamadouche
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| |
Collapse
|
|
46
|
Kosse NM, Heesterbeek PJC, Schimmel JJP, van Hellemondt GG, Wymenga AB, Defoort KC. Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2018; 26:1792-1799. [PMID: 29181560 DOI: 10.1007/s00167-017-4792-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The primary aim of the study was to examine stability and alignment after total knee arthroplasty (TKA) using patient-specific instrumentation (PSI) and conventional instrumentation (CI). The hypothesis was that stability and alignment would be better using PSI than CI, 12 months postoperatively. The secondary aim included the evaluation of clinical outcomes after TKA. METHODS In this prospective randomized controlled trial, 42 patients with knee osteoarthritis received a Genesis II PS prosthesis with either PSI or CI. Patients visited the hospital preoperatively and postoperatively after 6 weeks and 3 and 12 months. To evaluate stability, varus-valgus laxity was determined in extension and flexion using stress radiographs 12 months postoperatively. Three months postoperatively, a long-leg radiograph and CT scan were obtained to measure hip-knee-ankle (HKA) alignment and component rotation. Furthermore, frontal and sagittal alignment of the components, the Knee Society Score, VAS Pain, VAS Satisfaction, Knee injury and Osteoarthritis Outcome score, Patella score (Kujala), University of California Los Angeles activity score, anterior-posterior laxity, (serious) adverse device-related events, and intraoperative complications were reported. The clinical outcomes were compared using independent t tests or non-parametric alternatives, and repeated measurements ANOVA with a significance level of p < 0.05. RESULTS No significant differences were found between the two groups regarding stability, HKA angle, and rotational alignment. In four patients, the PSI did not fit correctly on the tibia and/or femur requiring intraoperative modifications. Both groups improved significantly over time on all clinical outcomes, with no significant differences between the groups 12 months postoperatively. The PSI group showed less tibial slope than the patients in the CI group [PSI 2.6° versus CI 4.8° (p = 0.02)]. Finally, the PSI group more frequently received a thinner insert size than the CI group (p = 0.03). CONCLUSIONS Patients operated with PSI did not differ from CI in terms of stability and alignment. However, in the PSI group ligament releases were more often required intraoperatively. Furthermore, the two methods did not show different clinical results. It seems that the preoperative planning for the PSI facilitates more conservative bone cuts than CI, but whether this is clinically relevant should be investigated. Since PSI is more expensive and time consuming than CI, and does not outperform CI with regard to clinical results, we recommend to use CI. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Nienke M Kosse
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
| | - Petra J C Heesterbeek
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
| | - Janneke J P Schimmel
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
| | | | - Ate B Wymenga
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Koen C Defoort
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| |
Collapse
|
|
47
|
Kuriyama S, Hyakuna K, Inoue S, Kawai Y, Tamaki Y, Ito H, Matsuda S. Bone-femoral component interface gap after sagittal mechanical axis alignment is filled with new bone after cementless total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1478-1484. [PMID: 28194499 DOI: 10.1007/s00167-017-4452-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study retrospectively evaluated the fate of mismatch between an uncemented femoral component and each femoral cut surface (i.e., wedge-shaped gap) relative to sagittal mechanical alignment in total knee arthroplasty (TKA). METHODS Primary TKA was performed on 99 consecutive knees. The femoral components were aligned to the sagittal mechanical axis with CT-based navigation. All patients were assessed with postoperative true lateral radiographs. Bone-side surfaces of the uncemented femoral component were divided into five zones: anterior flange, anterior chamfer, posterior chamfer, posterior part, and distal part, which were defined as zones 1 to 5, respectively. Bone filling of wedge-shaped gaps in each zone was evaluated after 1 year. RESULTS Femoral anterior notching did not occur. However, wedge-shaped gaps were observed in at least one zone in 23 of 99 knees (23%), most frequently in zone 5 (18%). There were 9 and 7 gaps in zones 1 and 2, respectively. The femoral component showed malpositioning of approximately 3° of flexion in cases with wedge-shaped gaps in zones 2 and/or 5. After one year, 67% (6/9) of zone 1, 100% (7/7) of zone 2, and 94% (17/18) of zone 5 wedge-shaped gaps were filled in with new bone. CONCLUSIONS Femoral alignment relative to sagittal mechanical axis caused wedge-shaped gaps due to unstable anterior bone cutting through hard bone, but the small gaps were not clinically significant and filled in within one year. Sagittal setting of the femoral component should aim for the anatomical axis rather than the mechanical axis. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Katsufumi Hyakuna
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Satoshi Inoue
- Department of Orthopaedic Surgery, Nakae Hospital, Wakayama, Japan
| | - Yasutsugu Kawai
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
|
48
|
Van Leeuwen JAMJ, Snorrason F, Röhrl SM. No radiological and clinical advantages with patient-specific positioning guides in total knee replacement. Acta Orthop 2018; 89:89-94. [PMID: 29161930 PMCID: PMC5810839 DOI: 10.1080/17453674.2017.1393732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Although the use of patient-specific positioning guides (PSPGs) in total knee replacement (TKR) in theory is promising, the technique has not yet proven its superior- ity compared with the conventional method. We compared radio- logical alignment and clinical outcome between TKR performed with the use of PSPGs and the conventional operation method. Patients and methods - 3 hospitals participated in a prospec- tive trial. 109 patients were randomized to either the conventional method or to the use of PSPGs. Postoperatively a full-length standing anteroposterior radiograph and a postoperative CT scan were taken. On the CT scan the alignments were measured for both the femoral and tibial components in the frontal, sagit- tal, and axial plane. The Knee injury and Osteoarthritis Outcome Score (KOOS), the Eurocol-5D-3L (Eq5D) descriptive system and visual analogue scale (VAS), a pain score (NRS), and range of motion (ROM) were recorded preoperatively, and at 3 months, 1, and 2 years. The operation time and length of hospital stay were recorded. Results - 90 patients were available for postoperative CT mea- surements. A statistically significant difference was found between the conventional TKR instrumentation and the use of PSPGs for the frontal femoral (mean (SD) 0.6° (1.7) vs. -0.3° (2.2), CI 0.08 to 1.69) and tibial (-0.3° (1.5) vs. 0.9° (2.1), CI -1.98 to -0.44) compo- nent angles and for the tibial alignment in the sagittal plane (-3.8° (3.0) vs. -2.2° (2.5), CI -2.72; -0.42). The proportions of outliers were similar between the groups as well as the hip-knee-ankle angle, the KOOS sub scores, the Eq5D, pain (NRS), ROM, opera- tion time, and length of hospital stay. Interpretation - The use of PSPGs requires a preoperative CT scan or MRI and the guides have an additional cost. As this study was not able to prove any extra benefit of the use of PSPGs we recommend the conventional operation method for TKR.
Collapse
Affiliation(s)
- Justin A M J Van Leeuwen
- Department of Orthopaedic Surgery, Betanien Hospital, Skien, Norway,Faculty of Medicine, University of Oslo, Oslo, Norway,Correspondence:
| | - Finnur Snorrason
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
|
49
|
Wieser K. CORR Insights®: Femoral Component Varus Malposition is Associated with Tibial Aseptic Loosening After TKA. Clin Orthop Relat Res 2018; 476:408-409. [PMID: 29389791 PMCID: PMC6259687 DOI: 10.1007/s11999.0000000000000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Karl Wieser
- K. Wieser, University of Zurich, Balgrist Hospital, Zürich, Switzerland
| |
Collapse
|
|
50
|
Tan H, Wang Y, Long T, Nie B, Mao Z, Yue B. How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 42:537-542. [PMID: 29356933 DOI: 10.1007/s00264-018-3778-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/10/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Distal femoral resection in total knee arthroplasty (TKA) is commonly performed using intramedullary jigs with a pre-operatively planned valgus cut angle (VCA). For valgus knees with lateral femoral condyle hypoplasia, the method of determining the accurate VCA has not been clarified. The aim of the present study is to introduce a method that can accurately determine the distal femoral VCA in the valgus knee arthroplasty. METHODS Twenty patients with valgus deformity caused by lateral femoral condylar hypoplasia underwent primary TKA with individually measured VCA. The VCA was defined as the acute crossing angle of the anatomical and mechanical axes of the femur on a pre-operative X-ray film, and the two axes almost always crossed at the distal femoral diaphysis, but not the centre of the knee as generally described. The entry point of the femoral intramedullary guide rod was determined on the extension of the femoral anatomical axis and was usually medial to the centre of the knee. According to the pre- and post-operative X-ray films, the mechanical lateral distal femoral angle (mLDFA), and coronal alignment of the femoral components were measured. The post-operative knee pain and function were evaluated using the Visual Analog Scale and Knee Society Score, respectively. RESULTS The mean VCA measured according to the above method was 6.4° ± 1.0° (4.7-8.2°), and the femoral entry point was located at a mean distance of 7.4 ± 2.1 mm (4.5-10.9 mm) medial to the centre of the knee joint. The mean mLDFA before and after operation was 77.4° ± 5.7° (74-82°) and 88.4° ± 1.7° (86-90°), respectively, showing a statistically significant difference (P < 0.01). CONCLUSIONS The deformity of the distal femoral diaphysis is quite various in different valgus knees. The VCA and the femoral entry point should be determined individually for each case. The application of the current method resulted in good post-operative mechanical axis alignment and clinical results after TKA. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Honglue Tan
- Department of Bone and Joint Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandongzhong Road, Shanghai, People's Republic of China, 200001.,Department of Knee Joint Surgery, Henan Luoyang Orthopedic-Traumatological Hospital, Henan Orthopedic Hospital, Luoyang, China
| | - You Wang
- Department of Bone and Joint Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandongzhong Road, Shanghai, People's Republic of China, 200001
| | - Teng Long
- Department of Bone and Joint Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandongzhong Road, Shanghai, People's Republic of China, 200001
| | - Binen Nie
- Department of Bone and Joint Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandongzhong Road, Shanghai, People's Republic of China, 200001
| | - Zhenyang Mao
- Department of Bone and Joint Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandongzhong Road, Shanghai, People's Republic of China, 200001
| | - Bing Yue
- Department of Bone and Joint Surgery, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 145 Shandongzhong Road, Shanghai, People's Republic of China, 200001.
| |
Collapse
|