The accuracy of bony resection from patient-specific guides during total knee arthroplasty

Levy, Yadin D.; An, Vincent V.G.; Shean, Christopher J.; Groen, Floris R; Walker, Peter; Bruce, Warwick

doi:10.1007/s00167-016-4254-3

Cited by 13 publications

(19 citation statements)

References 22 publications

(55 reference statements)

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“…Instead of technology, KA surgeons rely on the caliper to detect a resection deviation from the femoral target. Correcting a distal over-resection is achieved by modifying chamfer cuts and filling any gaps with cement [ 4 , 5 ]. In contrast, correcting a posterior over-resection is more challenging, which some surgeons left under-corrected.…”

Section: Discussionmentioning

confidence: 99%

“…Technology proponents argue that robotic, navigation, and patient-specific instrumentation more accurately hit the femoral target than manual instruments [ 12 , 14 , 22 , 28 ]. Whereas manual instrument proponents argue that technology lengthens the operation, adds expense, and induces stacked errors arising from transforming images into a 3D model, planning the resection planes, and registering instruments [ 1 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Unrestricted caliper verified kinematic alignment (KA) sets the femoral component coincident to the patient’s pre-arthritic joint lines, a sine qua non for restoring the native limb alignment and tibial compartment forces without releasing ligaments [ 17 , 18 , 23 , 24 ]. The essential instrument is an inexpensive caliper, which measures the thickness of the distal and posterior resections enabling correction when they deviate from the femoral target before implantation [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments

Howell

Nedopil

Hull

2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Surgeons performing total knee arthroplasty (TKA) are interested in the accuracy and time it takes to make the four femoral resections that determine the setting of the femoral component. A method for quantifying the error of each resection is the thickness, measured by a caliper, minus the femoral target. The present study tested the hypothesis that the mean deviation of the resection from the femoral target, the percentage of resections with a deviation of ± 0.5, 1.0, 1.5, and 2.0 mm, and the time to complete the femoral cuts were not different between experienced (E) and less-experienced (LE) surgeons performing unrestricted caliper verified kinematically aligned (KA) TKA with manual instruments. Methods This study analyzed intraoperative verification worksheets from 203 patients treated by ten E surgeons and 58 patients treated by four LE surgeons. The worksheet recorded (1) the thickness of the femoral target for the distal medial (DM), distal lateral (DL), posterior medial (PM), and posterior lateral (PL) resections and the caliper thickness of the resections with a resolution of 0.5 mm, and (2) the time to complete them. The most accurate resection has a mean difference ± standard deviation of 0 ± 0.0 mm. Results The accuracy of the 1044 initial resections (261 patients) was significantly closer to the femoral target for E vs. the LE surgeons: 0.0 ± 0.4 vs. − 0.3 ± 0.5 for the DM, 0.0 ± 0.5 vs. − 0.4 ± 0.6 for the DL, − 0.1 ± 0.5 vs. − 0.2 ± 0.5 PM, and − 0.1 ± 0.5 vs. − 0.4 ± 0.6 for the PL resections (p ≤ 0.0248). E surgeons completed the femoral resections in 12 min; 5 min faster than LE surgeons (p < 0.0001). Conclusions Because the mean difference in femoral resections with manual instruments for E vs. LE surgeons was < 0.5 mm which is within the caliper’s resolution, differences in accuracy were not clinically relevant. Surgeons exploring other alignment options and robotic, navigation, and patient-specific instrumentation might find these values helpful when deciding to change. Level of evidence III; case–control study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments

Howell

Nedopil

Hull

2022

Knee Surg Sports Traumatol Arthrosc

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“…In previous studies on the accuracy of osteotomy provided by patient-specific cutting guides in TKA, the acceptable difference between planned and actual bone cuts has been reported as 1.5 mm or less [ 12 ]. The difference between the planned and actual thickness of resected bone for osteotomy has been reported to range between 0.5 and 2 mm when using patient-specific 3D cutting guides [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The difference between the planned and actual thickness of resected bone for osteotomy has been reported to range between 0.5 and 2 mm when using patient-specific 3D cutting guides [ 13 , 14 ]. In an 81-knee series, Levy et al [ 12 ] showed that this difference was within acceptable limits for about 80% of femur cuts and 70% of tibial cuts, indicating that patient-specific cutting guide has only moderate accuracy. Kievit et al [ 14 ] studied the accuracy of osteotomy when patient-specific instrumentation was used for TKA in cadavers and found high similarity between planned and actual osteotomy planes.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides

Çalbıyık

2017

Med Sci Monit

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BackgroundPatient-specific instruments have recently gained attention for ensuring the accuracy of osteotomy and correct alignment in total knee arthroplasty (TKA). We aimed to report our experience with TKA performed by using CT-based 3D model of cutting guides in our clinic.Material/MethodsA total of 36 patients (mean age, 67.58±8.46 years; 24 females, 12 males) who underwent TKA with 3D patient-specific cutting guides in our clinic were included in the study. Differences between preoperatively planned bone resections and actual bone resections were calculated. Femoral and tibial component angles were measured on radiographs of the knee. The change in knee pain was evaluated by patients on a 10-point visual analog scale (VAS). Patients were followed up for 6 months postoperatively.ResultsThe actual bone resection was 0.5–1.5 mm higher than the planned resection for all sides, being statistically significant for posterior lateral and distal medial sides (1.1±1.3 mm and 1.5±0.9 mm, respectively; p<0.05). On postoperative radiographs, coronal tibial component angle was 88.8°±0.9° and coronal femoral component angle was 95.2°±1.6°, showing good postoperative alignment. The VAS pain score of patients significantly decreased from preoperative 3.9±0.8 to 1.1±0.9 at 6 months after the operation. One patient developed superficial tissue infection on postoperative follow-up, which was effectively treated. No other pathology was detected in the postoperative period.ConclusionsPatient-specific cutting guides can provide intraoperative guidance for better placement of the implant in TKA and increase the accuracy of osteotomy and postoperative alignment.

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No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation

Maus

Marques

Scheunemann

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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The accuracy of bony resection from patient-specific guides during total knee arthroplasty

Abstract: IV, case series with no comparison group.

Cited by 13 publications

References 22 publications

Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments

Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments

Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides

No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation

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