Clinical Efficacy of Preoperative CT-Assisted Planning for Primary Total Knee Arthroplasty: A Pilot Randomized Clinical Trial

Abstract

This study aims to determine the mean posterior condylar angle (PCA) in the included population and its relation to coronal alignment; and to know the clinical importance of the use of preoperative computed tomography (CT) scan in total knee arthroplasty (TKA). We randomized 50 patients with primary knee osteoarthritis into 2 groups. We used CT scan axial images to measure the PCA. In the first group we followed the CT scan plan (group 1), but in the second we did not follow the plan and adjusted rotation to the standard three degrees (group 2). The mean age of the included patients was 63 years. The radiological data of the included patients showed 5 patients with valgus deformity and 45 patients with varus deformity with the mean coronal alignment of 7.5 degrees. CT scan showed the mean PCA of 3.7 degrees (1.3 degrees). The axial knee postoperative X-ray showed the mean patellar tilt angle of 2.1 degrees (0.5 degrees) and 1.9 degrees (0.5 degrees) in groups 1 and 2, respectively. The congruence angle was 4 degrees (2.6 degrees) in group 1 and 5.5 degrees (3.2 degrees) in group 2. The median Knee Society functional score in group 1 was 85 (12), while it was 84 (7.5) in group 2. The median postoperative Western Ontario and McMaster Universities Arthritis Index score in group 1 was 84 (18.6) whereas 80.2 (13.6) in group 2. The median postoperative Bartlett score in group 1 was 30 (5), while it was 30 (6) in group 2. The use of preoperative CT scan did not improve the patient functional scores after TKA.

The CT knee arthrogram revisited

“… 8 In addition, preoperative non-contrast CT imaging is very useful for accurate size measurements for total Knee Arthroplasty. 9 …”

Machine Learning for Opportunistic Screening for Osteoporosis and Osteopenia Using Knee CT Scans

“…27,28 While CT scans of the knee are often used for the evaluation of trauma/suspected fracture and arthritis, a growing number of CT scans are used for the evaluation of the knee prior to total knee arthroplasty (TKA) because CT scans have been found to better characterize and detect osteoarthritic changes and better predict prosthetic sizes preoperatively. [29][30][31][32] Prior research has suggested that fully cemented primary implants with stem extensions should be considered for use in osteoporotic TKA patients to reduce the risk of micromotion and loosening. [33][34][35][36][37][38][39][40] Low BMD has been associated with intraoperative and periprosthetic fractures, component migration, and aseptic loosening in patients with TKA.…”