Which method for femoral component sizing when performing kinematic alignment TKA? An in silico study

Huang, Fasen; Harris, Simon; Zhou, Tianyu; Roby, Gabriel B.; Preston, Benjamin; Rivière, Charles

doi:10.1016/j.otsr.2023.103769

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…First and foremost, the quality of the expert landmarks plays a pivotal role in establishing the ground truth. Given the limited number of experts and significant inter-observer variability for certain landmarks, it can be argued if the expert mean landmarks truly serve as a robust ground truth [10]. Interobserver dispersion of the landmarks is likely influenced by the difficulty of manually locating the landmark [21] and variations in training or background among observers [22].…”

Section: Discussionmentioning

confidence: 99%

“…They can be divided into three large groups: knowledgebased, template-based and learning-based [9]. The first category exploits knowledge of the human anatomy to characterize landmarks by a set of unique geometric or anatomical characteristics such as surface normal direction, local curvature, or spatial relation to other landmarks [10]. Template-based approaches like statistical shape models start with an annotated template image or template mesh, which is elastically deformed to match the image or mesh of the subject's anatomy [11].…”

Section: Introductionmentioning

confidence: 99%

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Automated Landmark Annotation for Morphometric Analysis of Distal Femur and Proximal Tibia

Grammens,

Van Haver,

Lumban-Gaol

et al. 2024

J. Imaging

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Manual anatomical landmarking for morphometric knee bone characterization in orthopedics is highly time-consuming and shows high operator variability. Therefore, automation could be a substantial improvement for diagnostics and personalized treatments relying on landmark-based methods. Applications include implant sizing and planning, meniscal allograft sizing, and morphological risk factor assessment. For twenty MRI-based 3D bone and cartilage models, anatomical landmarks were manually applied by three experts, and morphometric measurements for 3D characterization of the distal femur and proximal tibia were calculated from all observations. One expert performed the landmark annotations three times. Intra- and inter-observer variations were assessed for landmark position and measurements. The mean of the three expert annotations served as the ground truth. Next, automated landmark annotation was performed by elastic deformation of a template shape, followed by landmark optimization at extreme positions (highest/lowest/most medial/lateral point). The results of our automated annotation method were compared with ground truth, and percentages of landmarks and measurements adhering to different tolerances were calculated. Reliability was evaluated by the intraclass correlation coefficient (ICC). For the manual annotations, the inter-observer absolute difference was 1.53 ± 1.22 mm (mean ± SD) for the landmark positions and 0.56 ± 0.55 mm (mean ± SD) for the morphometric measurements. Automated versus manual landmark extraction differed by an average of 2.05 mm. The automated measurements demonstrated an absolute difference of 0.78 ± 0.60 mm (mean ± SD) from their manual counterparts. Overall, 92% of the automated landmarks were within 4 mm of the expert mean position, and 95% of all morphometric measurements were within 2 mm of the expert mean measurements. The ICC (manual versus automated) for automated morphometric measurements was between 0.926 and 1. Manual annotations required on average 18 min of operator interaction time, while automated annotations only needed 7 min of operator-independent computing time. Considering the time consumption and variability among observers, there is a clear need for a more efficient, standardized, and operator-independent algorithm. Our automated method demonstrated excellent accuracy and reliability for landmark positioning and morphometric measurements. Above all, this automated method will lead to a faster, scalable, and operator-independent morphometric analysis of the knee.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Automated Landmark Annotation for Morphometric Analysis of Distal Femur and Proximal Tibia

Grammens,

Van Haver,

Lumban-Gaol

et al. 2024

J. Imaging

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Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review

Ollivier,

Luyckx,

Stragier

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePatellofemoral pain, maltracking and instability remain common and challenging complications after total knee arthroplasty. Controversy exists regarding the effect of kinematic alignment on the patellofemoral joint, as it generally leads to more femoral component valgus and internal rotation compared to mechanical alignment. The aim of this systematic review is to thoroughly examine the influence of kinematic alignment on the third space.MethodsA systematic search of the Pubmed, Cochrane and Web of Science databases was performed to screen for relevant articles published before 7 April 2024. This led to the final inclusion of 42 articles: 2 cadaveric, 9 radiographic, 12 computer simulation and 19 clinical studies. The risk of bias was evaluated with the risk of bias in non‐randomised studies ‐ of interventions tool as the lowest level of evidence of the included clinical studies was IV. The effects of kinematic alignment on patellar kinematics and kinetics, trochlear anatomy reconstruction and patellofemoral complication rate were investigated.ResultsKinematic alignment closely restores native patellar kinematics and kinetics, better reproduces native trochlear anatomy than mechanical alignment and leads to a 0%–11.4% incidence of patellofemoral complications. A more valgus joint line of the distal femur can cause lateral trochlear undercoverage and a trochlear angle orientation medial to the quadriceps vector when applying kinematic alignment, both of which can be solved by using an adjusted design with a 20.5° valgus trochlea.ConclusionKinematic alignment appears to be a safe strategy for the patellofemoral joint in most knees, provided that certain precautions are taken to minimize the risk of complications.Level of EvidenceLevel IV clinical studies, in vitro research.

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Total knee arthroplasty: Where are we after the “kinematic alignment” wave?

Arnold,

Lustig,

Pasquier

et al. 2024

Orthopaedics & Traumatology: Surgery & Research

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Which method for femoral component sizing when performing kinematic alignment TKA? An in silico study

Cited by 3 publications

References 23 publications

Automated Landmark Annotation for Morphometric Analysis of Distal Femur and Proximal Tibia

Automated Landmark Annotation for Morphometric Analysis of Distal Femur and Proximal Tibia

Kinematic alignment adequately restores trochlear anatomy, patellar kinematics and kinetics in total knee arthroplasty: A systematic review

Total knee arthroplasty: Where are we after the “kinematic alignment” wave?

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