Radiographic Accuracy in TKA with a CT-based Patient-specific Cutting Block Technique

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2013 Aug 15

PMID 23942882

Citations 35

Authors

P P Koch

D Muller

M Pisan

S F Fucentese

Affiliations

Soon will be listed here.

Abstract

Purpose: Patient-specific instrumentation (PSI) technology for the implantation of total knee arthroplasty (TKA) has a rising interest in the orthopaedic community. Data of PSI are controversially discussed. The hypothesis of this paper is that the radiological accuracy of CT-based PSI is similar to the one of navigated TKA published in the literature.

Methods: Since 2010, all 301 consecutively performed PSI TKAs (GMK MyKnee©) were included in this study. The radiological assessment consisted in a preoperative and postoperative standard X-ray and long-standing X-ray. Changes from the planned to the definitively implanted component size were documented. Postoperative analysis included limb alignment and position of femoral and tibial components (for varus/valgus and flexion or tibial slope).

Results: The postoperative average hip-knee-ankle angle was 180.1° ± 2.0°. In the frontal plane a total of 12.4 % of outliers >3°, for the tibial components 4.1 % of outliers >3° and for the femoral components 4.8 % of outliers >3° were measured. A total of 12.3 % of outliers for posterior tibial slope and 9 % of outliers >3° for the femoral flexion were noted. 10.8 % of the 602 planned size components were adapted intraoperatively.

Conclusion: Although it is still unknown which limb axis is the correct one for the best clinical result, a technology providing the aimed axis in a most precise way should be chosen. Comparing the outcome of the current study with the data from the literature, there does not seem to be any difference compared to computer-assisted surgery.

Level Of Evidence: IV.

Citing Articles

Preoperative difference between 2D and 3D planning correlates with difference between planned and achieved surgical correction in patient-specific instrumented total knee arthroplasty.

Pfluger P, Pedrazzini A, Jud L, Vlachopoulos L, Hodel S, Fucentese S J Exp Orthop. 2024; 12(1):e70128.

PMID: 39737426 PMC: 11683782. DOI: 10.1002/jeo2.70128.

The Accuracy of CT-Based Three-Dimensional Templating in Predicting Implant Sizes in Patients Undergoing Robot-Assisted Total Knee Arthroplasty.

Adkar N, Patil M, Vaidya S, Kumbar R, Kerhalkar R, Mote G Indian J Orthop. 2024; 58(10):1388-1394.

PMID: 39324083 PMC: 11420422. DOI: 10.1007/s43465-024-01244-x.

The coronal alignment differs between two-dimensional weight-bearing and three-dimensional nonweight bearing planning in total knee arthroplasty.

Pfluger P, Hodel S, Zimmermann S, Knechtle S, Vlachopoulos L, Fucentese S J Exp Orthop. 2024; 11(1):e12007.

PMID: 38455454 PMC: 10885761. DOI: 10.1002/jeo2.12007.

Restoring tibial obliquity for kinematic alignment in total knee arthroplasty: conventional versus patient-specific instrumentation.

Smolle M, Koutp A, Clar C, Leitner L, Leithner A, Sadoghi P Arch Orthop Trauma Surg. 2023; 143(9):5867-5872.

PMID: 36939891 PMC: 10449675. DOI: 10.1007/s00402-023-04845-7.

The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty-What Do They Tell Us and at What Risk?.

DAmore T, Klein G, Lonner J Arthroplast Today. 2022; 15:132-138.

PMID: 35573981 PMC: 9095648. DOI: 10.1016/j.artd.2022.03.008.

References

Daniilidis K, Tibesku C . Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop. 2012; 37(1):45-50. PMC: 3532632. DOI: 10.1007/s00264-012-1732-1. View

Stronach B, Pelt C, Erickson J, Peters C . Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res. 2012; 471(1):169-74. PMC: 3528928. DOI: 10.1007/s11999-012-2573-3. View

Nunley R, Ellison B, Zhu J, Ruh E, Howell S, Barrack R . Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res. 2011; 470(3):895-902. PMC: 3270188. DOI: 10.1007/s11999-011-2222-2. View

Brin Y, Nikolaou V, Joseph L, Zukor D, Antoniou J . Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop. 2010; 35(3):331-9. PMC: 3047658. DOI: 10.1007/s00264-010-1008-6. View

Cheng T, Zhao S, Peng X, Zhang X . Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials?. Knee Surg Sports Traumatol Arthrosc. 2011; 20(7):1307-22. DOI: 10.1007/s00167-011-1588-8. View

DLima D, Hermida J, Chen P, Colwell Jr C . Polyethylene wear and variations in knee kinematics. Clin Orthop Relat Res. 2001; (392):124-30. DOI: 10.1097/00003086-200111000-00015. View

Barrack R . The results of TKA: what the registries don't tell us. Orthopedics. 2011; 34(9):e485-7. DOI: 10.3928/01477447-20110714-43. View

Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C . A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am. 2007; 89(2):236-43. DOI: 10.2106/JBJS.F.00386. View

Heyse T, Tibesku C . Improved femoral component rotation in TKA using patient-specific instrumentation. Knee. 2012; 21(1):268-71. DOI: 10.1016/j.knee.2012.10.009. View

10.

Bellemans J, Colyn W, Vandenneucker H, Victor J . The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res. 2011; 470(1):45-53. PMC: 3237976. DOI: 10.1007/s11999-011-1936-5. View

11.

Hetaimish B, Khan M, Simunovic N, Al-Harbi H, Bhandari M, Zalzal P . Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty. 2012; 27(6):1177-82. DOI: 10.1016/j.arth.2011.12.028. View

12.

Noble Jr J, Moore C, Liu N . The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty. 2011; 27(1):153-5. DOI: 10.1016/j.arth.2011.07.006. View

13.

Collier M, Engh Jr C, McAuley J, Engh G . Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am. 2007; 89(6):1306-14. DOI: 10.2106/JBJS.F.00667. View

14.

Bonner T, Eardley W, Patterson P, Gregg P . The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br. 2011; 93(9):1217-22. DOI: 10.1302/0301-620X.93B9.26573. View

15.

Brin Y, Livshetz I, Antoniou J, Greenberg-Dotan S, Zukor D . Precise landmarking in computer assisted total knee arthroplasty is critical to final alignment. J Orthop Res. 2010; 28(10):1355-9. DOI: 10.1002/jor.21139. View

16.

Ng V, DeClaire J, Berend K, Gulick B, Lombardi Jr A . Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res. 2011; 470(1):99-107. PMC: 3237987. DOI: 10.1007/s11999-011-1996-6. View

17.

Nunley R, Ellison B, Ruh E, Williams B, Foreman K, Ford A . Are patient-specific cutting blocks cost-effective for total knee arthroplasty?. Clin Orthop Relat Res. 2011; 470(3):889-94. PMC: 3270159. DOI: 10.1007/s11999-011-2221-3. View

18.

Watters T, Mather 3rd R, Browne J, Berend K, Lombardi Jr A, Bolognesi M . Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv. 2011; 20(2):112-6. View

19.

Ast M, Nam D, Haas S . Patient-specific instrumentation for total knee arthroplasty: a review. Orthop Clin North Am. 2012; 43(5):e17-22. DOI: 10.1016/j.ocl.2012.07.004. View

20.

Choong P, Dowsey M, Stoney J . Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty. 2008; 24(4):560-9. DOI: 10.1016/j.arth.2008.02.018. View