A Retrospective Study Comparing a Patient-specific Design Total Knee Arthroplasty With an Off-the-Shelf Design: Unexpected Catastrophic Failure Seen in the Early Patient-specific Design

Overview

Journal J Am Acad Orthop Surg Glob Res Rev

Specialty Orthopedics

Date 2019 Dec 26

PMID 31875200

Citations 7

Authors

Carlos J Meheux

Kwan J Park

Terry A Clyburn

Affiliations

Soon will be listed here.

Abstract

Methods: Retrospective study analyzing PSD and OTS by a single surgeon. Implant design change in PSD occurred during the period of data collection leading to PSD-1 and PSD-2 subgroups. Radiographic data including MAA, femorotibial angle, coronal-tibial angle, tibial slope and patella-sulcus angle, and complications were analyzed. Minimum follow-up was 2 years or until revision, and patients completed Knee Society scores preoperatively and postoperatively at 3, 6, 12, 24 weeks, and final follow-up.

Results: There were 136 patients (154 knees), average age (62.76 +/- 8.4 years), and follow-up (3.1 +/- 1.5 years). The groups included PSD-1 (77 knees), PSD-2 (36 knees), and OTS (41 knees). The PSD-2 group had better Knee Society function scores compared with PSD-1 and OTS at all timepoints except final follow-up. PSD-2 had significantly shorter hospital stay ( = 0.000012) and less hemoglobin drop ( = 0.032) compared with PSD-1 and OTS. No differences were observed in MAA (P = 0.349) or final range of motion (P = 0.629) between the 3 groups. PSD-2 had more normal femorotibial angle, coronal-tibial angle, and tibial slope compared with PSD-1 and OTS. Failures requiring revision were 23% (18/77) PSD-1, 0% PSD-2, and 3% (1/35) OTS. Most common modes of failure were tibial subsidence (56%) and polyethylene locking mechanism failure (22%) in PSD-1.

Conclusion: Catastrophic failure was seen in the PSD-1 group with tibial subsidence and polyethylene locking mechanism failure. PSD-2 had better early Knee Society function scores, shorter hospital stay, lower hemoglobin drop, radiographic alignment, and no failures compared with PSD-1 and OTS.

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References

Schroeder L, Martin G . In Vivo Tibial Fit and Rotational Analysis of a Customized, Patient-Specific TKA versus Off-the-Shelf TKA. J Knee Surg. 2018; 32(6):499-505. DOI: 10.1055/s-0038-1653966. View

Liu S, Long H, Zhang Y, Ma B, Li Z . Meta-Analysis of Outcomes of a Single-Radius Versus Multi-Radius Femoral Design in Total Knee Arthroplasty. J Arthroplasty. 2015; 31(3):646-54. DOI: 10.1016/j.arth.2015.10.017. View

Wylde V, Dieppe P, Hewlett S, Learmonth I . Total knee replacement: is it really an effective procedure for all?. Knee. 2007; 14(6):417-23. DOI: 10.1016/j.knee.2007.06.001. View

Oberbek J, Synder M . Impact of Body Mass Index (BMI) on Early Outcomes of Total Knee Arthroplasty. Ortop Traumatol Rehabil. 2015; 17(2):127-34. DOI: 10.5604/15093492.1157089. View

Callaghan J, Wells C, Liu S, Goetz D, Johnston R . Cemented rotating-platform total knee replacement: a concise follow-up, at a minimum of twenty years, of a previous report. J Bone Joint Surg Am. 2010; 92(7):1635-9. DOI: 10.2106/JBJS.I.01012. View

Cherian J, Kapadia B, Banerjee S, Jauregui J, Issa K, Mont M . Mechanical, Anatomical, and Kinematic Axis in TKA: Concepts and Practical Applications. Curr Rev Musculoskelet Med. 2014; 7(2):89-95. PMC: 4092202. DOI: 10.1007/s12178-014-9218-y. View

Bourne R, Chesworth B, Davis A, Mahomed N, Charron K . Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res. 2009; 468(1):57-63. PMC: 2795819. DOI: 10.1007/s11999-009-1119-9. 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

Lombardi Jr A, Berend K, Adams J . Patient-specific approach in total knee arthroplasty. Orthopedics. 2008; 31(9):927-30. DOI: 10.3928/01477447-20080901-21. View

10.

Fitz W . Unicompartmental knee arthroplasty with use of novel patient-specific resurfacing implants and personalized jigs. J Bone Joint Surg Am. 2009; 91 Suppl 1:69-76. DOI: 10.2106/JBJS.H.01448. View

11.

Goyal T, Tripathy S . Does Patient-Specific Instrumentations Improve Short-Term Functional Outcomes After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis. J Arthroplasty. 2016; 31(10):2173-80. DOI: 10.1016/j.arth.2016.03.047. View

12.

Scott C, Howie C, MacDonald D, Biant L . Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br. 2010; 92(9):1253-8. DOI: 10.1302/0301-620X.92B9.24394. View

13.

Daniilidis K, Yao D, Gosheger G, Berssen C, Budny T, Dieckmann R . Does BMI influence clinical outcomes after total knee arthroplasty?. Technol Health Care. 2016; 24(3):367-75. DOI: 10.3233/THC-151128. View

14.

Li N, Tan Y, Deng Y, Chen L . Posterior cruciate-retaining versus posterior stabilized total knee arthroplasty: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2012; 22(3):556-64. DOI: 10.1007/s00167-012-2275-0. View

15.

Lee W, Kwan Y, Chong H, Yeo S . The minimal clinically important difference for Knee Society Clinical Rating System after total knee arthroplasty for primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016; 25(11):3354-3359. DOI: 10.1007/s00167-016-4208-9. View

16.

Kopinski J, Aggarwal A, Nunley R, Barrack R, Nam D . Failure at the Tibial Cement-Implant Interface With the Use of High-Viscosity Cement in Total Knee Arthroplasty. J Arthroplasty. 2016; 31(11):2579-2582. DOI: 10.1016/j.arth.2016.03.063. View

17.

Wilson T . The measurement of patellar alignment in patellofemoral pain syndrome: are we confusing assumptions with evidence?. J Orthop Sports Phys Ther. 2007; 37(6):330-41. DOI: 10.2519/jospt.2007.2281. View

18.

Thienpont E, Schwab P, Fennema P . Efficacy of Patient-Specific Instruments in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am. 2017; 99(6):521-530. DOI: 10.2106/JBJS.16.00496. View

19.

Culler S, Martin G, Swearingen A . Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty. Arthroplast Today. 2017; 3(4):257-263. PMC: 5712025. DOI: 10.1016/j.artd.2017.05.001. View

20.

Slamin J, Parsley B . Evolution of customization design for total knee arthroplasty. Curr Rev Musculoskelet Med. 2012; 5(4):290-5. PMC: 3702756. DOI: 10.1007/s12178-012-9141-z. View