Accuracy of a Novel 3D‐Printed Patient‐Specific Intramedullary Guide to Control Femoral Component Rotation in Total Knee Arthroplasty

Abstract

Objective: Total knee arthroplasty (TKA) is one of the most universal and effective means for treating terminal stage osteoarthritis (OA) of knee. Accurate intramedullary guide of femur is the basis for the distal femoral cuts. Determining the surgical transepicondylar axis (sTEA) is the key to reconstruction of the femoral rotational alignment, because the correct rotational alignment can place the femoral component in the right position, balance the flexion gap so that the inner and outer tension is equal, get stability during the flexion process of the knee, and enhance the quality of life of patients. With the development of three-dimensional printing (3DP) technology in the medical domain, the application of patient-specific instrumentation (PSI) in arthroplasty has become more common. The aim of this study was to evaluate the accuracy of a novel 3D-printed patient-specific intramedullary guide to control femoral component rotation in TKA.Methods: Eighty patients (65 females and 15 males) with knee OA were included in this prospective randomized study. The patients were divided into two groups by random number table method, 40 in each group. TKA assisted by PSI (PSI group) and conventional TKA (conventional group) was performed respectively. Clinical outcomes [operation time, postoperative drainage volume, duration of drainage, Hospital for Special Surgery knee score (HSS), American Knee Society knee score (AKS)] and radiological outcomes [hip-knee-ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis-femoral transepicondylar axis angle (PFA), depth of intramedullary guide] were compared between and within the two groups.Results: PSI group had less postoperative drainage volume but longer operation time than the conventional group (P < 0.05). The AKS and HSS scores after surgery were improved compared with those before surgery in each group (P < 0.05). However, there was no significant difference in the duration of drainage and range of motion (ROM) after surgery between the two groups. For the radiological results, the HKA and PFA were improved after surgery in both groups (P < 0.05).The postoperative PFA and PCA of the PSI group were closer to 0 , which was better than that of the conventional group (P < 0.05). The depth of intramedullary guide in the PSI group was less than the conventional group (P < 0.05). But there was no significant difference in HKA before and after surgery between the two groups as well as the preoperative PFA. Conclusion:The short-term clinical efficacy of TKA assisted by PSI was similar to the conventional TKA. Although TKA assisted by PSI spent more time during operation, it could assist in intramedullary guide and align femoral rotation more accurately.

Effect of Femoral Nerve Block with Different Concentrations of Chloroprocaine on the Recovery of Joint Function in Rehabilitation Training after Knee Replacement: A Prospective, Double-Blind, Randomized, Controlled Clinical Study

“…Thus, in our study, we further compared the number of patients with a knee exion angle above 100° in the three groups, and we found that there were more patients in groups C1 and C2 than in the control group on the 7th day and at 3 months after surgery. AKS scoring is a commonly used method to evaluate knee joint function [7,8].…”

3D Printing Technology for Biomedical Practice: A Review

“…However, researchers are focused on the design and fabrication of high wear-and tear-resistant biomedical implants to overcome the pain of osteoarthritis (OA) patients (Ref [19][20][21], whereas many researchers presented metal, composite materials fabricated through laser sintering technique using Ti-6Al-4V with nano-cBN/TiO 2 reinforcements (Ref [22][23][24][25][26]. The author reported that on adding nano-cBN/TiO 2 reinforcements, the service life of the implant increased very significantly.…”

Emerging trend in manufacturing of 3D biomedical components using selective laser sintering: A review

“…In addition to this, the investigation can also be carried out on the effects of the shape and size of the reinforced particle in the base powder on the performance of the biomedical components. 88.7 ± 1.5 MPa 1.31 ± 0.2 g/cm 3 Average asperity height: 24.5 μm ----- [22] 101.03MPa Volume fraction: 31%…”

“…There are various types of additive manufacturing state-of-the-art and techniques in the design and development of various 3D components [1,2]. Recently, researchers are involved in the design and fabrication of improved biomedical implants used in knee and hip joint replacement for Osteoarthritis (OA) patients [3][4][5]. Osteoarthritis (OA) is a form of degenerative joint pain caused by wear and tear on joints.…”