Influence of landmark and surgical variability on virtual assessment of total knee arthroplasty

Abstract

Given advances in recent years in imaging modalities and computational hardware/software, virtual analyses are increasingly valuable and practical for evaluating total knee arthroplasty (TKA). However, the influence of variabilities at each step in computational analyses on predictions of TKA performance for a population has not yet been thoroughly investigated, nor the relationship between these variabilities and expected variations in surgical practice. Understanding these influences is nevertheless essential for ensuring the clinical relevance of theoretical predictions. Here, a morphological analysis of proximal tibial resections within TKA is proposed and investigated. The goals of this analysis are to quantify the influence of variability in landmark detection on resection parameters and to evaluate this sensitivity relative to expected clinical variability in TKA resections. Results here are directly applicable to population-level computational analyses of morphological and functional TKA performance.

Combined manual and automatic landmark detection for enhanced surface registration of anatomical structures: an extensive parameter study for femur and clavicle

“…Dai et al reported an average intra user variability of 2.9 mm and a maximum deviation of up to 6.3 mm (Dai et al 2014). In case of the clavicle, the correspondence quality is already within intra-user variability, therefore the manual identification of landmarks in the clavicle could be omitted.…”

A Validated, Automated, 3-Dimensional Method to Reliably Measure Tibial Torsion

“…However, manual selection of tibial landmarks is known to introduce errors that will compromise intra- and interrater reliability, because unpredictable human error and arbitrary choices are introduced. 6,41 This must be avoided to ensure consistent measurements. Therefore, for the new measurement presented in this article, we applied a standard method to create a reference frame for the bone slicing.…”

“…3,29,45,46 A validated and repeatable method to assess tibial torsion using CT or MRI is lacking and must be generated. 19,48 Ideally, such a method should ensure time efficiency for busy clinical settings, 27 minimize the high error associated with manual measurements, 6,43 and permit the generation of large, comparable data sets of normative and pathological alignment worldwide. The first aim of the present article is to define a reliable and clinically reasoned method for the calculation of tibial torsion that is automated, removing the potential for human error.…”

Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty

“…The neutral rotational axis was defined as the line connecting the medial third of the tubercle and the center of the PCL attachment site (Insall's line), projected onto the resection plane of the two-dimensional (2D) digital image of the tibial plateau. 9,10 The mediolateral line (MLL) was drawn to be perpendicular to the Insall line in the 2D coordinate system. The anteroposterior line (APL) was drawn parallel to the Insall line and passed through the center of the MLL.…”

“…6 Asymmetric tibial component designs have been developed; however, these twocomponent types cannot usually prevent overhang from the posteromedial or posterolateral zones during a well-aligned tibial component placement from the mediolateral and anterior aspects of the ideal component rotation. [7][8][9][10][11][12] Therefore, this study aimed to investigate (1) whether the tibial surface area exhibited any changes following tibial plateau cuts at different slope angles, (2) whether there was a change in the compatibility of the symmetric or asymmetric tibial baseplates with the tibial surface or overhang beyond bone margins following cuts at different slope angles, and (3) which slope cut angle could reduce the overhang or underhang. The hypothesis of our study was that during the implantation of the tibial component by providing rotational, mediolateral, and maximum coverage, overhang/underhang that may occur in the posterior cortex of the tibial component can be avoided by using different slope cut angles.…”