scholarly journals Patient-specific instrumentation improved three-dimensional accuracy in total knee arthroplasty: a comparative radiographic analysis of 1257 total knee arthroplasties

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Leo Pauzenberger ◽  
Martin Munz ◽  
Georg Brandl ◽  
Julia K. Frank ◽  
Philipp R. Heuberer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Three Dimensional ◽  
Mobile Bearing ◽  
Patient Specific ◽  
Limb Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

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.

Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty

The Knee ◽  
2020 ◽  
Vol 27 (5) ◽  
pp. 1501-1509
Author(s):  
Jordan S. Broberg ◽  
Douglas D.R. Naudie ◽  
James L. Howard ◽  
Edward M. Vasarhelyi ◽  
Richard W. McCalden ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Contact Kinematics ◽  
Conventional Instrumentation ◽  
Total Knee

scholarly journals Acute Perioperative Comparison of Patient-Specific Instrumentation versus Conventional Instrumentation Utilization during Bilateral Total Knee Arthroplasty

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Jerrod A. Steimle ◽  
Michael T. Groover ◽  
Brad A. Webb ◽  
Brian J. Ceccarelli
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Bilateral Total Knee Arthroplasty ◽  
Discharge Disposition ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
Total Knee

Utilizing patient-specific instrumentation during total knee arthroplasty has gained popularity in recent years with theoretical advantages in blood loss, intraoperative time, length of stay, postoperative alignment, and functional outcome, amongst others. No study has compared acute perioperative measures between patient-specific instrumentation and conventional instrumentation in the bilateral total knee arthroplasty setting. We compared patient-specific instrumentation versus conventional instrumentation in the setting of bilateral total knee arthroplasty to determine any benefits in the immediate perioperative period including surgical time, blood loss, pain medication use, length of stay, and discharge disposition. A total of 49 patients with standard instrumentation and 31 patients with patient-specific instrumentation were retrospectively reviewed in a two-year period at one facility. At baseline, the groups were comparable with respect to age, ASA, BMI, and comorbid conditions. We analyzed data on operative time, blood loss, hemoglobin change, need for transfusion, pain medication use, length of stay, and discharge disposition. There was no statistically significant difference between groups in regards to these parameters. Patient-specific instrumentation in the setting of bilateral total knee arthroplasty did not provide any immediate perioperative benefit compared to conventional instrumentation.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

2018 ◽  
Vol 32 (06) ◽  
pp. 483-489 ◽  
Author(s):  
Davide Cucchi ◽  
Alessandra Menon ◽  
Beatrice Zanini ◽  
Riccardo Compagnoni ◽  
Paolo Ferrua ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Significant Treatment ◽  
Longitudinal Measurements ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Conventional Instrumentation ◽  
Total Knee

AbstractPatient-specific instrumentation (PSI) may contribute to reduced blood loss related to total knee arthroplasty (TKA). The purpose of this study was to compare the estimated hemoglobin (Hb) and red blood cell volume (RBC) losses in two groups of patients undergoing TKA with PSI and conventional instrumentation. Pre- and postoperative blood samples were collected from 22 patients randomly assigned to receive a PSI-assisted or conventional TKA. Post- to preoperative Hb difference was calculated and RBC loss was estimated according to Sehat et al. A significant difference in Hb reduction in favor of the PSI group was registered on the last day of stay (p = 0.0084) and significant treatment effect (p = 0.027) on Hb reduction after intervention was found with a regression model for longitudinal measurements. This study demonstrated that PSI leads to a significant trend in earlier Hb regain. These promising results suggest a beneficial effect of PSI in blood loss reduction.

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