Clinical Study of 3D Imaging and 3D Printing Technique for Patient-Specific Instrumentation in Total Knee Arthroplasty

Qiu, Bing; Liu, Fei; Tang, Bo‐Hui; Deng, Biyong; Liu, Fang; Zhu, Weimin; Zhen, Dong; Xue, Mingyuan; Zhang, Mingjiao

doi:10.1055/s-0036-1597980

Cited by 27 publications

(9 citation statements)

References 40 publications

(35 reference statements)

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“…In the Knee Joint, most investigations conducted are focused predominantly on total knee arthroplasty (TKA) and their importance in the development of patientspecific instrumentation (PSI), and custom-made implants [8][9][10]. Nevertheless, anterior cruciate ligament (ACL) tear remains the most frequently performed intra-articular surgery in orthopedic trauma [11,12].…”

Section: Introductionmentioning

confidence: 99%

Multi-color and Multi-Material 3D Printing of Knee Joint models

Ruiz

Dhaher

2021

3D Print Med

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Objective This study reports on a new method for the development of multi-color and multi-material realistic Knee Joint anatomical models with unique features. In particular, the design of a fibers matrix structure that mimics the soft tissue anatomy. Methods Various Computer-Aided Design (CAD) systems and the PolyJet 3D printing were used in the fabrication of three anatomical models wherein fibers matrix structure is mimicked: (i) Anterior cruciate ligament reconstruction (ACL-R) model used in the previous study. (ii) ACL-R model, incorporating orientations, directions, locations, and dimensions of the tunnels, as well as a custom-made surgical guide (SG) for avoiding graft tunnel length mismatch. (iii) Total knee arthroplasty (TKA) model, including custom-made implants. Before models 3D printing, uni-axial tensile tests were conducted to obtain the mechanical behaviors for individual No. 1 (A60-A50), No. 2 (A50-A50), No. 3 (A50-A40), and No. 4 (A70-A60) soft tissue-mimicking polymers. Each material combination represents different shore-hardness values between fiber and matrix respectively. Results We correlated the pattern of stress-strain curves in the elastic region, stiffness, and elastic modulus of proposed combinations with published literature. Accordingly, material combinations No. 1 and No. 4 with elastic modules of 0.76-1.82 MPa were chosen for the soft tissues 3D printing. Finally, 3D printing Knee Joint models were tested manually simulating 50 flexo-extension cycles without presenting ruptures. Conclusion The proposed anatomical models offer a diverse range of applications. These may be considered as an alternative to replacing cadaver specimens for medical training, pre-operative planning, research and education purposes, and predictive models validation. The soft tissue anatomy-mimicking materials are strong enough to withstand the stretching during the flexo-extension. The methodology reported for the design of the fiber-matrix structure might be considered as a start to develop new patterns and typologies that may mimic soft tissues.

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Section: Introductionmentioning

confidence: 99%

Multi-color and Multi-Material 3D Printing of Knee Joint models

Ruiz

Dhaher

2021

3D Print Med

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“…Six RCTs evaluated the accuracy of femoral rotation by comparing the outliers between the PSI and conventional instrumentation groups [17, 26, 27, 33, 34, 36]. Thirteen articles were used to evaluate the accuracy of femoral coronal plane alignment between the PSI and conventional groups [1, 4, 8, 10, 12, 18, 27–29, 33, 34, 36, 37]. Twelve studies evaluated the accuracy of tibial coronal plane alignment between different groups [1, 4, 5, 12, 18, 27–29, 33, 34, 36, 37].…”

Section: Resultsmentioning

confidence: 99%

“…Nine trials assessed the femoral accuracy of the sagittal plane in TKA, which was determined with or without PSI [1, 4, 8, 12, 18, 29, 33, 34, 37]. Eleven RCTs focused on comparing the proportion of outliers in the tibial vertical plane [1, 4, 12, 18, 27–29, 33, 34, 36, 37].…”

Section: Resultsmentioning

confidence: 99%

Fewer femoral rotational outliers produced with CT- than with MRI-based patient-specific instrumentation in total knee arthroplasty

Yang

Liao

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Previous studies comparing the surgical accuracy between computed tomography (CT)‐ and magnetic resonance imaging (MRI)‐based patient‐specific instrumentation (PSI) methods have produced contradictory results. The aim of this study was to determine which is the more reliable imaging method (CT versus MRI) for patient‐specific total knee arthroplasty (TKA). CT‐based PSI is hypothesised to have an advantage regarding the number of outliers. Methods A total of 22 randomised controlled trials (RCTs), including 1749 TKA cases, were eligible for the meta‐analysis. RCTs, systematic reviews and meta‐analyses on this topic published in databases before September 2018 were identified by a literature search. The primary outcome was the number of lower extremities with greater than 3° of difference in alignment angles between the postoperative outcomes and target outcomes. The parameters calculated from the meta‐analysis included risk ratios (RRs) and 95% confidence intervals (CIs). Additionally, the publication bias and heterogeneity of the studies were assessed. Results The risk of femoral rotational outliers in the PSI group (RR = 0.48; 95% CI 0.24–0.98) was significantly reduced. Furthermore, subgroup analysis showed that the accuracy in the CT‐based PSI group was significantly higher than that in the MRI‐based CSI group (RR = 0.31; 95% CI 0.10–0.92). Conclusion This meta‐analysis shows that when performing TKA with PSI, preoperative CT is beneficial for the production of the PSI, resulting in a significantly lower proportion of outliers in femoral rotational alignment. CT should be the preferred choice for imaging when performing TKA surgery with PSI to obtain better femoral rotational alignment. Level of evidence Therapeutic study (systematic review and meta‐analysis), Level I.

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“…These systems offer precision through planning with 3 dimensional (3D) lower extremity computer models 9, 10. With the PSI method, the 3D model of the extremity is studied in a 3D design software for simulations of the ideal surgical osteotomies which are then used to design and produce the PSI 11, 12. Theoretically, use of PSI in TKR surgery should provide precise osteotomies just as they were planned in the 3D design software, thus it should also improve the mechanical alignment of the patients when compared to the conventional surgery 9, 10, 13.…”

Section: Introductionmentioning

confidence: 99%

Postoperative mechanical alignment analysis of total knee replacement patients operated with 3D printed patient specific instruments: A Prospective Cohort Study

Gemalmaz

Sariyilmaz

Özkunt

et al. 2019

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveTotal knee replacement (TKR) is a surgical treatment for final stage gonarthrosis. The lifespan of the prosthetic implants used in TKR surgery is a major interest for the orthopaedic research community.Previously, proper implant alignment of the implants has been advocated for longevity of the TKR surgery. Recently, patient-specific (PSI) instruments have been proposed to improve the mechanical alignment of the TKR by permitting better implant positioning over conventional TKR surgery. The aim of this study is to compare the mechanical alignment results of patients operated with PSIs and conventional instruments.MethodsTwo groups of 20 patients chosen in a quasi-random manner have been compared in this study. In the first group femoral distal and tibial osteotomies were made by a PSI which was produced by the patients' computed tomography scans. All osteotomies in the control group were made with the TKR set's routine instruments by conventional means. Patients' preoperative and postoperative mechanical femorotibal angles (mFTA), femoral coronal angles (FCA), tibial coronal angles (TCA) were measured and the number of outliers which showed more than 3° of malalignment were counted in both groups for comparison.ResultsThe average postoperative mFTA was found to be 2.09° for the PSI group and in was found to be 2.84° for the control which was not statistically significant. The comparison of postoperative FCA and TCA also did not show significant difference between the groups. The number of outliers showing more than 3° of malalignment per group were found to be 1 out of 20 (5%) for the PSI group and 7 out of 20 (35%) for the control which was statistically significant.ConclusionIn this study patient-specific instrumentation provided significantly better mechanical alignment compared to conventional TKR for the frequency of outlier cases with malalignment beyond 3°. PSI proved no significant difference when the groups were compared for mFTA, FCA and TCA. Our findings support that PSI may improve TKR alignment by improving the ratio of the outlier patients with marked malalignment.Level of EvidenceLevel III, Therapeutic Study.

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Clinical Study of 3D Imaging and 3D Printing Technique for Patient-Specific Instrumentation in Total Knee Arthroplasty

Cited by 27 publications

References 40 publications

Multi-color and Multi-Material 3D Printing of Knee Joint models

Multi-color and Multi-Material 3D Printing of Knee Joint models

Fewer femoral rotational outliers produced with CT- than with MRI-based patient-specific instrumentation in total knee arthroplasty

Postoperative mechanical alignment analysis of total knee replacement patients operated with 3D printed patient specific instruments: A Prospective Cohort Study

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