Magnetic resonance imaging (MRI) or computed tomography-based patient-specific instrumentation (PSI) may allow for reliable alignment and fewer outliers when compared with conventionally instrumented total knee arthroplasty (TKA). However, some authors have suggested that frequent intraoperative surgeon-directed changes may still be required. This study evaluated the accuracy of PSI to predict component sizing and alignment during TKA. A total of 84 patients (89 knees) who underwent a TKA using a PSI system were evaluated. An MRI-based preoperative plan of every knee was provided and approved by the surgeons. This demonstrated the proposed prosthetic component alignment, as well as the femoral, tibial, and bearing insert component size and position. Intraoperative changes to these components were prospectively recorded and compared with the computerized preoperative plan. Major changes were defined as any changes in femoral or tibial resection, size, and position of the components. Minor changes were defined as any change in the size of the polyethylene bearing insert. The preoperative plan was able to correctly predict the size of the implanted tibial and femoral component in 93 and 95.5% of the cases, respectively. Thirteen major intraoperative changes were made. In one knee, the proposed femoral resection was not acceptable (because of the presence of significant amount of osteophytes) and was abandoned in favor of a manual extramedullary guide. In another patient, the proposed femoral and tibial components were upsized. In two other patients, the femoral components were downsized, in four patients, the tibial components were downsized, and in another patient, it was upsized. There were also 16 minor changes, which included 2-mm upsizing of the polyethylene liner in 13 knees and 4-mm upsizing in 3 knees. Surgical experience is necessary to recognize improper component size, incorrect surgical resection, or nonideal alignment when performing TKA using PSI. The authors believe that the design and manufacture of PSI combined with a comprehensive templating resulted in excellent intraoperative concordance of the preoperative plan at the default settings with minimal changes.
Patients who receive hip arthroplasty today desire prostheses that not only have great longevity, but are also suitable for a very active lifestyle. Advances in metallurgy, tribologic behavior, surgical technique, as well as improvements in strength and microstructure, have made ceramic-on-ceramic and metal-on-metal bearings available for young patients requiring a great deal of mobility. The purpose of this study was to assess if the bearing surface had an effect, if any, on postoperative activity levels and clinical outcomes in patients receiving three different types of hip arthroplasty. This study includes three groups of 30 patients who had each received conventional metal-on-polyethylene total hip arthroplasty (THA), ceramic-on-ceramic THA, or hip resurfacing arthroplasty. All groups were matched by men to women ratio, age, body mass index, diagnosis, preoperative activity levels, and length of follow-up. Clinical outcomes evaluated included weighted postoperative activity levels, Harris hip scores, patient satisfaction scores, revision rates, and complication rates. Patients who had received a metal-on-metal resurfacing had achieved significantly higher activity scores (mean 10.5 points; range, 1-28 points) compared to patients who had received ceramic-on-ceramic (mean 6.9 points; range, 0-34 points) or metal-on-polyethylene bearings (mean 5.6 points; range, 1-18 points). The mean postoperative Harris hip scores (94 vs 92 vs 91 points), patient satisfaction scores (9 vs 8.4 vs 8.3 points), aseptic revision (3% vs 0% vs 0%), and complication rates (3% vs 3% vs 3%) were similar between resurfacing, ceramic-on-ceramic, and metal-on-polyethylene bearing groups, respectively. This study showed that in cohorts of similarly matched arthroplasty patients in multiple demographics factors and preoperative activity levels, metal-on-metal resurfacing arthroplasty may offer higher postoperative activity levels. For patients with higher activity levels, resurfacing arthroplasty may be advantageous compared to other types of bearings.
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