Patient-specific positioning guides for total knee arthroplasty: no significant difference between final component alignment and pre-operative digital plan except for tibial rotation

This retrospective study was to determine if patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM) tibial guide (group 1, n=48), PSI with EM tibial guide (group 2, n=68), and conventional instrumentation (CI) group (group 3, n=50). Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9±13.6 min) compared to the CI group (group 3, 82.8±24.9 min) (P<0.001). However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3±18.8 min). This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

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Does Patient-Specific Instrumentation Improve Femoral and Tibial Component Alignment in Total Knee Arthroplasty? A Prospective Randomized Study

Advances in Experimental Medicine and Biology - Rehabilitation Science in Context ◽

10.1007/5584_2018_193 ◽

2018 ◽

pp. 11-17 ◽

Cited By ~ 5

Author(s):

Artur Stolarczyk ◽

Lukasz Nagraba ◽

Tomasz Mitek ◽

Magda Stolarczyk ◽

Jarosław Michał Deszczyński ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Randomized Study ◽

Prospective Randomized Study ◽

Patient Specific ◽

Component Alignment ◽

Patient Specific Instrumentation ◽

Tibial Component Alignment ◽

Total Knee

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No Evidence of Superiority in Reducing Outliers of Component Alignment for Patient-specific Instrumentation for Total Knee Arthroplasty: a Systematic Review

Orthopaedic Surgery ◽

10.1111/os.12150 ◽

2015 ◽

Vol 7 (1) ◽

pp. 19-25 ◽

Cited By ~ 10

Author(s):

Qing-meng Zhang ◽

Ji-ying Chen ◽

Heng Li ◽

Wei Chai ◽

Ming Ni ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Specific ◽

Component Alignment ◽

Patient Specific Instrumentation ◽

Total Knee

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Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA

The Journal of Knee Surgery ◽

10.1055/s-0040-1701453 ◽

2020 ◽

Cited By ~ 1

Author(s):

Prakrit Kumar ◽

Jacob Elfrink ◽

James P. Daniels ◽

Ajay Aggarwal ◽

James A. Keeney

Keyword(s):

Total Knee Arthroplasty ◽

Surgical Technique ◽

Knee Arthroplasty ◽

Demographic Characteristics ◽

Patient Specific ◽

Posterior Stabilized ◽

Component Alignment ◽

Cruciate Retaining ◽

Femoral Notching ◽

Total Knee

AbstractCustomized individually manufactured total knee arthroplasty (CIM-TKA) was developed to improve kinematic total knee arthroplasty (TKA) performance. Component placement accuracy may influence the success of CIM-TKA designs. We performed this study to compare radiographic component alignment and revision rates of a cruciate retaining (CR) CIM-TKA and a contemporary posterior stabilized TKA (PS-TKA). After obtaining Institutional Review Board approval, we identified 94 CR CIM-TKAs (76 patients) and 91 PS-TKAs (82 patients) performed between July 1, 2013 and December 31, 2014 with a minimum 2-year follow-up (mean 41.1 months, range 24–59 months). We performed a retrospective electronic medical record review to identify patient demographic characteristics and revision procedures performed. Postoperative plain radiographs were reviewed to assess component alignment including cruciate ligament imbalance, femoral overhang, and femoral notching. Demographic characteristics, component malalignment, and revision surgery rates were assessed using a student's t-test or two-tailed Fisher's exact test, with a p-value < 0.05 designating significance. Technical errors were more commonly identified with CR CIM-TKA (29.8 vs. 9.9%, p < 0.001), including higher rates of tibiofemoral instability (13.8 vs. 1.1%, p < 0.01), femoral notching (12.8 vs. 3.3%, p = 0.03), and patellofemoral malalignment (20.2 vs. 7.7%, p = 0.02). CR CIM-TKA had more frequent coronal plane malposition (26.6 vs. 9.9%, p < 0.01) or sagittal plane reconstruction > 3 degrees outside of an optimized range (20.2 vs. 9.9%, p = 0.06). Aseptic revisions occurred more frequently with the CR CIM-TKA design (9.6 vs. 3.3%, p = 0.13). Demographic characteristics were not significantly different between the treatment groups. CR CIM-TKA may improve kinematic performance for patients undergoing knee replacement surgery. However, our study observations suggest that careful attention to surgical technique is important for optimizing implant survivorship with the CR CIM-TKA design. Additional study is needed to determine whether higher revision rates identified during this study are related to patient selection, surgical technique, or implant design.

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Use of Shorter Intramedullary Guide for Ipsilateral Total Knee Arthroplasty following Prior Total Hip Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0037-1603796 ◽

2017 ◽

Vol 31 (04) ◽

pp. 348-351 ◽

Cited By ~ 1

Author(s):

Bradley Webb ◽

Slif Ulrich ◽

Kenneth MacKinlay ◽

Langan Smith ◽

Arthur Malkani

Keyword(s):

Total Knee Arthroplasty ◽

Total Hip Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Limb Alignment ◽

Component Alignment ◽

Total Hip ◽

Significant Difference ◽

Total Knee

AbstractAlignment after total knee arthroplasty (TKA) plays an important role with respect to patient satisfaction and implant survivorship. In patients undergoing ipsilateral TKA with prior total hip arthroplasty (THA), the femoral intramedullary (IM) guide cannot be fully inserted into the femoral canal because of the prior THA. The purpose of this study was to determine the effect of femoral component alignment using a shorter IM guide during TKA in patients with an ipsilateral THA. We identified 42 patients undergoing ipsilateral TKA with the use of a short IM guide in the setting of a prior THA. A matched cohort group was identified from our total joint registry that included 42 patients who underwent primary TKA. The surgical goal was to achieve 5 degrees of valgus on the femoral side and 0 degree on the tibial side with an overall postoperative tibial–femoral angle of 5 degrees of valgus. Patients were evaluated clinically using Knee Society pain scores (KSSs), function scores, and with radiography. Both the tibial–femoral limb alignment and the femoral component alignment were compared using Student's t-test. There were no significant differences between the two groups with respect to sex, age, body mass index (BMI), pre- and postoperative KSSs. There was a statistically significant difference between the two groups with respect to radiographic tibial–femoral limb alignment, 4.33 degrees of valgus in the short stem THA–TKA group versus 5.4 degrees of valgus in the TKA group (p < 0.04); however, this difference did not correlate to a difference in postoperative outcomes. An adequate tibial–femoral component alignment was achieved in patients undergoing ipsilateral TKA with prior THA using a shortened IM femoral guide.

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The Accuracy and Clinical Success of Robotic-Assisted Total Knee Arthroplasty

HSS Journal ® ◽

10.1177/15563316211026307 ◽

2021 ◽

pp. 155633162110263

Author(s):

Brian T. Nickel ◽

Kaitlin M. Carroll ◽

Andrew D. Pearle ◽

Laura J. Kleeblad ◽

Joost Burger ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Rating Scale ◽

High Reliability ◽

Patient Specific ◽

Component Alignment ◽

Robotic Assisted ◽

Patient Reported ◽

Total Knee

Background: Robotic-assisted total knee arthroplasty (rTKA) has emerged as a patient-specific customizable tool that enables 3-dimensional preoperative planning, intraoperative adjustment, robotic-assisted bone preparation, and soft-tissue protection. Haptic rTKA may enhance component positioning, but only a few small studies have examined patient satisfaction and clinical outcomes after haptic rTKA. Purpose: In patients who underwent haptic rTKA, we sought to evaluate (1) the discrepancy in alignment between the executed surgical plan and implanted alignment in the coronal and sagittal planes 1 year postoperatively and (2) patient-reported outcomes 2 years postoperatively. Methods: From a prospectively collected database, we reviewed 105 patients who underwent haptic rTKA from August 2016 to May 2017. Two fellowship-trained arthroplasty surgeons independently reviewed hip-to-ankle standing biplanar radiographs to measure overall limb alignment and individual tibial and femoral component alignment relative to the mechanical axis and compared this to the executed surgical plan. Patient-reported outcomes were collected preoperatively and at 2 years postoperatively using the Lower Activity Extremity Score (LEAS), Knee Injury and Osteoarthritis Outcome Score Junior (KOOS Jr.), and Numeric Pain Rating Scale (NPRS). Results: Mean patient age was 62.4 years, and mean body mass index was 30.6 kg/m2. Interobserver reliability was significant with a κ of 0.89. Absolute mean deviations in postoperative coronal alignment compared to intraoperative alignment were 0.625° ± 0.70° and 0.45° ± 0.50° for the tibia and femur, respectively. Absolute mean deviations in postoperative tibial sagittal alignment were 0.47° ± 0.76°. Overall mechanical alignment was 0.97° ± 1.79°. Outcomes in LEAS, KOOS Jr., and NPRS changed from 8 to 10, 78 to 88.3, and 8 to 1, respectively. Conclusions: Haptic rTKA demonstrated high reliability and accuracy (less than 1°) of tibial coronal, femoral coronal, and tibial sagittal component alignment postoperatively compared to the surgical plan. Patient-reported outcomes improved, as well. A more rigorous study on long-term outcomes is warranted.

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A study on radiological outcomes of accelerometer based hand held navigation system in total knee arthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201727 ◽

2020 ◽

Vol 6 (3) ◽

pp. 556

Author(s):

Hiranyakumar S. ◽

Shivaraj Nadagouda ◽

Vishnu Harikrishnan

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Navigation System ◽

Mechanical Axis ◽

Patient Specific ◽

Computer Assisted ◽

Component Alignment ◽

Patient Specific Instrumentation ◽

Wear And Tear ◽

Total Knee

Background: The goal of obtaining more accurate component alignment in total knee arthroplasty (TKA) has led to the development of techniques like portable accelerometer-based handheld navigation system, computer assisted system, patient specific instrumentation. Among which hand held navigation has showed promising results for achieving accurate resection and alignment and only few studies were done to assess radiological outcome or the effective component alignment using portable accelerometer-based hand held navigation system in TKA.Methods: TKA using portable accelerometer-based hand held navigation system (Smith and Nephew- knee align) was done on 25 knees with primary osteoarthritis. Preoperative and post-operative mechanical axis and component alignments were measured using hip-to-ankle radiographs.Results: Among the femoral components, 92.0% were placed within 90°±2° to the femoral mechanical axis in the coronal and 96.0% of the tibial components were placed within 90°±2° to the mechanical axis in the coronal plane, 94.3% of the TKAs had an overall lower extremity alignment within 3° of neutral to the mechanical axis, based on postoperative hip-to-ankle radiographs.Conclusions: The degree of accuracy in positioning the femoral and tibial component in TKA using portable accelerometer-based hand held navigation system (knee align) is very much promising and is an effective intraoperative tool for reducing the proportion of outliers for component placement and thus decreasing the chances of instability and early wear and tear of the components in TKA.

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Intra-Operative and Anatomic Verification of a TKA Computational Model for Pre-Operative Surgical Planning

10.29007/hvqg ◽

2019 ◽

Author(s):

Joshua Twiggs ◽

Edgar Wakelin ◽

Justin Roe ◽

Brett Fritsch ◽

Brad Miles

Keyword(s):

Total Knee Arthroplasty ◽

Contact Force ◽

Knee Arthroplasty ◽

Patient Specific ◽

Koos Score ◽

Significant Difference ◽

Patient Reported ◽

Joint Dynamics ◽

Operative Planning ◽

Total Knee

A promising measure of dynamic outcomes in Total Knee Arthroplasty (TKA) is the simulation of joint dynamics. These simulations are potentially useful for pre-operative planning, but are not yet validated for patient-specific variations in anatomy, which forms the aim of this paper. 284 patients from a database of total knee arthroplasty patients were analysed using a pre-operatively defined simulation predicting post-operative knee dynamics; each patient had previously undergone pre- and post-operative CT imaging and had been assessed using the Knee Injury and Osteoarthritis Outcome (KOOS) score at 6 months following surgery. A significant correlation was found between the simulated contact force and laxity in mid-flexion (r=-0.452, p<0.0001), and between the medio- lateral difference in contact force and difference in distal-vs-posterior femoral collateral ligament offset (r=-0.473, p<0.0001). A significant difference of 5 KOOS pain points (p=0.02) was found for patients with unusually low or high simulated contact force compared to normal. These results indicate the preoperative simulation is capable of distinguishing patient-specific kinematics prior to surgery, thereby demonstrating the utility of this simulation for making pre-surgical predictions of patient-specific kinematics and patient-reported outcomes.

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