The effect of implant size difference on patient outcomes and failure after bilateral simultaneous total knee arthroplasty

Tang, Alex; Yeroushalmi, David; Zak, Stephen; Lygrisse, Katherine A.; Schwarzkopf, Ran; Meftah, Morteza

doi:10.1016/j.jor.2020.06.009

Cited by 11 publications

(3 citation statements)

References 26 publications

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“…[21][22][23] In the literature, implant size overestimation is not common, and several studies discuss a tendency to underestimate the tibial implant size to reduce soft tissue impingement due to implant overhang. 18,[23][24][25] One study in patients undergoing simultaneous bilateral TKA found an increased risk for aseptic loosening when the tibial component sizes were asymmetric, suggesting the importance of proper sizing in implant longevity. 26 In recent years, vendors have continued to increase the number of available component sizes for TKA.…”

Section: Discussionmentioning

confidence: 99%

Increased Accuracy in Templating for Total Knee Arthroplasty Using 3D Models Generated from Radiographs

et al. 2022

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Templating prior to total hip arthroplasty is a widely adopted practice that aims to improve operative efficiency and reduce clinical outliers. Predicting implant size before total knee arthroplasty (TKA), although less common, could increase operating room efficiency by reducing necessary equipment needed for the procedure. This study compared templating accuracy in TKA using two-dimensional (2D) digital radiographs to a novel imaging technology that generates a three-dimensional (3D) model from these 2D radiographs. Two hundred and two robotic-assisted primary TKA surgical cases using Persona Knee System (Zimmer Biomet, Warsaw, IN) were retrospectively analyzed. For all cases, 3D templating was completed preoperatively using a novel radiographic image acquisition protocol. Using the same radiographs, the knee was templated using a 2D digital templating program. All surgeons were blinded to the final implant sizes, and all templating was done independently. The accuracy of predictions within ± 1 from the final implant size was determined for the femoral and tibial components. The accuracy (within 1 size) of tibial size predictions was comparable between attending surgeons and residents (87 vs. 82%, p = 0.08), but attending surgeons more accurately predicted the femoral size (77 vs. 60%, p < 0.05). The 2D to 3D imaging technology more accurately predicted both tibial and femoral sizes compared with the attending surgeons (99.5 vs. 87%, p < 0.05; 84% vs. 77%, p < 0.05). However, the imaging technology, attending surgeons, and residents were all more likely to overestimate femur size (p < 0.05). Moreover, the 3D imaging technology predicted the exact tibial component size in 93.1% of cases, which was significantly greater compared with residents (40%, p < 0.01) and attending surgeons (53%, p < 0.01). The 2D to 3D imaging technology more accurately predicted tibial and femoral component sizes compared with 2D digital templating done by surgeons. All templating predictions were more accurate for the tibial implant size than for the femoral size. The increased accuracy of implant size predictions from this 3D templating technology has the potential to improve intraoperative efficiency and minimize costs and surgical time.

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Section: Discussionmentioning

confidence: 99%

Increased Accuracy in Templating for Total Knee Arthroplasty Using 3D Models Generated from Radiographs

et al. 2022

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“…The appropriate size of the femoral and tibial components is essential for achieving an acceptable alignment and correct lower limb balance in patients undergoing total knee arthroplasty (TKA) [ 1 , 2 ]. In posterior reference systems, smaller size results in notching in the anterior cortex of the femur, while in anterior reference systems, a smaller size results in flexion gap enlargement and knee instability [ 3 , 4 ]. Therefore, developing reliable strategies to preoperatively predict the appropriate size of TKA components, specifically in patients with sizes outside the normal range, is particularly important.…”

Section: Introductionmentioning

confidence: 99%

Preoperative predictors of implant size in patients undergoing total knee arthroplasty: a retrospective cohort study

Ostovar

Bahaeddini

Bagherifard

et al. 2023

BMC Musculoskelet Disord

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Background Traditionally, the size of total knee arthroplasty (TKA) components is predicted by preoperative radiographic templating, which is of limited accuracy. This study aimed to evaluate the role of demographic data and ankle volume in predicting implant size in TKA candidates. Methods In a retrospective study, 415 patients who underwent TKA at a single institution were included. The mean age of the patients was 67.5 ± 7.1 years. The mean BMI of the patients was 31.1 ± 4.7 kg/m2. TKA implants were Zimmer Biomet NexGen LPS-Flex Knee in all cases. The demographic data included age, sex, height, weight, BMI, ethnicity, and ankle volume. Ankle volume was assessed with the figure-of-eight method. Multivariate linear regression analysis was used for predicting factors of implant size. Results Multivariate linear regression analysis showed that the Sex (β:1.41, P < 0.001), height (β:0.058, P < 0.001), ankle volume (β:0.11, P < 0.001), and Age (β:0.017, P = 0.004) were significant predictors of tibial component size. Sex (β:0.89, P < 0.001), height (β:0.035, P < 0.001), and ankle volume(β:0.091, P < 0.001) were significant predictors of femoral component size in the multivariate analysis. Conclusion Demographic data, adjunct with the ankle volume, could provide a promising model for preoperative prediction of the size of tibial and femoral components in TKA candidates.

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“…Correct sizing of total knee arthroplasty (TKA) components is an essential aspect of the procedure. Indeed, implant malalignment or incorrect sizing may lead to early aseptic loosening and failure, instability, over‐stuffing with increased capsular tension and stiffness, or tibial overhang and persistent pain [2, 20, 29]. To better anticipate final implant size in TKA, preoperative templating has traditionally been used as this allows the surgeon to estimate the implant size that will best accommodate each patient’s anatomy [18, 30].…”

Section: Introductionmentioning

confidence: 99%

Machine learning algorithms predict within one size of the final implant ultimately used in total knee arthroplasty with good-to-excellent accuracy

Kunze

Polce

Patel

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To develop a novel machine learning algorithm capable of predicting TKA implant sizes using a large, multicenter database. Methods A consecutive series of primary TKA patients from two independent large academic and three community medical centers between 2012 and 2020 was identiied. The primary outcomes were inal tibial and femoral implant sizes obtained from an automated inventory system. Five machine learning algorithms were trained using six routinely collected preoperative features (age, sex, height, weight, and body mass index). Algorithms were validated on an independent set of patients and evaluated through accuracy, mean absolute error (MAE), and root mean-squared error (RMSE). Results A total of 11,777 patients were included. The support vector machine (SVM) algorithm had the best performance for femoral component size(MAE = 0.73, RMSE = 1.06) with accuracies of 42.2%, 88.3%, and 97.6% for predicting exact size, ± one size, and ± two sizes, respectively. The elastic-net penalized linear regression (ENPLR) algorithm had the best performance for tibial component size (MAE 0.70, RMSE = 1.03) with accuracies of 43.8%, 90.0%, and 97.7% for predicting exact size, ± one size, and ± two sizes, respectively. Conclusion Machine learning algorithms demonstrated good-to-excellent accuracy for predicting within one size of the inal tibial and femoral components used for TKA. Patient height and sex were the most important factors for predicting femoral and tibial component size, respectively. External validation of these algorithms is imperative prior to use in clinical settings. Level of evidence Case-control, III.

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The effect of implant size difference on patient outcomes and failure after bilateral simultaneous total knee arthroplasty

Cited by 11 publications

References 26 publications

Increased Accuracy in Templating for Total Knee Arthroplasty Using 3D Models Generated from Radiographs

Increased Accuracy in Templating for Total Knee Arthroplasty Using 3D Models Generated from Radiographs

Preoperative predictors of implant size in patients undergoing total knee arthroplasty: a retrospective cohort study

Machine learning algorithms predict within one size of the final implant ultimately used in total knee arthroplasty with good-to-excellent accuracy

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