Three-dimensional analysis of accuracy of patient-matched instrumentation in total knee arthroplasty: Evaluation of intraoperative techniques and postoperative alignment

AbstractThis study aimed to investigate whether overhang or underhang around the tibial component that occurs during the placement of tibial baseplates was affected by different slope angles of the tibial plateau and determine the changes in the lateral and medial plateau diameters while changing the slope angle in total knee arthroplasty. Three-dimensional tibia models were reconstructed using the computed tomography scans of 120 tibial dry bones. Tibial plateau slope cuts were performed with 9, 7, 5, 3, and 0 degrees of slope angles 2-mm below the subchondral bone in the deepest point of the medial plateau. Total, lateral, and medial tibial plateau areas and overhang/underhang rates were measured at each cut level. Digital implantations of the asymmetric and symmetric tibial baseplates were made on the tibial plateau with each slope angles. Following the implantations, the slope angle that prevents overhang or underhang at the bone border and the slope angle that has more surface area was identified. A significant increase was noted in the total tibial surface area, lateral plateau surface area, and lateral anteroposterior distance, whereas the slope cut angles were changed from 9 to 0 degrees in both gender groups. It was found that the amount of posteromedial underhang and posterolateral overhang increased in both the asymmetric and symmetric tibial baseplates when the slope angle was changed from 0 to 9 degrees. Although the mediolateral diameter did not change after the proximal tibia cuts at different slope angles, the surface area and anteroposterior diameter of the lateral plateau could change, leading to increased lateral plateau area. Although prosthesis designs are highly compatible with the tibial surface area, it should be noted that the component overhangs, especially beyond the posterolateral edge, it can be prevented by changing the slope cut angle in males and females.

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Finite-element analysis of the proximal tibial sclerotic bone and different alignment in total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3008-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Ye-Ran Li ◽

Yu-Hang Gao ◽

Chen Yang ◽

Lu Ding ◽

Xuebo Zhang ◽

...

Keyword(s):

Finite Element ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Three Dimensional ◽

Genu Varum ◽

Sclerotic Bone ◽

Dimensional Measurements ◽

Tibial Cut ◽

Total Knee

Abstract Background Despite potential for improving patient outcomes, studies using three-dimensional measurements to quantify proximal tibial sclerotic bone and its effects on prosthesis stability after total knee arthroplasty (TKA) are lacking. Therefore, this study aimed to determine: (1) the distribution range of tibial sclerotic bone in patients with severe genu varum using three-dimensional measurements, (2) the effect of the proximal tibial sclerotic bone thickness on prosthesis stability according to finite-element modelling of TKA with kinematic alignment (KA), mechanical alignment (MA), and 3° valgus alignment, and (3) the effect of short extension stem augment utilization on prosthesis stability. Methods The sclerotic bone in the medial tibial plateau of 116 patients with severe genu varum was measured and classified according to its position and thickness. Based on these cases, finite-element models were established to simulate 3 different tibial cut alignments with 4 different thicknesses of the sclerotic bone to measure the stress distribution of the tibia and tibial prosthesis, the relative micromotion beneath the stem, and the influence of the short extension stem on stability. Results The distribution range of proximal tibial sclerotic bone was at the anteromedial tibial plateau. The models were divided into four types according to the thickness of the sclerotic bone: 15 mm, 10 mm, 5 mm, and 0 mm. The relative micromotion under maximum stress was smallest after MA with no sclerotic bone (3241 μm) and largest after KA with 15 mm sclerotic bone (4467 μm). Relative micromotion was largest with KA and smallest with MA in sclerotic models with the same thickness. Relative micromotion increased as thickness of the sclerotic bone increased with KA and MA (R = 0.937, P = 0.03 and R = 0.756, P = 0.07, respectively). Relative micromotion decreased with short extension stem augment in the KA model when there was proximal tibial sclerotic bone. Conclusions The influence of proximal tibial sclerotic bone on prosthesis’s stability is significant, especially with KA tibial cut. Tibial component’s short extension stem augment can improve stability.

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Knee motion symmetry was not restored in patients with unilateral bi-cruciate retaining total knee arthroplasty—in vivo three-dimensional kinematic analysis

International Orthopaedics ◽

10.1007/s00264-018-3986-8 ◽

2018 ◽

Vol 42 (12) ◽

pp. 2817-2823 ◽

Cited By ~ 10

Author(s):

Paul Arauz ◽

Yun Peng ◽

Young-Min Kwon

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Kinematic Analysis ◽

Three Dimensional ◽

Knee Motion ◽

Cruciate Retaining ◽

Total Knee

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Qualitative and quantitative analysis of patellar vascular anatomy by novel three-dimensional micro-computed-tomography: Implications for total knee arthroplasty

The Knee ◽

10.1016/j.knee.2019.02.003 ◽

2019 ◽

Vol 26 (6) ◽

pp. 1330-1337 ◽

Cited By ~ 4

Author(s):

Dingyu Wang ◽

Zhongcheng Shen ◽

Dong Jiang ◽

Xu Li ◽

Xuan Fang ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Quantitative Analysis ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Vascular Anatomy ◽

Qualitative And Quantitative Analysis ◽

Micro Computed Tomography ◽

Qualitative And Quantitative ◽

Total Knee

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Three-dimensional printed porous tantalum prosthesis for treating inflammation after total knee arthroplasty in one-stage surgery – a case report

Journal of International Medical Research ◽

10.1177/0300060519891280 ◽

2019 ◽

Vol 48 (3) ◽

pp. 030006051989128

Author(s):

Fuyou Wang ◽

Hao Chen ◽

Pengfei Yang ◽

Aikeremujiang Muheremu ◽

Peng He ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Chronic Inflammation ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Bone Defects ◽

Left Knee ◽

Severe Osteoporosis ◽

Porous Tantalum ◽

3D Printed ◽

Total Knee

Chronic inflammation and bone defects after total knee arthroplasty are a challenge for the orthopedic surgeon. There have been few reports on application of a three-dimensional (3D) printed porous tantalum prosthesis in such situations. We report an 83-year-old female patient who presented to our clinic with consistent pain of the left knee for 10 years and a severe decline in mobility for 2 years. Chronic inflammation, loosening of a tibial prosthesis with a bone defect, and severe osteoporosis were diagnosed. The patient was treated with computer designed and manufactured, personalized, 3D printed porous pure tantalum pad-assisted left total knee arthroplasty. The surgery went smoothly and the patient achieved a satisfactory recovery after surgery. A 3D printed porous tantalum prosthesis can be used to reconstruct tibial bone defects in patients with chronic inflammation after joint replacement surgeries.

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