Patient-specific Instrumentation Improved Three-dimensional Accuracy in Total Knee Arthroplasty: a Comparative Radiographic Analysis of 1257 Total Knee Arthroplasties

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2019 Dec 14

PMID 31831022

Citations 13

Authors

Leo Pauzenberger

Martin Munz

Georg Brandl

Julia K Frank

Philipp R Heuberer

Brenda Laky

Eva Schwameis

Werner Anderl

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty.

Methods: Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ± 3° or from the intraoperative component-positioning goals of > ± 2°. Deviations greater than ± 5° from set targets were considered to be severe outliers.

Results: Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05).

Conclusions: Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ± 5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (> 5° deviation) outliers.

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.

Total Knee Arthroplasty in Paget's Disease using 3D-Printed Patient-Specific Femoral Jig - A Case Report.

Sathikumar A, Jacob G, Varghese J, Mathew V J Orthop Case Rep. 2023; 13(8):84-88.

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Closed-leg standing long leg radiographs can be a useful tool to assess whether the joint line is parallel to the ground in restricted kinematic alignment total knee arthroplasty.

Kobayashi T, Goto K, Otsu M, Michishita K J Exp Orthop. 2023; 10(1):42.

PMID: 37037997 PMC: 10086086. DOI: 10.1186/s40634-023-00606-y.

Research Advances in the Application of AI for Preoperative Measurements in Total Knee Arthroplasty.

Li W, Xu S, Zhang D, Bi H, Gu G Life (Basel). 2023; 13(2).

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Trends in Computer-Assisted Surgery for Total Knee Arthroplasty in Germany: An Analysis Based on the Operative Procedure Classification System between 2010 to 2021.

Heinz T, Eidmann A, Anderson P, Weissenberger M, Jakuscheit A, Rudert M J Clin Med. 2023; 12(2).

PMID: 36675478 PMC: 9863460. DOI: 10.3390/jcm12020549.

References

Daniilidis K, Tibesku C . A comparison of conventional and patient-specific instruments in total knee arthroplasty. Int Orthop. 2013; 38(3):503-8. PMC: 3936083. DOI: 10.1007/s00264-013-2028-9. View

Anderl W, Pauzenberger L, Kolblinger R, Kiesselbach G, Brandl G, Laky B . Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc. 2014; 24(1):102-11. DOI: 10.1007/s00167-014-3345-2. View

Ritter M, Davis K, Meding J, Pierson J, Berend M, Malinzak R . The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am. 2011; 93(17):1588-96. DOI: 10.2106/JBJS.J.00772. View

Vanlommel L, Vanlommel J, Claes S, Bellemans J . Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc. 2013; 21(10):2325-30. DOI: 10.1007/s00167-013-2481-4. View

Cavaignac E, Pailhe R, Laumond G, Murgier J, Reina N, Laffosse J . Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty: a meta-analysis. Int Orthop. 2014; 39(8):1541-52. DOI: 10.1007/s00264-014-2549-x. View

Rhoads D, Noble P, Reuben J, Mahoney O, Tullos H . The effect of femoral component position on patellar tracking after total knee arthroplasty. Clin Orthop Relat Res. 1990; (260):43-51. View

Boonen B, Schotanus M, Kerens B, van der Weegen W, van Drumpt R, Kort N . Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2013; 21(10):2206-12. DOI: 10.1007/s00167-013-2620-y. View

Kim K, Bin S, Kim J . The Correlation between Posterior Tibial Slope and Maximal Angle of Flexion after Total Knee Arthroplasty. Knee Surg Relat Res. 2012; 24(3):158-63. PMC: 3438277. DOI: 10.5792/ksrr.2012.24.3.158. View

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

10.

Thienpont E, Fennema P, Price A . Can technology improve alignment during knee arthroplasty. Knee. 2013; 20 Suppl 1:S21-8. DOI: 10.1016/S0968-0160(13)70005-X. View

11.

Pietsch M, Hofmann S . Early revision for isolated internal malrotation of the femoral component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011; 20(6):1057-63. DOI: 10.1007/s00167-011-1637-3. View

12.

Berger R, Crossett L, Jacobs J, Rubash H . Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res. 1999; (356):144-53. DOI: 10.1097/00003086-199811000-00021. View

13.

Thienpont E, Bellemans J, Delport H, Van Overschelde P, Stuyts B, Brabants K . Patient-specific instruments: industry's innovation with a surgeon's interest. Knee Surg Sports Traumatol Arthrosc. 2013; 21(10):2227-33. DOI: 10.1007/s00167-013-2626-5. View

14.

Kamat Y, Aurakzai K, Adhikari A, Matthews D, Kalairajah Y, Field R . Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?. Int Orthop. 2008; 33(6):1567-70. PMC: 2899163. DOI: 10.1007/s00264-008-0690-0. View

15.

Thienpont E, Schwab P, Fennema P . A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Joint J. 2014; 96-B(8):1052-61. DOI: 10.1302/0301-620X.96B8.33747. View

16.

Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H . Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res. 2000; (366):155-63. DOI: 10.1097/00003086-199909000-00019. View

17.

Thienpont E, Paternostre F, Van Wymeersch C . The indirect cost of Patient-Specific Instruments. Acta Orthop Belg. 2015; 81(3):462-70. View

18.

Keshmiri A, Maderbacher G, Baier C, Zeman F, Grifka J, Springorum H . Significant influence of rotational limb alignment parameters on patellar kinematics: an in vitro study. Knee Surg Sports Traumatol Arthrosc. 2014; 24(8):2407-14. DOI: 10.1007/s00167-014-3434-2. View

19.

Lotke P, Ecker M . Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am. 1977; 59(1):77-9. View

20.

Zhang Q, Chen J, Li H, Chai W, Ni M, Zhang Z . No evidence of superiority in reducing outliers of component alignment for patient-specific instrumentation for total knee arthroplasty: a systematic review. Orthop Surg. 2015; 7(1):19-25. PMC: 6583490. DOI: 10.1111/os.12150. View