Resection accuracy of patient‐specific cutting guides in total knee replacement

Wernecke, Gregory C.; Taylor, Scott; Wernecke, Penny; MacDessi, Samuel J.; Chen, Darren B.

doi:10.1111/ans.14143

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…In theory, measurements with the same method can result in much smaller errors. In addition, the Several previous studies have explored the accuracy of PSI-assisted osteotomy [19,21,22,[24][25][26]. All of them reported high accuracy of distal femoral condyle osteotomy.…”

Section: Discussionmentioning

confidence: 99%

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The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

Liang

Yang

Wang

et al. 2021

BioMed Research International

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Purpose. Bony resection is the primary step during total knee arthroplasty. The accuracy of bony resection was highly addressed because it was deemed to have a good relationship with mechanical line. Patient-specific instruments (PSI) were invented to copy the bony resection references from the preoperative surgical plan during a total knee arthroplasty (TKA); however, the accuracy still remains controversial. This study was aimed at finding out the accuracy of the bony resection during PSI-assisted TKA. Methods. Forty-two PSI-assisted TKAs (based on full-length leg CT images) were analyzed retrospectively. Resected bones of every patient were given a CT scan, and three-dimensional radiographs were reconstructed. The thickness of each bony resection was measured with the three-dimensional radiographs and recorded. The saw blade thickness (1.27 mm) was added to the measurements, and the results represented intraoperative bone resection thickness. A comparison between intraoperative bone resection thickness and preoperatively planned thickness was conducted. The differences were calculated, and the outliers were defined as >3 mm. Results. The distal femoral condyle had the most accurate bone cuts with the smallest difference (median, 1.0 mm at the distal medial femoral condyle and 0.8 mm at the distal lateral femoral condyle) and the least outliers (none at the distal medial femoral condyle and 1 (2.4%) at the distal lateral femoral condyle). The tibial plateau came in second (median difference, 0.8 mm at the medial tibial plateau and 1.4 mm at the lateral tibial plateau; outliers, none at the medial tibial plateau and 1 (2.6%) at the lateral tibial plateau). Regardless of whether the threshold was set to >2 mm (14 (17.9%) at the tibial plateau vs. 12 (14.6%) at the distal femoral condyle, p > 0.05 ) or >3 mm (1 (1.3%) at the tibial plateau vs. 1 (1.2%) at the distal femoral condyle, p > 0.05 ), the accuracy of tibial plateau osteotomy was similar to that of the distal femoral condyle. Osteotomy accuracy at the posterior femoral condyle and the anterior femoral condyle were the worst. Outliers were up to 6 (15.0%) at the posterior medial femoral condyle, 5 (12.2%) at the posterior lateral femoral condyle, and 6 (15.8%) at the anterior femoral condyle. The percentages of overcut and undercut tended to 50% in most parts except the lateral tibial plateau. At the lateral tibial plateau, the undercut percentage was twice that of the overcut. Conclusion. The tibial plateau and the distal femoral condyle share a similar accuracy of osteotomy with PSI. PSI have a generally good accuracy during the femur and tibia bone resection in TKA. PSI could be a kind of user-friendly tool which can simplify TKA with good accuracy. Level of Evidence. This is a Level IV case series with no comparison group.

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Section: Discussionmentioning

confidence: 99%

“…Some researchers smartly came up with a way to study PSI accuracy without using X-ray measurement. In these studies, the amount of bony resection was measured and compared with planned osteotomy [18][19][20][21][22]. However, the results of these studies were covered with controversy.…”

Section: Introductionmentioning

confidence: 99%

The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

Liang

Yang

Wang

et al. 2021

BioMed Research International

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“…Wernecke GC. et al noted in their study, in which they used patient-specific cutting guides, that they were required to perform additional bone resection for 37% of their patients and of these additional cuts, 16% was implemented on the tibial side 13 . In the study of Pietsch M. et al, in which cutting guides were used, the rate of additional resection was 62% in the distal femur and 34% in the proximal tibia 14 .…”

Section: Resultsmentioning

confidence: 99%

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

TİFTİKÇİ,

SERBEST,

KAYA

et al. 2023

Acta Orthop Belg

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This study aimed to demonstrate that measuring the medial gap before bone resection during total knee arthroplasty (TKA) provides an optimum gap adjustment in varus knees. In this study, patients were separated into two groups. Group 1 included patients whose medial joint gap was measured before bone resection and Group 2 included patients who underwent conventional technique without measuring. The medial joint gap was measured with a custom-made gap measuring device up to the point that the knee was corrected and aligned along its mechanical axis. Medial joint gap distances, distal medial femoral bone cut thicknesses, amounts of tibial resection calculated; gap internal distances measured after cutting and the thicknesses of the trial inserts were recorded. A comparison was made between the groups concerning the number of patients requiring an additional tibial bone cut and the distribution of insert thicknesses. Extra tibial bone resections were performed in two (5.7%) patients in Group 1 and 10 (28.6%) patients in Group 2. In Group 1, where the medial joint gap was measured, the need for an additional bone resection was statistically less (p=0.018). In comparing the distribution of insert size by group, the number of patients on whom an 8 mm insert had been used was significantly greater in Group 1 (p=0.024). The findings obtained in this study suggest that measuring the medial joint gap before bone resection in total knee arthroplasty may prevent repeated bone recutting and additional bone resections.

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“…of their patients and of these additional cuts, 16% was implemented on the tibial side [13]. In the study of Pietsch M. et al, in which cutting guides were used, the rate of additional resection was 62% in the distal femur and 34% in the proximal tibia [14].…”

Section: Discussionmentioning

confidence: 99%

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

Tiftikçi

Serbest

Tosun

et al. 2020

Preprint

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PurposeThe aim of this study was to demonstrate that measuring the medial gap before bone resection during total knee arthroplasty (TKA) provides an optimum gap adjustment in varus knees.MethodsPatients were separated into two groups, Group 1 being those whose medial joint gap was measured prior to bone resection and Group 2 comprising those who underwent conventional measured resection technique without measuring. The medial joint gap was measured with a custom-made gap measuring device up to the point that the knee was corrected and aligned along its mechanical axis. Medial joint gap distances, distal medial femoral bone cut thicknesses, amounts of tibial resection calculated, gap internal distances measured after cutting, and the thicknesses of the trial inserts were recorded. A comparison was made between the groups in terms of the number of patients requiring an additional tibial bone cut and the distribution of insert thicknesses.ResultsExtra tibial bone resections performed in two (5.7%) patients in Group 1 and in 10 (28.6%) patients in Group 2. In Group 1, where the medial joint gap was measured, the need for an additional bone resection was statistically less. (p=0.018). In the comparison of distribution of insert size by group, the number of patients on whom an 8 mm insert had been used was significantly greater in Group 1 (p=0.024). ConclusionMeasuring the medial joint gap prior to bone resection in total knee arthroplasty may prevent repeated bone recutting and additional bone resections. Furthermore, we can use this method to avoid the disadvantages of the measured resection technique.

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Resection accuracy of patient‐specific cutting guides in total knee replacement

Abstract: Intraoperatively, PSGs could not accurately recreate the preoperative plan. PSGs are marketed as user-friendly tools to simplify TKA but our research demonstrates the need for surgeons to monitor surgical progression and compensate for errors occurring during the use of PSGs.

Cited by 7 publications

References 17 publications

The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

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