Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays

Ooka, Nelson Hiroyuki Miyabe; Campos, André Luiz Siqueira; Fonseca, Vitor Mudesto da; Rodrigues, Luis Edmundo Oliveira; Filho, Edmilson Barbosa; Franco, José Sergio; Albuquerque, Rodrigo Satamini Pires e; Gameiro, Vinícius Schott

doi:10.1007/s00264-018-3764-7

Cited by 12 publications

(19 citation statements)

References 25 publications

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“…Coronal deformity of the limb does not appear to modify accuracy between sizes measured in X-rays and the size of implanted components [23]. This study supports this statement as agreement levels did not change depending on the preoperative mechanical axis.…”

Section: Discussionsupporting

confidence: 78%

“…Availability problems were common, measurement was subjective, the size chosen was not recorded in the patient's clinical history, oversizing or undersizing errors would occur because X-ray magnification was often unknown and, in addition, X-ray images are no longer represented on photographic plates. For some authors, there was a marked discrepancy between the size measured with these acetate templates and the size required by the bone [23]. Discrepancies were up to 50% in the femur and up to 70% in the tibia [6].…”

Section: Discussionmentioning

confidence: 99%

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Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2019

Journal of Orthopaedic Translation

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Summary Background One of the possible causes of dissatisfaction reported by many patients after total knee replacement (TKR) is the lack of agreement between component size and bone structure. To avoid this complication and facilitate the procedure, preoperative planning with digitized templates is recommended. Surgical navigation indicates the best position and the most adequate size of arthroplasty and may therefore replace preoperative radiographic measurement. The objective of the study was to check agreement between the sizes of TKR components measured before surgery with digitized templates, the size recommended by the navigation and sizes actually implanted. Methods In 103 patients scheduled for TKR, preoperative full-limb radiography was performed to measure the mechanical and anatomical axes of the limb, femur and tibia. The most adequate size of the femoral and tibial components was planned by superimposing digitized templates. The size recommended in navigation and the size of the finally implanted components were also recorded. Results A high level of agreement was found between the sizes of femoral and tibial components measured by X-rays and in navigation (0.750 and 0.772, respectively) (intraclass correlation and Cronbach's alpha). Agreement between the sizes recommended by X-rays and navigation and those finally implanted was 0.886 for the femur and 0.891 for the tibia. Agreement levels were not different in cases with prior deformities of limb axis. Conclusions The high level of agreement found in component sizes between radiographic measurement with digitized templates and navigation suggests that preoperative X-ray measurement is not needed when navigation is used for placement of implants during TKR. The translational potential of this article Computer-assisted surgery may avoid preoperative measurement with templates in TKR.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement

Hernández-Vaquero

Noriega-Fernandez

Roncero-Gonzalez

et al. 2019

Journal of Orthopaedic Translation

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“…Preoperative templating accuracy may be as low as 28 to 48% for femoral components and 37 to 55% for tibial components in TKA. 9, 16 The variability in the size and shape of the distal femur may account for low accuracy. [17][18][19] There are also distinct differences in anthropometric measurements of arthritic and nonarthritic knees as degeneration changes bony geometry.…”

Section: Discussionmentioning

confidence: 99%

Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

et al. 2018

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Patient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (: 17.965; odds ratio [OR]: 24.957, 3.250-191.661; < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively ( 36.436; OR: 33.480, 7.400-151.481; < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652-0.890; < 0.001) for the femur and 0.833 (0.717-0.911; < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.

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“…Templating was accurate only 28.21% of the time when using anteroposterior and 35.90% of the time using lateral radiographs for femoral components. These results did not show significant improvement for tibial components showing 37.61% and 47.01% accuracy for anteroposterior and lateral views, respectively, demonstrating poor results with radiographic templating overall [7]. Templating is also time-consuming, costly, and cumbersome.…”

Section: Introductionmentioning

confidence: 92%

Patient Demographics and Anthropometric Measurements Predict Tibial and Femoral Component Sizing in Total Knee Arthroplasty

et al. 2020

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Background: Accurate sizing is critical for the overall success of a total knee arthroplasty (TKA). This study's primary purpose was to investigate the ability to predict the tibial and femoral component size in a single implant system from patient demographics and anthropometric data. A secondary goal was to compare the predicted tibial and femoral component sizes from our statistical model with a previously validated electronic application used to predict the implant size. Methods: A consecutive series of 484 patients undergoing a primary TKA at a single institution was reviewed. Data on height, weight, body mass index, sex, age, and component size were collected. A proportional odds model was developed to predict tibial and femoral component sizes. The relationship between the proportional odds model predictions was also compared with the component sizes determined by the Arthroplasty Size Predictor electronic application. Results: Weight, height, and sex predicted the implanted component size with an accuracy of 54.0% (n ¼ 247/484) for the tibia and 51.1% (n ¼ 231/484) for the femur. The accuracy improved to 94.4% (n ¼ 457/ 484) for the tibia and 93.4% (n ¼ 452/484) for the femur within ±1 component size. Our data are highly correlated to the Arthroplasty Size Predictor for the predicted tibial component size (r ¼ 0.91, P < .001) and femoral component size (r ¼ 0.89, P < .001). Conclusions: Our novel templating model may improve operative efficiency for a single TKA system. Our findings have a high concordance with a widely available electronic application used to predict implant sizes for a variety of TKA systems.

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Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays

Abstract: Pre-operative templating is an unreliable and inaccurate tool. There is no relation between coronal deformity and accuracy of templating.

Cited by 12 publications

References 25 publications

Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement

Agreement in component size between preoperative measurement, navigation and final implant in total knee replacement

Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

Patient Demographics and Anthropometric Measurements Predict Tibial and Femoral Component Sizing in Total Knee Arthroplasty

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