scholarly journals The use of imageless navigation to quantify cutting error in total knee arthroplasty

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ran Schwarzkopf ◽  
Morteza Meftah ◽  
Scott E. Marwin ◽  
Michelle A. Zabat ◽  
Jeffrey M. Muir ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Resection ◽  
Cutting Guide ◽  
Imageless Navigation ◽  
Valgus Angle ◽  
Flexion Extension ◽  
Cutting Error ◽  
Total Knee ◽  
Implant Alignment ◽  
Resection Depth

Abstract Purpose Navigated total knee arthroplasty (TKA) improves implant alignment by providing feedback on resection parameters based on femoral and tibial cutting guide positions. However, saw blade thickness, deflection, and cutting guide motion may lead to final bone cuts differing from planned resections, potentially contributing to suboptimal component alignment. We used an imageless navigation device to intraoperatively quantify the magnitude of error between planned and actual resections, hypothesizing final bone cuts will differ from planned alignment. Materials and methods A retrospective study including 60 consecutive patients undergoing primary TKA using a novel imageless navigation device was conducted. Device measurements of resection parameters were obtained via attachment of optical trackers to femoral and tibial cutting guides prior to resection. Following resection, optical trackers were placed directly on the bone cut surface and measurements were recorded. Cutting guide and bone resection measurements of both femoral and tibial varus/valgus, femoral flexion, tibial slope angles, and both femoral and tibial medial and lateral resection depths were compared using a Student's t-test. Results Femoral cutting guide position differed from the actual cut by an average 0.6 ± 0.5° (p = 0.85) in the varus/valgus angle and 1.0 ± 1.0° (p = 0.003) in the flexion/extension angle. The difference between planned and actual cut measurements for medial and lateral femoral resection depth was 1.1 ± 1.1 mm (p = 0.32) and 1.2 ± 1.0 mm (p = 0.067), respectively. Planned cut measurements based on tibial guide position differed from the actual cut by an average of 0.9 ± 0.8° (p = 0.63) in the varus/valgus angle and 1.1 ± 1.0° (p = 0.95) in slope angle. Measurement of medial and lateral tibial resection depth differed by an average of 0.1 ± 1.8 mm (p = 0.78) and 0.2 ± 2.1 mm (p = 0.85), respectively. Conclusions Significant discrepancies between planned and actual femoral bone resection were demonstrated for flexion/extension angle, likely the result of cutting error. Our data highlights the importance of cut verification postresection to confirm planned resections are achieved, and suggests imageless navigation may be a source of feedback that would allow surgeons to intraoperatively adjust resections to achieve optimal implant alignment.

Adjustable Slot Cutting Guide for Improved Accuracy During Bone Resection in Total Knee Arthroplasty

2013 ◽  
Vol 7 (4) ◽  
Author(s):  
Thomas P. James ◽  
Owen P. McGonigle ◽  
Imran S. Hasan ◽  
Eric L. Smith
Keyword(s):  
Computer Navigation ◽  
Cutting Plane ◽  
Bone Resection ◽  
Cutting Guide ◽  
Blade Thickness ◽  
Flexion Extension ◽  
Cutting Error ◽  
Cutting Guides ◽  
Total Knee ◽  
Slot Cutting

Slotted cutting guides are used by orthopaedic surgeons to improve the accuracy of bone resection during total knee replacement. Accuracy of the saw cuts has an effect on patient mobility and on implant survival time. While computer navigation systems have improved the accuracy of cutting guide placement, the contribution to cutting error from blade toggle within the slots of the cutting guide persists. In this research, equations were derived to quantify angular cutting error based on the parameters affecting blade and cutting guide geometry. Analytically, the relationship between cutting plane error and blade thickness was determined to be linear. A smaller gap, due to thicker blades with minimal tooth offset, results in less cutting error. From an experimental standpoint, six commercially available cutting guides were tested for femoral plane cutting accuracy by resection of synthetic bone under the guidance of computer navigation. The results indicate an average flexion/extension error of 3.8 deg for a 0.89 mm thick blade and 2.0 deg for a 1.27 mm blade. Varus/valgus error due to twisting of the blade within the slot was less than 1.0 deg, regardless of blade thickness. To improve upon cutting accuracy, an adjustable slot cutting guide was designed and tested. From more closely matching slot width to blade thickness, the results indicate that cutting plane error can be reduced to less than 1.0 deg in both the flexion/extension and varus/valgus planes.

A Finite-Element Study of Metal Backing and Tibial Resection Depth in a Composite Tibia Following Total Knee Arthroplasty

2016 ◽  
Vol 138 (4) ◽  
Author(s):  
Susumu Tokunaga ◽  
Renee D. Rogge ◽  
Scott R. Small ◽  
Michael E. Berend ◽  
Merrill A. Ritter
Keyword(s):  
Finite Element ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Implant Design ◽  
Bone Resection ◽  
Element Analysis ◽  
Term Survival ◽  
Tibial Resection ◽  
Total Knee ◽  
Resection Depth

Prosthetic alignment, patient characteristics, and implant design are all factors in long-term survival of total knee arthroplasty (TKA), yet the level at which each of these factors contribute to implant loosening has not been fully described. Prior clinical and biomechanical studies have indicated tibial overload as a cause of early TKA revision. The purpose of this study was to determine the relationship between tibial component design and bone resection on tibial loading. Finite-element analysis (FEA) was performed after simulated implantation of metal backed (MB) and all-polyethylene (AP) TKA components in 5 and 15 mm of tibial resection into a validated intact tibia model. Proximal tibial strains significantly increased between 13% and 199% when implanted with AP components (p < 0.05). Strain significantly increased between 12% and 209% in the posterior tibial compartment with increased bone resection (p < 0.05). This study indicates elevated strains in AP implanted tibias across the entirety of the proximal tibial cortex, as well as a posterior shift in tibial loading in instances of increased resection depth. These results are consistent with trends observed in prior biomechanical studies and may associate the documented device history of tibial collapse in AP components with increased bone strain and overload beneath the prosthesis.

The Effects of Bone Resection Depth and Malalignment on Strain in the Proximal Tibia After Total Knee Arthroplasty

2010 ◽  
Vol 25 (2) ◽  
pp. 314-318 ◽  
Author(s):  
Michael E. Berend ◽  
Scott R. Small ◽  
Merrill A. Ritter ◽  
Christine A. Buckley
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Proximal Tibia ◽  
Bone Resection ◽  
Total Knee ◽  
Resection Depth

scholarly journals The Effect of Femoral Cutting Guide Design Improvements for Patient-Specific Instruments

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Oh-Ryong Kwon ◽  
Kyoung-Tak Kang ◽  
Juhyun Son ◽  
Yun-Jin Choi ◽  
Dong-Suk Suh ◽  
...  
Keyword(s):  
Motion Artifacts ◽  
Patient Specific ◽  
Bone Resection ◽  
Cutting Guide ◽  
Patient Specific Instruments ◽  
Mri Scans ◽  
Total Knee ◽  
Magnetic Resonance Imaging Mri ◽  
The Cost ◽  
Implant Alignment

Although the application of patient-specific instruments (PSI) for total knee arthroplasty (TKA) increases the cost of the surgical procedure, PSI may reduce operative time and improve implant alignment, which could reduce the number of revision surgeries. We report our experience with TKA using PSI techniques in 120 patients from March to December 2014. PSI for TKA were created from data provided by computed tomography (CT) scans or magnetic resonance imaging (MRI); which imaging technology is more reliable for the PSI technique remains unclear. In the first 20 patients, the accuracy of bone resection and PSI stability were compared between CT and MRI scans with presurgical results as a reference; MRI produced better results. In the second and third groups, each with 50 patients, the results of bone resection and stability were compared in MRI scans with respect to the quality of scanning due to motion artifacts and experienced know-how in PSI design, respectively. The optimized femoral cutting guide design for PSI showed the closest outcomes in bone resection and PSI stability with presurgical data. It is expected that this design could be a reasonable guideline in PSI.

scholarly journals Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Dongquan Shi ◽  
Xingquan Xu ◽  
Anyun Guo ◽  
Jin Dai ◽  
Zhihong Xu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Mechanical Alignment ◽  
Early Loosening ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted.Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement.Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P=0.03).Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

An imaging measurement study of normal knee parameters in southeast China

2021 ◽  
Vol 17 ◽  
Author(s):  
Huitong Liu ◽  
Bingqiang Xu ◽  
Eryou Feng ◽  
Shizhang Liu ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Age Groups ◽  
Young Group ◽  
Normal Female ◽  
Valgus Angle ◽  
Significant Difference ◽  
Total Knee

Background: Imaging measurement of distal femur and proximal tibia has been the hot point in the research of total knee arthroplasty and prosthesis development, which is an important treatment for patients with advanced knee joint disease. This study retrospectively investigated the digital imaging measurement of normal knee parameters in southeast China and evaluated their clinical value. Methods: From February 2010 to May 2014, and in accordance with the inclusion criteria, a total of 677 knees (334 female knees and 343 male knees) were categorized into 3 age groups. Clinical and digital imaging data, including the distal femoral condyle diameter (FCD), tibial plateau diameter (TPD), the distance between the medial tibial plateau and fibular head (DPF), tibiofemoral valgus angle, distal femoral valgus angle, proximal tibia (PT) varus angle and the angle from femoral condyle to tibial perpendicular (FT), were measured by using AutoCAD 10.0 software. All measured variables were statistically analyzed by SPSS statistical software (version 18.0). Results: Data are presented as the mean ± standard deviation. The normal female and male femoral condyle diameter was (7.69 ± 0.46) cm and (8.68 ± 0.55) cm, while the normal female and male tibial plateau diameter was (7.66 ± 0.46) cm and (8.60 ± 0.55) cm, respectively. The normal female and male DPF was (0.76 ± 0.36) cm and (0.79 ± 0.36) cm. For females and males, the tibiofemoral valgus angle and distal femoral valgus angle were (3.89 ± 2.20) ° and (3.29 ± 2.12) °, (9.03 ± 2.18) ° and (8.25 ± 2.20) °. As the two methods to measure tibial plateau varus angle, PT angle of normal female and male was (4.29 ± 1.86) ° and (4.84 ± 2.23) °, while the normal female and male FT angle was (5.34 ± 1.95) ° and (5.52 ± 2.07) °. Based on the data obtained, we found significant differences between the two genders in terms of the femoral condyle diameter and tibial plateau diameter in all age groups (P < 0.01). The DPF parameter showed an obvious difference between the young group and the middle-aged group (P < 0.05), and no significant difference was observed between the sides and genders (P > 0.05). The distal femoral valgus angle showed statistical differences between genders in the left side of the young group and middle-aged group (P < 0.05), while angle PT and FT showed no significant difference (P > 0.05). Conclusion: A large number of knee measurements was obtained, and a local knee database was developed in this study. Imaging measurement prior to total knee arthroplasty is clinically important for increasing the accuracy and long-term efficacy of total knee arthroplasty. These data can also provide useful information for knee surgery and sports medicine as well as prosthesis development.

scholarly journals Patients' Perception of Bone and Tissue Excision, and the Size and Weight of Prostheses at Total Knee Arthroplasty

2017 ◽  
Vol 03 (03) ◽  
pp. e110-e112
Author(s):  
Benjamin Rossi ◽  
Narlaka Jayasekera ◽  
Fionnuala Kelly ◽  
Keith Eyres
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Recovery ◽  
Patient Perception ◽  
Femoral Bone ◽  
Bone Resection ◽  
Orthopaedic Literature ◽  
Total Knee ◽  
A Prospective Study ◽  
Revision Tka

AbstractThe aim of this study is to ascertain patients' perception of the amount of bone and tissue excision and size and weight of their implanted prostheses at total knee arthroplasty (TKA). To our knowledge, no prior study in the English orthopaedic literature has analyzed these parameters against patient perception of TKA. In a prospective study of eight consecutive TKA (six primary and two single-stage revision TKA procedures) by a single surgeon, patients estimated the weight of their implanted knee. We assessed actual weights of their implants and bone cement. Patients estimated the size of their prostheses by sketching the tibial and femoral bone cuts upon a printout of an anteroposterior and lateral radiographs of their preoperative knee. We utilized an articulated plastic model knee for patient reference. Our study shows almost half a kilogram of weight is added postoperatively to the surgical site as a result of tissue excision, explanted material, and implanted prosthesis and cement. All patients overestimated the weight of their implanted prostheses and extent of bone excision. Thus, even ‘well-informed’ patients overestimate their bone resection and weight of implanted prosthesis at TKA. We postulate such misconceptions among TKA patients are common, and may impact negatively upon patient perception of TKA, their postoperative recovery and outcome.

Surgical Variability of Resection Parameters During Total Knee Arthroplasty

2012 ◽  
Author(s):  
Yifei Dai ◽  
Adam Henderson ◽  
Joern Seebeck ◽  
Jeffrey E. Bischoff
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Morphological Analysis ◽  
Bone Resection ◽  
Component Placement ◽  
Clinical Applicability ◽  
Component Design ◽  
Total Knee ◽  
Computational Analyses ◽  
Single Set

There is intrinsic surgical variability in the practice of total knee arthroplasty (TKA), and thus computational analyses of TKA should account for this variability to ensure clinical applicability and robustness of results. Statistical inputs within computational analyses have been used to assess the biomechanical characteristics of TKA implants [1], and such methodologies are promising when applied to morphological analysis of TKA in order to motivate component design, assess current designs, and improve the understanding of surgical outcomes. Analyses to date either directly use actual TKA component placement or bone resection data [2], or assume a single set of parameters for placement and resection across the entire specimen group that was investigated [3], and thus do not account for surgical variability. This could be due to a lack of available data to quantify clinical variability in TKA component placement.

Sign in / Sign up

Export Citation Format

Share Document