Component position alignment with patient-specific jigs in total knee arthroplasty

Moopanar, Terence R.; Amaranath, Jeevaka E.; Sorial, Rami

doi:10.1111/ans.12674

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…[27][28][29] Previous studies have suggested that PSI systems may be less predictable than manual instrumentation techniques in addressing sagittal plane component positioning. 20,23,33 Stronach et al reported a significantly higher rate of tibial slope outliers among PSI-TKAs when compared with a TKA placed with manual instrumentation. Moopanar et al reported less frequent optimization of coronal plane alignment and tibial slope in their series of 261 consecutive patients treated with PSI-TKA.…”

Section: Discussionmentioning

confidence: 99%

“…However, PSI systems have not demonstrated improved accuracy when compared with manual instrumentation techniques in several published studies. [19][20][21][22][23][24] In another PSI-TKA study, the investigators reported a requirement for intraoperative modifications in the majority of cases with the use of a noncustomized implant design. 25 While manually instrumented TKA may accommodate intraoperative modification, it is not clear whether this would be either feasible or appropriate for a CIM-TKA placed using PSI technology.…”

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confidence: 99%

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Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA

et al. 2020

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Customized individually manufactured total knee arthroplasty (CIM-TKA) was developed to improve kinematic total knee arthroplasty (TKA) performance. Component placement accuracy may influence the success of CIM-TKA designs. We performed this study to compare radiographic component alignment and revision rates of a cruciate retaining (CR) CIM-TKA and a contemporary posterior stabilized TKA (PS-TKA). After obtaining Institutional Review Board approval, we identified 94 CR CIM-TKAs (76 patients) and 91 PS-TKAs (82 patients) performed between July 1, 2013 and December 31, 2014 with a minimum 2-year follow-up (mean 41.1 months, range 24–59 months). We performed a retrospective electronic medical record review to identify patient demographic characteristics and revision procedures performed. Postoperative plain radiographs were reviewed to assess component alignment including cruciate ligament imbalance, femoral overhang, and femoral notching. Demographic characteristics, component malalignment, and revision surgery rates were assessed using a student's t-test or two-tailed Fisher's exact test, with a p-value < 0.05 designating significance. Technical errors were more commonly identified with CR CIM-TKA (29.8 vs. 9.9%, p < 0.001), including higher rates of tibiofemoral instability (13.8 vs. 1.1%, p < 0.01), femoral notching (12.8 vs. 3.3%, p = 0.03), and patellofemoral malalignment (20.2 vs. 7.7%, p = 0.02). CR CIM-TKA had more frequent coronal plane malposition (26.6 vs. 9.9%, p < 0.01) or sagittal plane reconstruction > 3 degrees outside of an optimized range (20.2 vs. 9.9%, p = 0.06). Aseptic revisions occurred more frequently with the CR CIM-TKA design (9.6 vs. 3.3%, p = 0.13). Demographic characteristics were not significantly different between the treatment groups. CR CIM-TKA may improve kinematic performance for patients undergoing knee replacement surgery. However, our study observations suggest that careful attention to surgical technique is important for optimizing implant survivorship with the CR CIM-TKA design. Additional study is needed to determine whether higher revision rates identified during this study are related to patient selection, surgical technique, or implant design.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA

et al. 2020

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“…In a prospective cohort study Boonen et al [21] used the same method as in our study and concluded that the preoperative plane was adequately reproduced within a range of ±3°in all planes, except for tibial component rotation where the deviation was on average 3.2°. Several studies using measurement on CT slices such as a modified Perth protocol [31] have reported superior alignment accuracy with PSG compared to conventional instrumentation [32][33][34][35][36][37]. In two separate studies Heyse and Tibesku [38,39] analyzed rotational alignment with MRI and also observed the superior outcome of PSG compared to conventional technique in terms of outliers.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional analysis of accuracy of component positioning in total knee arthroplasty with patient specific and conventional instruments: A randomized controlled trial

et al. 2017

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PSG led to adequate component positioning accuracy compared to the pre-operative plan. For the femoral component, the positioning was significantly closer to the planned position in the coronal plane, a similar trend was observed for the sagittal plane. But, for the tibial component, significantly more slope was introduced. A better prediction of component sizing was found with PSG compared to conventional surgery.

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“…This is similar to a recent paper by Moonpanar et al looking at MRI generated PSI, in which 96.2% of patients were within 3 of neutral alignment. 33 A retrospective study by Ng et al found outliers for component alignment to be similar in both MRI generated PSI and conventional TKR. 11 They found 10% tibial component outliers and 22% femoral component outliers with PSI compared to 7% outliers in tibial component and 18% femoral component outliers when using manual instrumentation.…”

Section: Discussionmentioning

confidence: 99%

“…This is similar to a recent paper by Moonpanar et al looking at MRI generated PSI, in which 96.2% of patients were within 3° of neutral alignment. 33…”

Section: Discussionmentioning

confidence: 99%

Patient-specific instrumentation for total knee arthroplasty

Nabavi¹,

Olwill²,

et al. 2017

J Orthop Surg (Hong Kong)

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Purpose: To assess the accuracy of total knee replacements (TKRs) performed using CT-based patient-specific instrumentation by postoperative CT scan. Method: Approval from the Ethics Committee was granted prior to commencement of this study. Fifty prospective and consecutive patients who had undergone TKR (Evolis, Medacta International) using CT-based patient-specific instrumentation (MY KNEE, Medacta International) were assessed postoperatively using a CT scan and the validated Perth protocol measurement technique. The hip-knee-ankle (HKA) angle of the lower limb in the coronal plane; the coronal, sagittal, and rotational orientation of the femoral component; and the coronal and sagittal orientation of the tibial component were measured. These results were then compared to each patient's preoperative planning. The percentage of patients found to be less than or equal to 3 of planned alignment was calculated. One patient was excluded as the femoral cutting block did not fit the femur as predicted by planning and therefore underwent a conventional TKR. Results: Ninety-eight percent of patients were within 3 of planned alignment in the coronal plane reproducing the predicted HKA angle. Predicted coronal plane orientation of the tibial and femoral component was achieved in 100% and 96% of patients, respectively. The sagittal orientation of the femoral component was within 3 in 98% of patients. The planned sagittal positioning of the tibial component was achieved in 92% of patients. Furthermore, 90% of patients were found to have a femoral rotation within 3 of planning. Eighty-six percent of patients achieved goodto-excellent outcome at 12 months (Oxford Knee Score > 34). Conclusion: We have found that TKR using this patientspecific instrumentation accurately reproduces preoperative planning in all six of the parameters measured in this study.

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Component position alignment with patient-specific jigs in total knee arthroplasty

Abstract: PSJ for TKA shows good accuracy in alignment when compared with conventional TKA. However, improvements in the development of the tibial alignment cutting guides will aid in further increasing its overall accuracy and reproducibility.

Cited by 10 publications

References 26 publications

Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA

Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA

Three-dimensional analysis of accuracy of component positioning in total knee arthroplasty with patient specific and conventional instruments: A randomized controlled trial

Patient-specific instrumentation for total knee arthroplasty

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