|
1
|
Tibesku CO, Haas SB, Saunders C, Harwood DA. Comparison of clinical outcomes of VISIONAIRE patient-specific instrumentation with conventional instrumentation in total knee arthroplasty: a systematic literature review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:4379-4393. [PMID: 36449066 PMCID: PMC10293358 DOI: 10.1007/s00402-022-04698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Malalignment and resulting complications are major challenges in total knee arthroplasty (TKA) which patient-specific instrumentation (PSI) is proposed to alleviate. Previous PSI meta-analyses of TKA outcomes typically do not differentiate between PSI systems and assess relatively few outcomes, so the value of their findings is limited. VISIONAIRE™ cutting guides (Smith + Nephew Inc., Memphis, TN, USA) is a PSI system based on preoperative magnetic resonance and X-ray imaging. A systematic literature review (SLR) and meta-analysis, focussed specifically on VISIONAIRE, were conducted to assess TKA accuracy, intraoperative outcomes, and postoperative outcomes, compared with conventional instrumentation (CI). MATERIALS AND METHODS The SLR was performed using PubMed, Embase, and Google Scholar databases to identify relevant studies published until March 2022. Depending on statistical heterogeneity, meta-analyses were performed for outcome measures with fixed effect (I2 < 50%) or random-effects models (I2 ≥ 50%). Dichotomous outcomes were reported as odds ratios and continuous outcomes were reported as mean differences. Descriptive analyses were performed for outcomes not amenable to meta-analysis. RESULTS Outcomes for VISIONAIRE versus CI were reported in 25 studies. Compared with CI, VISIONAIRE reduced odds of mechanical outliers by 40% (p < 0.0001), with no statistically significant differences in odds of overall coronal, sagittal, or rotational plane component outliers. VISIONAIRE improved surgical efficiency (operating room, turnover, and tourniquet times reduced by 7.3% (p = 0.02), 42% (p = 0.022), and 15.9% (p = 0.01), respectively), lowering the odds of blood transfusion by 53% (p = 0.01) and shortening patients' hospital stays (11.1% reduction; p < 0.0001). There were no significant differences between groups in incidence of postoperative complications and (descriptively analyzed) return-to-function outcomes. CONCLUSION Options for PSI in TKA differ substantially, and it is important to assess the outcomes of individual systems. The current findings suggest that VISIONAIRE guides can lead to improved alignment accuracy and surgical efficiency compared with CI, without compromising postoperative safety and return-to-function outcomes.
Collapse
Affiliation(s)
| | - Steven B Haas
- Knee Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | | | | |
Collapse
|
|
2
|
Pereira EG, Carvalho MM, Oliveira T, Sacramento T, Cruz H, Viegas R, Fontes AP, Marreiros A, Sousa JP. Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender. J Knee Surg 2023; 36:173-180. [PMID: 34225366 DOI: 10.1055/s-0041-1731455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.
Collapse
Affiliation(s)
- Eduardo G Pereira
- Universidade do Algarve-Faculdade de Medicina e Ciências Biomédicas, Campus de Gambelas Faro, Portugal
| | - Maria M Carvalho
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Tiago Oliveira
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Telmo Sacramento
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Henrique Cruz
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Rui Viegas
- Departamento de Ortopedia e Traumatologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ana P Fontes
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| | - Ana Marreiros
- Universidade do Algarve-Faculdade de Medicina e Ciências Biomédicas, Campus de Gambelas Faro, Portugal.,Algarve Biomedical Center - Research Institute (ABC-RI)-Faculdade de Medicina e Ciência Biomédicas, Campus de Gambelas Faro, Portugal
| | - João P Sousa
- Departamento de Ortopedia e Traumatologia, Hospital Particular do Algarve-Urbanização Casal de Gambelas, Lote 2, Gambelas Faro, Portugal
| |
Collapse
|
|
3
|
Minimum 5-Year Outcomes of a Multicenter, Prospective, Randomized Control Trial Assessing Clinical and Radiological Outcomes of Patient-Specific Instrumentation in Total Knee Arthroplasty. J Arthroplasty 2022; 37:1579-1585. [PMID: 35077818 DOI: 10.1016/j.arth.2022.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patient-specific instrumentation (PSI) was developed to produce more accurate alignment of components and consequently improve clinical outcomes when used in total knee arthroplasty. We compare radiological accuracy and clinical outcomes at a minimum of 5-year follow-up between patients randomized to undergo total knee arthroplasty performed using PSI or traditional cutting block techniques. METHODS This multicenter, randomized control trial included patients blinded to the technique 1used. Outcome measures were coronal alignment measured radiologically, Euroqol-5D, Oxford knee score, and International Knee Society Score measured at 1- and 5-year follow-up. RESULTS At a minimum 5-year follow-up, there were 38 knees in the PSI group and 39 in the conventional instrumentation group for analysis. Baseline demographics and clinical outcome scores were matched between groups. Overall, there was no significant difference in the coronal femoral angle (P = .59), coronal tibial angle (P = .37), tibiofemoral angle (P = .99), sagittal femoral angle (P = .34), or the posterior tibia slope (P = .12) between knees implanted using PSI and those implanted with traditional cutting blocks. On the measurement of coronal alignment, intraobserver reliability tests demonstrated substantial agreement (k = 0.64). Clinical outcomes at both 1-year and 5-year follow-up demonstrated statistically significant and clinically relevant improvement in scores from baseline in both groups, but no difference could be detected between the Euroqol-5D (P = .78), Oxford knee score (P = .24), or International Knee Society Score (P = .86) between the 2 groups. CONCLUSION This study has shown no additional benefit to PSI in terms of improved alignment or functional outcomes at minimum 5-year follow-up over traditional techniques.
Collapse
|
|
4
|
A Study of Surgical Accuracy with X-Ray-Based Patient-Specific Instrument (X3DPSI ®) vs Conventional Instrument in Total Knee Arthroplasty Surgeries. Indian J Orthop 2022; 56:1240-1250. [PMID: 35813546 PMCID: PMC9232679 DOI: 10.1007/s43465-022-00623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Patient-specific instruments (PSI) have been shown to be a good solution in getting accurate bone cuts in total knee arthroplasty (TKA) in many studies. However, the need for an extra CT/MRI makes the existing PSI method costly and unsafe. X-ray-based PSI can solve these problems, if proven to be accurate. The purpose of this study was to introduce a novel method to measure the performance of X-ray to 3D-based PSI (X3DPSI ® ) in achieving planned bone cuts by comparing with conventional instruments (CI). MATERIALS AND METHODS This was a prospective study of a total of ten patients undergoing TKA surgery. Preoperative full length lower limb scanogram was done with specialized calibration strap-on marker to develop X3DPSI ® which was used intraoperatively for the placement of guiding pins for the cutting jig. Similarly, intraoperative guide pins were placed using CI also. Calibrated intraoperative X-ray images, in AP and LAT view, were taken while the cutting-block guiding pins were placed on the distal femur and proximal tibia. These X-ray images were used to calculate the cutting plane alignments for femur and tibia and to simulate the postoperative hip-knee-ankle (HKA) angle and MAD (mechanical axis deviation), in a virtual Tabplan3D environment for both the methods. RESULTS The results showed that there was a significant difference between the two methods in terms of femoral cutting plane angles and in terms of the HKA angles and MAD. There was no significant difference in the tibial cutting plane angles in the coronal plane. CONCLUSION The mechanical axis alignment achieved based on the virtual cuts made using the X3DPSI ® was significantly better than the alignment achieved based on the cuts made using the CI, in terms of both HKA and MAD. This novel method of X-ray-based PSI is a low-cost alternative to CT/MRI-based PSI if found to be accurate in future planned studies.
Collapse
|
|
5
|
Deng T, Liu T, Lei Q, Cai L, Chen S. Patient-specific instrumentation combined with a new tool for gap balancing is useful in total knee replacement: a 3-year follow-up of a retrospective study. J Orthop Surg Res 2021; 16:309. [PMID: 33980282 PMCID: PMC8114523 DOI: 10.1186/s13018-021-02467-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The purpose of this study was to determine whether the gap-balancing technique with patient-specific instrumentation (PSI) and a new balancing device in total knee arthroplasty (TKA) can improve knee function to a greater extent than can the measured resection technique. Materials and methods Data from 150 patients who underwent TKA from August 2014 to June 2016 were studied retrospectively. The gap-balancing technique assisted by PSI and the new balancing device was used in 80 patients (82 knees), and the measured resection technique was used in 70 patients (70 knees). The surgical, imaging, and knee function data were compared. Results The gap-balancing technique assisted by PSI and the new balancing device was found to be feasible in all operated knees and reliable. In total, 150 patients (152 knees) of ages ranging from 52 to 78 years (mean 67 years) underwent TKA during the study period. The follow-up period ranged from 35 to 52 months (mean 45 months). Only one patient, who was included in the gap-balancing group, underwent a revision surgery at 2 years postoperatively due to infection. There were no differences in the incidence of anterior knee pain between the two groups. The mean flexion angle, KSS scores, and VAS scores did not significantly differ between the measured resection group and gap-balancing group at 12 weeks or 36 weeks postoperatively. The average joint line displacement was 1.3 ± 1.1 mm (range 0–3) proximally in the GB (gap-balancing) group and 1.2 ± 1.4 mm in the MR (measured-resection) group. No outliers >5 mm in either group were recorded. The mean leg axis deviation from the neutral mechanical axis was 1.8°±1.5° varus (range 0°–3°varus) versus the neutral mechanical axis in the GB group and 1.4°±1.2°(range 0°–3°)in the MR group. No outliers with >3° deviation in either group were recorded. Conclusions The gap-balancing technique performed with the new balancing device and PSI can yield accurate femoral component alignment as well as outcomes similar to those of measured resection at 3 years. The new balancing device can be taken into consideration by surgeons who prefer performing the gap-balancing technique with PSI.
Collapse
Affiliation(s)
- Ting Deng
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Tangyou Liu
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Qing Lei
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China.
| | - Lihong Cai
- Department of Radiology, The Third Hospital of Changsha, Changsha, China
| | - Song Chen
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| |
Collapse
|
|
6
|
Massé V, Ghate RS. Using standard X-ray images to create 3D digital bone models and patient-matched guides for aiding implant positioning and sizing in total knee arthroplasty. Comput Assist Surg (Abingdon) 2021; 26:31-40. [PMID: 33721547 DOI: 10.1080/24699322.2021.1894239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
X-Atlas™ is a new imaging technology intended to advance the state of the art in patient-specific instrumentation. It uses standard AP and lateral radiographs instead of CT or MRI scans to create 3D bone models, which can be used to perform pre-operative surgical planning and fabricate TKA personalized guides. The aim of this study was to validate X-Atlas™ and evaluate the accuracy of personalized guides created with this imaging technology. Its ability to predict implant size was also determined. The accuracy of the X-Atlas™ imaging technology was evaluated by comparing the landmarks of X-Atlas™ 3D Bone models to MRI-reconstructed bone models. The accuracy of PSI guides created with X-Atlas™ (X-PSI™ guides) was evaluated during a validation study (16 specimen knees) and a clinical study (50 patients; Health Canada #CSU2015-12K). Optical navigation was used to measure positioning accuracy. In addition, the ability of X-Atlas™ to predict implant size was assessed. The accuracy of the X-Atlas™ imaging technology was below 0.87 and 1.28 mm for the femoral and tibial landmarks, respectively. The accuracy of X-PSI™ guides to reproduce the pre-operative planned HKA was within ± 3° in 100% and 86.1% of cases, for the laboratory and clinical study respectively, which was significantly better than historical data for conventional instrumentation. X-Atlas™ was able to predict implant size to ± 1 size in 95.6% and 100%, for the femur and tibia component respectively. The X-Atlas™ imaging technology demonstrated excellent accuracy for reconstructing a 3D bone model. The results show that PSI guides created with X-Atlas™ (X-PSI™ guides) provide greater implant positioning accuracy than conventional instrumentation, without the requirement of advanced imaging. Furthermore, the X-Atlas™ imaging technology could effectively predict implant sizing, potentially reducing the number of instrument trays and improving surgical efficiency.
Collapse
Affiliation(s)
- Vincent Massé
- Department of Orthopaedic Surgery, Maisonneuve-Rosemont Hospital, Montreal University, Montreal, Canada
| | - Raju S Ghate
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Skokie, IL, USA.,Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
|
7
|
Turgeon TR, Cameron B, Burnell CD, Hedden DR, Bohm ER. A double-blind randomized controlled trial of total knee replacement using patient-specific cutting block instrumentation versus standard instrumentation. Can J Surg 2020; 62:460-467. [PMID: 31782643 DOI: 10.1503/cjs.018318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Patient-specific cutting blocks in total knee arthroplasty have been promoted to improve mechanical alignment, reduce alignment outliers and improve patient outcomes. The aim of this study was to compare the efficacy of patient-specific instrumentation (PSI) and conventional instrumentation (CI) in achieving neutral alignment and accurate component positioning in total knee arthroplasty. Methods We conducted a double-blinded randomized controlled trial in which patients were randomly assigned to treatment with either PSI or CI. Results Fifty-four patients were included in the study. No relevant improvement in coronal alignment was found between the PSI and CI groups with post-hoc power of 0.91. Tibial slope was found to be more accurately reproduced to the preoperative target of 3° with PSI than with CI (3.8°± 3.1° v. 7.7°± 3.6°, respectively, p < 0.001). There were no differences found in patient-reported outcome measures, surgical time or length of hospital stay. Conclusion Given the added cost of the PSI technique, its use is difficult to justify given the small improvement in only a single alignment parameter. Clinical trial registration Clinicaltrials.gov, no. NCT03416946
Collapse
Affiliation(s)
- Thomas R. Turgeon
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - Brett Cameron
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - Colin D. Burnell
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - David R. Hedden
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - Eric R. Bohm
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| |
Collapse
|
|
8
|
Pauzenberger L, Munz M, Brandl G, Frank JK, Heuberer PR, Laky B, Schwameis E, Anderl W. Patient-specific instrumentation improved three-dimensional accuracy in total knee arthroplasty: a comparative radiographic analysis of 1257 total knee arthroplasties. J Orthop Surg Res 2019; 14:437. [PMID: 31831022 PMCID: PMC6909617 DOI: 10.1186/s13018-019-1465-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/08/2019] [Indexed: 01/19/2023] Open
Abstract
Background The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty. Methods Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined. Measurements were performed on standardized coronal long-leg and sagittal knee radiographs. CT-scans were evaluated for accuracy of axial femoral implant rotation. Outliers were defined as deviations from the targeted neutral mechanical axis of > ± 3° or from the intraoperative component-positioning goals of > ± 2°. Deviations greater than ± 5° from set targets were considered to be severe outliers. Results Deviations from a neutral mechanical axis (conventional instrumentation: 2.3°± 1.7° vs. patient-specific instrumentation: 1.7°± 1.2°; p < 0.001) and numbers of outliers (conventional instrumentation: 25.8% vs. patient-specific instrumentation: 10.1%; p < 0.001) were significantly lower in the patient-specific instrumentation group. Significantly lower mean deviations and less outliers were detected regarding 3D-component-positioning in the patient-specific instrumentation compared to the conventional instrumentation group (all p < 0.05). Conclusions Patient-specific instrumentation prevented from severe limb malalignment and component-positioning outliers (> ± 5° deviation). Use of patient-specific instrumentation proved to be superior to conventional instrumentation in achieving more accurate limb alignment and 3D-component positioning, particularly regarding femoral component rotation. Furthermore, the use of patient-specific instrumentation successfully prevented severe (> 5° deviation) outliers.
Collapse
Affiliation(s)
- Leo Pauzenberger
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Sports Surgery Clinic, Dublin, Ireland
| | - Martin Munz
- Medical University of Vienna, Vienna, Austria
| | - Georg Brandl
- Vienna Shoulder & Sports Clinic, Vienna, Austria
| | | | - Philipp R Heuberer
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria.,Health Pi, Vienna, Austria
| | - Brenda Laky
- Vienna Shoulder & Sports Clinic, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria.,MedSciCare, Vienna, Austria
| | | | - Werner Anderl
- Vienna Shoulder & Sports Clinic, Vienna, Austria. .,Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria. .,Shoulder & Sports Center, Mödling, Austria.
| |
Collapse
|
|
9
|
Accuracy of patient-specific instrumentation in shoulder arthroplasty: a systematic review and meta-analysis. JSES OPEN ACCESS 2019; 3:117-129. [PMID: 31709351 PMCID: PMC6834995 DOI: 10.1016/j.jses.2019.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background There has been significant recent emphasis on the use of patient-specific instrumentation (PSI) in shoulder arthroplasty. However, clinical data are lacking to support the increased time and expense associated with PSI. Our purposes were to determine whether PSI significantly improves implantation accuracy during total shoulder arthroplasty (TSA) and to analyze available techniques and correlation with clinical outcomes. We hypothesized that PSI may improve glenoid component position radiographically but without correlation with clinical outcomes. Methods The MEDLINE, Scopus, Embase, and Cochrane Library databases were queried. Included articles reported use of any preoperative or intraoperative PSI techniques, models, or guides to assist with TSA prosthesis implantation. The primary outcomes were mean deviation from the preoperative plan in version (in degrees), inclination (in degrees), and entry-point offset on the glenoid (in millimeters). Results Among the included articles, 518 TSA procedures (352 anatomic and 166 reverse) were performed. The mean postoperative errors in both version and inclination angles were 5° or less in 20 articles (90.9%) using PSI. Meta-analysis revealed no statistically significant differences in version error (P > .999, I 2 = 64.6%), inclination error (P = .702, I 2 = 82.2%), or positional offset (P = .777, I 2 = 85.7%) between PSI and standard instrumentation. No data regarding patient-reported outcome measures, range of motion, strength, or glenoid component loosening and longevity were reported. Conclusions Meta-analysis revealed no significant differences in accuracy between PSI and standard instrumentation. Although PSI may possess the potential to improve TSA techniques, further investigations regarding long-term clinical outcomes, impact on operating room time, and cost-effectiveness are warranted before PSI can be routinely recommended over conventional instrumentation.
Collapse
|
|
10
|
León-Muñoz VJ, Martínez-Martínez F, López-López M, Santonja-Medina F. Patient-specific instrumentation in total knee arthroplasty. Expert Rev Med Devices 2019; 16:555-567. [PMID: 31154870 DOI: 10.1080/17434440.2019.1627197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures. During the past decade, patient-specific instrumentation (PSI) has been commercially introduced in order to simplify and make TKA surgery more effective, precise and efficient than conventional mechanical instrumentation (CI) and computer-assisted surgery (CAS). Nevertheless, there are critical arguments against PSI for routine use. The aim of the current manuscript is to describe advantages and limitations of PSI for primary TKA. AREAS COVERED By means of a description of the available literature different aspects are discussed (accuracy, clinical and functional outcomes, operative time, blood loss, efficiency and costs). EXPERT OPINION Most publications do not claim a significant increase in PSI accuracy over CI, but they also do not postulate PSIs accuracy is worse either. Regarding clinical aspects, PSI did not appear to give any advantage over standard techniques although, equally, it did not appear to show any disadvantages. PSI seems to reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room. Further studies will be required to more thoroughly assess all the advantages and disadvantages of this promising technology as an alternative to CI and CAS.
Collapse
Affiliation(s)
- Vicente J León-Muñoz
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain
| | - Francisco Martínez-Martínez
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain.,b Faculty of Medicine , University of Murcia , Murcia , Spain
| | - Mirian López-López
- c Subdirección General de Tecnologías de la Información. Servicio Murciano de Salud , Murcia , Spain
| | - Fernando Santonja-Medina
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain.,b Faculty of Medicine , University of Murcia , Murcia , Spain
| |
Collapse
|
|
11
|
McAuliffe MJ, Beer BR, Hatch JJ, Crawford RW, Cuthbert AR, Donnelly WJ. Impact of Image-Derived Instrumentation on Total Knee Arthroplasty Revision Rates: An Analysis of 83,823 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2019; 101:580-588. [PMID: 30946191 DOI: 10.2106/jbjs.18.00326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups. METHODS Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates. RESULTS IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the ≤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group. CONCLUSIONS IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients ≤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Michael J McAuliffe
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Benjamin R Beer
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Joshua J Hatch
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Ross W Crawford
- Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Alana R Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - William J Donnelly
- Department of Orthopaedics, Prince Charles Hospital, Chermside, Queensland, Australia
| |
Collapse
|
|
12
|
Chanalithichai N, Tammachote N, Jitapunkul C, Kanitnate S. Rotational component alignment in patient-specific total knee arthroplasty compared with conventional cutting instrument. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1297-1304. [PMID: 30923964 DOI: 10.1007/s00590-019-02423-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/22/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although many studies investigated the accuracy of customized cutting block (CCB), the data on rotational alignment are still lacking. The study aimed to assess whether CCB improved the component rotational position compared with conventional cutting instrument (CCI) using computed tomography scanning. METHODS Eighty-six of 102 total knee arthroplasties from the previous randomized study were analyzed. The outcomes were rotational position of the femoral and tibial components, frequency of outliers and intra-class correlation coefficient. RESULTS The mean femoral component rotation was not different between CCB versus CCI: 0.9° ± 0.8° versus 1.1° ± 1.1° (P = 0.29). Both groups had similar outlier frequencies: 2% (CCB) versus 2% (CCI) (P = 0.74). CCB had nearly 1° less mean tibial component deviation compared with CCI (P < 0.001): (1) dorsal tangent reference (DTR): 0.7° ± 0.8° versus 1.5° ± 1.0°, and (2) tibial trans-epicondylar reference (TTR): 0.5° ± 0.9° versus 1.4° ± 1.1°. Outlier frequencies were similar: (1) DTR: 0% CCB versus 5% CCI (P = 0.24), and (2) TTR: 5% in CCB versus 12% CCI (P = 0.20). Measurements based on tibial tubercle showed that CCB had ~ 1.4° less mean tibial component deviation compared with CCI: 0.3° ± 1.4° versus 1.7° ± 1.6° (P < 0.001) with a corresponding, less frequency of outliers: 0% versus 19% (P = 0.002). However, there was poor intra-observer reproducibility (0.61). CONCLUSIONS CCB did not improve femoral component rotational alignment compared with CCI nor affect outlier frequency, but it marginally improved the accuracy of tibial rotational alignment. The tibial tubercle reference point had poor intra-observer reproducibility.
Collapse
Affiliation(s)
- Nuttawut Chanalithichai
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| | - Nattapol Tammachote
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand.
| | - Chane Jitapunkul
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand
| |
Collapse
|
|
13
|
Gong S, Xu W, Wang R, Wang Z, Wang B, Han L, Chen G. Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1083-1095. [PMID: 30377714 PMCID: PMC6435625 DOI: 10.1007/s00167-018-5256-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3° from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance. METHODS A total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay. RESULTS There was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI - 0.71 to - 0.21, p = 0.0004, I2 = 48%). PSI resulted in approximately 0.4° less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI - 10.95 to - 3.75, p < 0.0001, I2 = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI - 146.65 to - 20.18, p = 0.01, I2 = 74%). We did not find any differences between PSI and SI with respect to any other parameters. CONCLUSIONS PSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level I.
Collapse
Affiliation(s)
- Song Gong
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Weihua Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ruoyu Wang
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zijian Wang
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Bo Wang
- 0000 0004 0368 7223grid.33199.31Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Lizhi Han
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Guo Chen
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| |
Collapse
|
|
14
|
Arbab D, Reimann P, Brucker M, Bouillon B, Lüring C. Alignment in total knee arthroplasty - A comparison of patient-specific implants with the conventional technique. Knee 2018; 25:882-887. [PMID: 29936030 DOI: 10.1016/j.knee.2018.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Incorrect positioning and malalignment of total knee arthroplasty (TKA) components can result in implant loosening. Restoration of neutral alignment of the leg is an important factor affecting the long-term results of TKA. The aim of our retrospective study was to compare mechanical axis in patients with conventional and patient-specific TKAs. METHODS 232 patients who underwent TKA between January 2013 and December 2014 were included to compare postoperative mechanical axis. 125 patients received a patient-specific TKA (iTotal CR®, Conformis) and 107 a conventional TKA (Triathlon®, Stryker). Standardized pre- and postoperative long-leg standing radiographs were retrospectively evaluated to compare the two patient cohorts. RESULTS 113 (90%) radiographs of patient-specific TKA and 88 (82%) of conventional TKA were available for comparison. The preoperative deviation from neutral limb axis was 9.0° (0.1–27.3°) in the patient-specific TKA cohort and 8.2° (0.2–18.2°) in the conventional TKA group. Postoperatively the patient-specific TKA group showed 3.2° (0.1–8.4°) and the conventional TKA cohort 2.3° (0.1–12.5°) deviation. However, the rate of ± 3° outliers from neutral limb axis was 16% in the patient-specific TKA cohort and 26% in the conventional TKA group. CONCLUSIONS Patient-specific TKA demonstrated fewer outliers from neutral leg alignment compared to conventional technique. Potential benefits in the long-term outcome and functional improvement require further investigation.
Collapse
Affiliation(s)
- Dariusch Arbab
- Department of Orthopedic Surgery, Klinikum Dortmund, Member Faculty of Health Witten/Herdecke University, Beurhausstraße 40, 44137 Dortmund, Germany.
| | - Pia Reimann
- Ruhr University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Martin Brucker
- Department of Orthopedic Surgery, Klinikum Dortmund, Beurhausstraße 40, 44137 Dortmund, Germany
| | - Bertil Bouillon
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109 Cologne, Germany.
| | - Christian Lüring
- Department of Orthopedic Surgery, Klinikum Dortmund, Beurhausstraße 40, 44137 Dortmund, Germany.
| |
Collapse
|
|
15
|
Functional Outcomes and Accuracy of Patient-Specific Instruments for Total Knee Arthroplasty. Surg Innov 2018; 25:470-475. [DOI: 10.1177/1553350618787074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Patient-specific instruments (PSIs) were developed to improve mechanical axis alignment for patients undergoing total knee arthroplasty (TKA) as neutral alignment (180°) is a predictor of long-term success. This study examines alignment accuracy and functional outcomes of PSI as compared with standard instruments (SIs). Methods. We retrospectively reviewed a consecutive series of TKA procedures using PSI. A total of 85 PSI procedures were identified, and these were compared with a matched cohort of 85 TKAs using SI. Intraoperative decision-making, estimated blood loss, efficiency, Knee Society Scores, and postoperative radiographs were evaluated. Results. One hundred and seventy patients with comparable patient demographics were reviewed. Eighty-one percent of the PSI procedures were within target (180 ± 3°) mechanical alignment, while the SI group had 70% of cases within the target plane ( P = .132). Mean target alignment (2.0° PSI vs 2.2° SI, P = .477) was similar between groups. Twenty-seven percent of patients in the PSI group had surgeon-directed intraoperative recuts to improve the perceived coronal alignment. The change in hematocrit was reduced in the PSI group (8.89 vs 7.21, P = .000). Procedure time and total operating room time were equivalent. Knee Society Scores did not differ between groups at 6 months or at 1 year. Conclusion. Patient-specific instrumentation decreased change in hematocrit, though coronal alignment and efficiency were equivalent between groups. Surgeons must evaluate cuts intraoperatively to confirm alignment. Functional outcomes are equivalent for PSI and SI groups.
Collapse
|
|
16
|
Chi-Kay L, King-him C, Kin-bong L, Wilson L. Computer-Assisted Planning and Three-Dimensional-Printed Patient-Specific Instrumental Guide for Corrective Osteotomy in Post-Traumatic Femur Deformity: A Case Report and Literature Review. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2018. [DOI: 10.1016/j.jotr.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Post-traumatic limb deformity is often multiplanar and thus is a difficult pathology to deal with surgically. Precise preoperative planning and accurate intraoperative execution are two main important steps that lead to satisfactory outcome. Computer-assisted planning and three-dimensional-printed patient-specific instrumental guides provide excellent aid to the two steps, respectively. We report a case of posttraumatic lower limb deformity in a patient who underwent closing wedge corrective osteotomy with the aid of the aforementioned new technologies.
Collapse
Affiliation(s)
- Lau Chi-Kay
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - Chui King-him
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - Lee Kin-bong
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| | - Li Wilson
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong
| |
Collapse
|
|
17
|
Tammachote N, Panichkul P, Kanitnate S. Comparison of Customized Cutting Block and Conventional Cutting Instrument in Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2018; 33:746-751.e3. [PMID: 29108794 DOI: 10.1016/j.arth.2017.09.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Customized cutting block (CCB) was designed to ensure the accurate alignment of knee prostheses during total knee arthroplasty. Given the paucity of CCB efficacy data, we compare CCB with conventional cutting guide using a randomized controlled trial. METHODS One hundred eight osteoarthritic knee patients underwent total knee arthroplasty by one experienced surgeon were randomized to receive CCB (n = 54) or conventional cutting instrument (CCI) surgery (n = 54). The primary outcomes were limb alignment, prostheses position, and operative time. The secondary outcomes were hemodynamic alteration after surgery, functional outcomes (modified Western Ontario and McMaster University Osteoarthritis Index) and range of motion at 2 years after surgery. RESULTS Mean hip-knee-ankle angle in the CCB group was 179.4° ± 1.8° vs 179.1° ± 2.4° in the CCI group, Δ = 0 (95% confidence interval [CI] -0.6 to 1.1, P = .55). Mean operative time was faster in the CCB arm: 93 ± 12 vs 104 ± 12 minutes, Δ = 11 (95% CI -16.7 to -7.2, P < .0001). There were no differences in hemodynamic parameters, mean blood loss (446 [CCB] vs 514 mL [CCI], Δ = -68 [95% CI -138 to 31 mL, P = .21]), postoperative hemoglobin changes, incidence of hypotension (systolic <90 mm Hg), oliguria, and rates of blood transfusion. Functional outcomes and range of motion were also similar. CONCLUSION There was no improvement in alignment, hemodynamic changes, blood loss, and knee functional outcomes. CCB reduced surgical time by 11 minutes in our population. CCB cost-effectiveness should be further investigated.
Collapse
Affiliation(s)
- Nattapol Tammachote
- Department of Orthopaedics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
| | - Phonthakorn Panichkul
- Department of Orthopaedics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
| | - Supakit Kanitnate
- Department of Orthopaedics, Thammasat University, Khlong Luang, Pathum Thani, Thailand
| |
Collapse
|
|
18
|
Shoji H, Teramoto A, Suzuki T, Okada Y, Watanabe K, Yamashita T. Radiographic assessment and clinical outcomes after total knee arthroplasty using an accelerometer-based portable navigation device. Arthroplast Today 2018; 4:319-322. [PMID: 30186913 PMCID: PMC6123170 DOI: 10.1016/j.artd.2017.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022] Open
Abstract
It has been reported that an accelerometer-based portable navigation device can achieve accurate bone cuts, but there have been few studies of clinical outcomes after total knee arthroplasty (TKA) using such a device. The aim of this study was to evaluate lower limb alignment and clinical outcomes after TKA using an accelerometer-based portable navigation device. Thirty-five patients (40 knees) underwent primary TKAs using an accelerometer-based portable navigation device. Postoperative radiographic assessments included the hip-knee-ankle angle, femoral component angle (FCA), and tibial component angle (TCA) in the coronal plane and the sagittal FCA and sagittal TCA in the sagittal plane. Clinical outcomes were evaluated by the Japanese Orthopedic Association score for osteoarthritic knees, Japanese Knee Osteoarthritis Measure, and the New Knee Society Score. The frequency of outliers (>3 degrees) was 10% for the hip-knee-ankle angle, 8% for FCA, 0% for TCA, 19% for sagittal FCA, and 9% for sagittal TCA. The Japanese Orthopedic Association score and Japanese Knee Osteoarthritis Measure were significantly improved postoperatively. The postoperative New Knee Society Score was 67.2% for symptoms, 50.3% for satisfaction, 58.6% for expectation, and 44.1% for function. TKA using an accelerometer-based portable navigation device achieved good results for both lower limb alignment and clinical outcomes.
Collapse
Affiliation(s)
- Hiroaki Shoji
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|
|
19
|
Physiological joint line total knee arthroplasty designs are especially sensitive to rotational placement - A finite element analysis. PLoS One 2018; 13:e0192225. [PMID: 29401510 PMCID: PMC5798979 DOI: 10.1371/journal.pone.0192225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Mechanical and kinematical aligning techniques are the usual positioning methods during total knee arthroplasty. However, alteration of the physiological joint line and unbalanced medio-lateral load distribution are considered disadvantages in the mechanical and kinematical techniques, respectively. The aim of this study was to analyse the influence of the joint line on the strain and stress distributions in an implanted knee and their sensitivity to rotational mal-alignment. Finite element calculations were conducted to analyse the stresses in the PE-Inlay and the mechanical strains at the bone side of the tibia component-tibia bone interface during normal positioning of the components and internal and external mal-rotation of the tibial component. Two designs were included, a horizontal and a physiological implant. The loading conditions are based on internal knee joint loads during walking. A medialization of the stresses on the PE-Inlay was observed in the physiological implant in a normal position, accompanied by higher stresses in the mal-rotated positions. Within the tibia component-tibia bone interface, similar strain distributions were observed in both implant geometries in the normal position. However, a medialization of the strains was observed in the physiological implant in both mal-rotated conditions with greater bone volume affected by higher strains. Although evident changes due to mal-rotation were observed, the stresses do not suggest a local plastic deformation of the PE-Inlay. The strains values within most of the tibia component-tibia bone interface were in the physiological strain zone and no significant bone changes would be expected. The physiological cut on the articular aspect showed no detrimental effect compared to the horizontal implant.
Collapse
|
|
20
|
Van Leeuwen JAMJ, Snorrason F, Röhrl SM. No radiological and clinical advantages with patient-specific positioning guides in total knee replacement. Acta Orthop 2018; 89:89-94. [PMID: 29161930 PMCID: PMC5810839 DOI: 10.1080/17453674.2017.1393732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Although the use of patient-specific positioning guides (PSPGs) in total knee replacement (TKR) in theory is promising, the technique has not yet proven its superior- ity compared with the conventional method. We compared radio- logical alignment and clinical outcome between TKR performed with the use of PSPGs and the conventional operation method. Patients and methods - 3 hospitals participated in a prospec- tive trial. 109 patients were randomized to either the conventional method or to the use of PSPGs. Postoperatively a full-length standing anteroposterior radiograph and a postoperative CT scan were taken. On the CT scan the alignments were measured for both the femoral and tibial components in the frontal, sagit- tal, and axial plane. The Knee injury and Osteoarthritis Outcome Score (KOOS), the Eurocol-5D-3L (Eq5D) descriptive system and visual analogue scale (VAS), a pain score (NRS), and range of motion (ROM) were recorded preoperatively, and at 3 months, 1, and 2 years. The operation time and length of hospital stay were recorded. Results - 90 patients were available for postoperative CT mea- surements. A statistically significant difference was found between the conventional TKR instrumentation and the use of PSPGs for the frontal femoral (mean (SD) 0.6° (1.7) vs. -0.3° (2.2), CI 0.08 to 1.69) and tibial (-0.3° (1.5) vs. 0.9° (2.1), CI -1.98 to -0.44) compo- nent angles and for the tibial alignment in the sagittal plane (-3.8° (3.0) vs. -2.2° (2.5), CI -2.72; -0.42). The proportions of outliers were similar between the groups as well as the hip-knee-ankle angle, the KOOS sub scores, the Eq5D, pain (NRS), ROM, opera- tion time, and length of hospital stay. Interpretation - The use of PSPGs requires a preoperative CT scan or MRI and the guides have an additional cost. As this study was not able to prove any extra benefit of the use of PSPGs we recommend the conventional operation method for TKR.
Collapse
Affiliation(s)
- Justin A M J Van Leeuwen
- Department of Orthopaedic Surgery, Betanien Hospital, Skien, Norway,Faculty of Medicine, University of Oslo, Oslo, Norway,Correspondence:
| | - Finnur Snorrason
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
|
21
|
牛 鸣, 马 飞, 马 菊, 李 军, 吴 旭, 王 同, 汪 玉. [Total knee arthroplasty with 3D printing technique versus conventional surgery: comparison of the outcomes]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1467-1475. [PMID: 29180326 PMCID: PMC6779639 DOI: 10.3969/j.issn.1673-4254.2017.11.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare the clinical outcomes of patients receiving total knee arthroplasty (TKA) using 3D printing technique and conventional surgical methods. METHODS From October, 2015 to February, 2017, 17 patients (20 knees) underwent TKA with the assistance of individualized navigation template and 16 concurrent patients (18 knees) matched for age, gender and knee society score received conventional TKA. The operation time, blood loss, and osteotomy data of the femoral condyle and tibia plateau were recorded. The mean femorotibial angle (MFTA) and sagittal tibial component angle (STCA) after the operation and the KSS at the last follow-up were compared between the two groups. RESULTS All the patients were followed up for 7-23 months, during which no infection or prosthesis loosening or motion was found. In patients receiving surgery with 3D printing technique, the osteotomy data of the femoral condyle and tibia plateau in the actual surgeries were consistent with those in surgical plans (P>0.05). The patients in the 3D group had a significantly shorter operation time and a higher KSS score than those in the conventional group (P<0.05). Significant differences were found between the two groups in postoperative MFTA and STCA (P<0.05). CONCLUSION The application of 3D printing technique can simplify the surgical procedure and improve the surgical precision and efficacy of TKA.
Collapse
Affiliation(s)
- 鸣 牛
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 飞 马
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 菊蓉 马
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 军伟 李
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 旭年 吴
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 同 王
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 玉良 汪
- 兰州大学第二医院创伤骨科，甘肃 兰州 730000Department of Traumatic Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730000, China
| |
Collapse
|
|
22
|
牛 鸣, 马 飞, 马 菊, 李 军, 吴 旭, 王 同, 汪 玉. [Total knee arthroplasty with 3D printing technique versus conventional surgery: comparison of the outcomes]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1467-1475. [PMID: 29180326 PMCID: PMC6779639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To compare the clinical outcomes of patients receiving total knee arthroplasty (TKA) using 3D printing technique and conventional surgical methods. METHODS From October, 2015 to February, 2017, 17 patients (20 knees) underwent TKA with the assistance of individualized navigation template and 16 concurrent patients (18 knees) matched for age, gender and knee society score received conventional TKA. The operation time, blood loss, and osteotomy data of the femoral condyle and tibia plateau were recorded. The mean femorotibial angle (MFTA) and sagittal tibial component angle (STCA) after the operation and the KSS at the last follow-up were compared between the two groups. RESULTS All the patients were followed up for 7-23 months, during which no infection or prosthesis loosening or motion was found. In patients receiving surgery with 3D printing technique, the osteotomy data of the femoral condyle and tibia plateau in the actual surgeries were consistent with those in surgical plans (P>0.05). The patients in the 3D group had a significantly shorter operation time and a higher KSS score than those in the conventional group (P<0.05). Significant differences were found between the two groups in postoperative MFTA and STCA (P<0.05). CONCLUSION The application of 3D printing technique can simplify the surgical procedure and improve the surgical precision and efficacy of TKA.
Collapse
Affiliation(s)
- 鸣 牛
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 飞 马
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 菊蓉 马
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 军伟 李
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 旭年 吴
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 同 王
- 甘肃省张掖市甘州区人民医院骨科，甘肃 张掖 734000Department of Orthopedics, Ganzhou People's Hospital, Zhangye 734000, China
| | - 玉良 汪
- 兰州大学第二医院创伤骨科，甘肃 兰州 730000Department of Traumatic Orthopedics, Second Hospital of Lanzhou University, Lanzhou 730000, China
| |
Collapse
|
|
23
|
Patient-specific instrumentation in total knee arthroplasty: simpler, faster and more accurate than standard instrumentation-a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2616-2621. [PMID: 26585908 DOI: 10.1007/s00167-015-3869-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE This randomized controlled trial was conducted to compare patient-specific instrumentation (PSI) to standard instrumentation regarding efficacy to achieve a good coronal alignment and differences in surgical time, blood loss and length of stay. METHODS Ninety-five of 100 randomized patients eligible for total knee arthroplasty were analysed. PSI with magnetic resonance and long-leg radiograph was performed in 47 patients, while 48 patients received standard instrumentation. Primary outcome measure was coronal alignment, evaluated with long-leg radiograph. Deviation >3° varus/valgus was considered an outlier. Surgical time was compared from skin to skin. Length of stay was a post hoc analysis. Blood loss was evaluated comparing the number of blood units spent, fall in haemoglobin and haematocrit levels. RESULTS Standard instrumentation had a higher number of outliers in the coronal alignment with a relative risk of 3.015, compared to PSI. Surgical time was reduced by 18 min (24.8 %) with the PSI, as well as length of stay, with a half-day reduction. Number of blood units spent was significantly less in the PSI group. Relative risk of transfusion was 7.09 for patients in the standard instrumentation group. Difference in Hg and Htc levels were not significant. No patient had to abandon PSI. Minor changes to preoperative plan occurred in 14.9 % of the patient: cut review in 4.3 % and insert change in 10.6 %. CONCLUSIONS Patient-specific instrumentation (PSI) is able to provide important advantages over standard instrumentation in total knee arthroplasty: it lowers the risk of outliers and transfusion, is a faster procedure and enables a shorter length of stay with a low rate of intraoperative adjustments. LEVEL OF EVIDENCE I.
Collapse
|
|
24
|
Colombelli A, Belluati A, Rizqallah Y, Guerra G, Busatto C. Patient specific instrumentation in total knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:45-47. [PMID: 28657562 DOI: 10.23750/abm.v88i2 -s.6511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The international literature and analysis of the prosthetic registers highlight a significant relationship between the alignment of the components and the survival of prosthetic implants of the knee. The patient specific instrumentation (PSI) technology exploits the data obtained with the MRN for the production of cutting blocks (CB) useful to a TKA. Revisiting the recent international literature, comparing the results of the conventional method and PSI, numerous studies confirm a statistically significant difference of inliers (± 3 degrees) for HKA. The purpose of this retrospective study was to investigate whether these statistically significant difference is also present in our group. METHODS Postoperative radiographic measures of alignment based on a mechanical limb axis (hip-knee-ankle angle, HKA) of 180° were sought. A range of 180° ± 3° varus/valgus was defined as optimal for mechanical axis. RESULTS The percentage of knees that had a HKA within ±3° of the desired value was 92.2. CONCLUSION the CB did accurately produce the desired HKA. The PS system is an effective and reproducible, whose organizational effort is fully justified.
Collapse
|
|
25
|
|
|
26
|
Thienpont E, Schwab PE, Fennema P. Efficacy of Patient-Specific Instruments in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2017; 99:521-530. [PMID: 28291186 DOI: 10.2106/jbjs.16.00496] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) was introduced with the aim of making the procedure of total knee arthroplasty more accurate and efficient. The purpose of this study was to compare PSI and standard instrumentation in total knee arthroplasty with regard to radiographic and clinical outcomes as well as operative time and blood loss. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed and Embase were searched from 2011 through 2015. We included randomized controlled trials and cohort studies that reported the effect of PSI on the aforementioned outcomes. The primary end point was deviation from the mechanical axis by >3°. Random and fixed-effect models were used for analysis. RESULTS A total of 44 studies, which included 2,866 knees that underwent surgery with PSI and 2,956 knees that underwent surgery with standard instrumentation, were evaluated. The risk of mechanical axis malalignment was significantly lower for PSI, with a pooled relative risk of 0.79 (p = 0.013). The risk of tibial sagittal-plane malalignment was higher for PSI than for standard instrumentation (relative risk = 1.32, p = 0.001), whereas the risk of femoral coronal-plane malalignment was significantly lower (relative risk = 0.74, p = 0.043). The risk of tibial coronal-plane malalignment was significantly higher for PSI only when employing fixed-effect meta-analysis (relative risk = 1.33, p = 0.042). Minor reductions in total operative time (-4.4 minutes, p = 0.002) and blood loss (-37.9 mL, p = 0.015) were noted for PSI. CONCLUSIONS PSI improves the accuracy of femoral component alignment and global mechanical alignment, but at the cost of an increased risk of outliers for the tibial component alignment. The impact of the increased probability of tibial component malalignment on implant longevity remains to be determined. Meta-analyses indicated significant differences with regard to operative time and blood loss in favor of PSI. However, these differences were minimal and, by themselves, not a substantial justification for routine use of the technology. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Emmanuel Thienpont
- 1University Hospital Saint Luc, Brussels, Belgium 2AMR Advanced Medical Research, Männedorf, Switzerland
| | | | | |
Collapse
|
|
27
|
MacDessi S, Marimuthu K, Kumar VS, Chen D, Harris IA. Patient-specific cutting guides for total knee arthroplasty. Hippokratia 2017. [DOI: 10.1002/14651858.cd012589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samuel MacDessi
- Sydney Knee Specialists; Orthopaedic Surgery; Suite 8, 19 Kensington Street Kogarah NSW Australia 2217
| | - Kanniraj Marimuthu
- All India Institute of Medical Sciences; Department of Orthopaedics; Aurobindo Marg Ansari Nagar New Delhi Delhi India 110029
| | - Venkatesan S Kumar
- Wrightington Hospital; Lower Limb Department; Hall Lane, Appley Bridge Wigan Lancashire UK WN6 9EP
| | - Darren Chen
- Sydney Knee Specialists; Orthopaedic Surgery; Suite 8, 19 Kensington Street Kogarah NSW Australia 2217
| | - Ian A Harris
- South Western Sydney Clinical School, UNSW Australia; Ingham Institute for Applied Medical Research; Elizabeth Street Liverpool New South Wales Australia 2170
| |
Collapse
|
|
28
|
Yamamura K, Minoda Y, Mizokawa S, Ohta Y, Sugama R, Nakamura S, Ueyama H, Nakamura H. Novel alignment measurement technique for total knee arthroplasty using patient specific instrumentation. Arch Orthop Trauma Surg 2017; 137:401-407. [PMID: 28097422 DOI: 10.1007/s00402-017-2628-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study was designed to evaluate the true accuracy of patient specific instrumentation (PSI) for total knee arthroplasty (TKA) using a new 3D measurement method. MATERIALS AND METHODS Consecutive 21 patients (30 knees) who underwent TKA using computed tomography (CT)-based PSI were retrospectively evaluated. Mean patient age was 69.2 years (62 to 77). The postoperative three-dimensional (3D) CT image were superimposed onto the preoperative 3D CT plan and measured the absolute difference in the prosthetic alignment using six parameters: coronal, sagittal, and axial alignment of the femoral and tibial prostheses. Cases in which the difference in the prosthetic alignment was greater than 3° were considered outliers. RESULTS For the femoral prosthesis, mean absolute differences between the preoperative 3D CT plan and postoperative 3D CT image were not significantly different and the rates of outliers were 10.0, 33.3, 23.3% in the coronal, sagittal, and axial planes. For the tibial prosthesis, mean absolute differences were significantly larger in the axial plane than in the coronal and sagittal planes (p < 0.001) and the rates of outliers were 23.3, 36.7, 63.3% in the coronal, sagittal, and axial planes. The rates of outliers for the axial alignment of tibial prosthesis were significantly higher than for the other five planes (p = 0.006). CONCLUSIONS The rotation of the tibial prosthesis with CT-based PSI was less accurate in the axial plane than in the other five planes.
Collapse
Affiliation(s)
- Kazumasa Yamamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan.
| | - Shigekazu Mizokawa
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Suguru Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Hideki Ueyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
|
29
|
Colombelli A, Belluati A, Rizqallah Y, Guerra G, Busatto C. Patient specific instrumentation in total knee arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 28657562 PMCID: PMC6178995 DOI: 10.23750/abm.v88i2-s.6511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The international literature and analysis of the prosthetic registers highlight a significant relationship between the alignment of the components and the survival of prosthetic implants of the knee. The patient specific instrumentation (PSI) technology exploits the data obtained with the MRN for the production of cutting blocks (CB) useful to a TKA. Revisiting the recent international literature, comparing the results of the conventional method and PSI, numerous studies confirm a statistically significant difference of inliers (± 3 degrees) for HKA. The purpose of this retrospective study was to investigate whether these statistically significant difference is also present in our group. METHODS Postoperative radiographic measures of alignment based on a mechanical limb axis (hip-knee-ankle angle, HKA) of 180° were sought. A range of 180° ± 3° varus/valgus was defined as optimal for mechanical axis. RESULTS The percentage of knees that had a HKA within ±3° of the desired value was 92.2. CONCLUSION the CB did accurately produce the desired HKA. The PS system is an effective and reproducible, whose organizational effort is fully justified.
Collapse
Affiliation(s)
- Andrea Colombelli
- Correspondence: Andrea Colombelli Via vicoli 50, 48121 Ravenna (Italy) Tel. 0039.3288274767 E-mail:
| | | | | | | | | |
Collapse
|
|
30
|
Patient-specific positioning guides for total knee arthroplasty: no significant difference between final component alignment and pre-operative digital plan except for tibial rotation. Knee Surg Sports Traumatol Arthrosc 2017; 25:2809-2817. [PMID: 26055253 PMCID: PMC5570763 DOI: 10.1007/s00167-015-3661-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 05/27/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess whether there is a significant difference between the alignment of the individual femoral and tibial components (in the frontal, sagittal and horizontal planes) as calculated pre-operatively (digital plan) and the actually achieved alignment in vivo obtained with the use of patient-specific positioning guides (PSPGs) for TKA. It was hypothesised that there would be no difference between post-op implant position and pre-op digital plan. METHODS Twenty-six patients were included in this non-inferiority trial. Software permitted matching of the pre-operative MRI scan (and therefore calculated prosthesis position) to a pre-operative CT scan and then to a post-operative full-leg CT scan to determine deviations from pre-op planning in all three anatomical planes. RESULTS For the femoral component, mean absolute deviations from planning were 1.8° (SD 1.3), 2.5° (SD 1.6) and 1.6° (SD 1.4) in the frontal, sagittal and transverse planes, respectively. For the tibial component, mean absolute deviations from planning were 1.7° (SD 1.2), 1.7° (SD 1.5) and 3.2° (SD 3.6) in the frontal, sagittal and transverse planes, respectively. Absolute mean deviation from planned mechanical axis was 1.9°. The a priori specified null hypothesis for equivalence testing: the difference from planning is >3 or <-3 was rejected for all comparisons except for the tibial transverse plane. CONCLUSION PSPG was able to adequately reproduce the pre-op plan in all planes, except for the tibial rotation in the transverse plane. Possible explanations for outliers are discussed and highlight the importance for adequate training surgeons before they start using PSPG in their day-by-day practise. LEVEL OF EVIDENCE Prospective cohort study, Level II.
Collapse
|
|
31
|
Tack P, Victor J, Gemmel P, Annemans L. 3D-printing techniques in a medical setting: a systematic literature review. Biomed Eng Online 2016; 15:115. [PMID: 27769304 PMCID: PMC5073919 DOI: 10.1186/s12938-016-0236-4] [Citation(s) in RCA: 595] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes. METHODS Three major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans. RESULTS 227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure. CONCLUSION 3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost-effectiveness analysis.
Collapse
Affiliation(s)
- Philip Tack
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jan Victor
- Ghent University Hospital, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Paul Gemmel
- Departement of Economics & Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| |
Collapse
|
|
32
|
Kinematic femoral alignment with gap balancing and patient-specific instrumentation in total knee arthroplasty: a randomized clinical trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:683-688. [DOI: 10.1007/s00590-016-1865-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/20/2016] [Indexed: 11/26/2022]
|
|
33
|
Rodrigues AST, Gutierres MAP. Patient-specific instrumentation in total knee arthroplasty. Should we adopt it? Rev Bras Ortop 2016; 52:242-250. [PMID: 28702380 PMCID: PMC5497018 DOI: 10.1016/j.rboe.2016.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/13/2016] [Indexed: 01/16/2023] Open
Abstract
Total knee arthroplasty (TKA) is a surgical procedure of paramount relevance that restores a substantial degree of function in arthritic knees. Increased consideration has been given to the influence of limb alignment on longevity after TKA, as errors in component placement can be associated with inferior function and compromised long-term performance. Consequently, numerous studies comparing patient-specific instrumentation (PSI) to standard instruments (SI) have been published. Patient-specific approaches use preoperative imaging to create specific materials for each patient's anatomy and were designed to achieve a higher rate of success in TKA, causing the entire procedure to be more efficient and cost-effective. However, it is not clear to what degree these studies support the potential advantages of PSI. Thus, the present study aimed to review the current evidence comparing PSI to SI, concerning alignment, cost-effectiveness, and postoperative functional evaluation.
Collapse
Affiliation(s)
- Ana Sofia Teles Rodrigues
- Universidade do Porto, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, Porto, Portugal
| | | |
Collapse
|
|
34
|
Hommel H, Perka C, Pfitzner T. Preliminary results of a new surgical technique in total knee arthroplasty (TKA) using the native ligament tension for femoral implant positioning in varus osteoarthritis. Arch Orthop Trauma Surg 2016; 136:991-7. [PMID: 27271756 DOI: 10.1007/s00402-016-2480-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE Individual implant alignment in total knee arthroplasty (TKA) has seen growing interest over the past years. This study therefore aimed to develop a surgical technique for implant alignment based on native ligament tension, and to present the results obtained using this technique. METHODS 25 patients were included in this prospective study. Patient-specific instrumentation (PSI) was used for the resection of the extension gap. Ligament tension was measured after the removal of all accessible osteophytes. In the event of asymmetry, the distal femur resection was adjusted up to 2.5° using an adjustable cutting block. The aim was to achieve a symmetrical extension gap without release, not a neutral leg axis. Femoral rotation was aligned on the basis of ligament tension. Patients were followed up to 3 months postoperatively. RESULTS The postoperative whole-leg axis was 2.8° ± 1.6° varus. Patients achieved a flexion of 118° ± 9°, a Knee Score of 91.5 ± 3.2 and a Function Score of 86.8 ± 8.3 points. CONCLUSION For the first time, the new surgical technique described here permits a ligament tension based femoral implant alignment together with PSI. It was shown to be safe, with encouraging clinical and radiological results. LEVEL OF EVIDENCE Therapeutic study level IV.
Collapse
Affiliation(s)
- Hagen Hommel
- Clinic of Orthopaedics, Sports Medicine and Rehabilitation, Krankenhaus Märkisch-Oderland GmbH, BT Wriezen, Wriezen, Germany
| | - Carsten Perka
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Tilman Pfitzner
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| |
Collapse
|
|
35
|
Functional ligament-guided femoral rotation with patient-specific instruments: description of a new surgical technique. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
36
|
Anderl W, Pauzenberger L, Schwameis E. [The MyKnee® patient-specific system. Rationale, Technique and Results]. DER ORTHOPADE 2016; 45:294-301. [PMID: 27025868 DOI: 10.1007/s00132-016-3241-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adequate three-dimensional component positioning and restoration of overall limb alignment are primary goals in total knee arthroplasty. Patient-specific instrumentation (PSI) is a potential way to improve accuracy of knee reconstruction surgery. However, currently available literature regarding the reliability of PSI shows inconsistent results for limb alignment restoration and component positioning. OBJECTIVES The purpose of this article is to illustrate the rationale for using PSI in total knee arthroplasty, to demonstrate the surgical technique, and to present our outcome with the MyKnee(®) system. METHODS We illustrate in detail the logistics and workflow involved in PSI for total knee arthroplasty. Finally, we present clinical and radiological results of patients undergoing knee arthroplasty using the MyKnee(®) system compared to a conventional instrumentation group. RESULTS PSI significantly improved accuracy and reduced the number of outliers regarding neutral mechanical alignment restoration as well as three-dimensional component positioning compared to conventional instrumentation. The early clinical outcome was comparable between the two instrumentation groups. However, clinical outcome in the subgroup of patients within ± 3° from neutral mechanical limb alignment was superior to limb alignment outliers. CONCLUSION The MyKnee(®) PSI system presents a reliable way to improve the accuracy of mechanical limb alignment restoration and three-dimensional component positioning in total knee arthroplasty. Nonetheless, an adequate surgical technique remains the crucial factor for successful total knee reconstruction.
Collapse
Affiliation(s)
- W Anderl
- Abteilung für Orthopädie, Krankenhaus der Barmherzigen Schwestern Wien, Stumpergasse 13, 1060, Wien, Österreich.
| | - L Pauzenberger
- Abteilung für Orthopädie, Krankenhaus der Barmherzigen Schwestern Wien, Stumpergasse 13, 1060, Wien, Österreich
| | - E Schwameis
- Abteilung für Orthopädie, Krankenhaus der Barmherzigen Schwestern Wien, Stumpergasse 13, 1060, Wien, Österreich
| |
Collapse
|
|
37
|
Tibesku CO. [Total knee arthroplasty with the use of patient specific instruments. The VISIONAIRE system]. DER ORTHOPADE 2016; 45:286-93. [PMID: 26952362 DOI: 10.1007/s00132-016-3239-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate component positioning and correct post-operative whole-leg alignment are crucial for ensuring the optimal long-term performance of a knee replacement. Patient-specific instrumentation (PSI) was introduced in an attempt to reduce outliers in the positioning of components and in the alignment of the leg axis in comparison with conventional techniques. METHODS AND RESULTS A review of our own investigations and studies by other groups, it has been shown that PSI could reduce the amount of outliers in the positioning of tibial and femoral components and in whole-leg alignment. In this way, PSI differs from other procedures for improving component placement, such as navigation, for which no advantage could be demonstrated, especially with regard to rotation in comparison with conventional techniques. In this publication we focus on the VISIONAIRE PSI system (Smith&Nephew). In addition, the efficiency aspects of PSI are discussed, which differ from the conventional method because of the use of disposable instruments.
Collapse
Affiliation(s)
- C O Tibesku
- sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Deutschland.
| |
Collapse
|
|
38
|
Honigmann P, Thieringer F, Steiger R, Haefeli M, Schumacher R, Henning J. A Simple 3-Dimensional Printed Aid for a Corrective Palmar Opening Wedge Osteotomy of the Distal Radius. J Hand Surg Am 2016; 41:464-9. [PMID: 26787406 DOI: 10.1016/j.jhsa.2015.12.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/20/2015] [Accepted: 12/13/2015] [Indexed: 02/02/2023]
Abstract
The reconstruction of malunited distal radius fractures is often challenging. Virtual planning techniques and guides for drilling and resection have been used for several years to achieve anatomic reconstruction. These guides have the advantage of leading to better operative results and faster surgery. Here, we describe a technique using a simple implant independent 3-dimensional printed drill guide and template to simplify the surgical reconstruction of a malunited distal radius fracture.
Collapse
Affiliation(s)
- Philipp Honigmann
- Department of Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland; Clinic for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Florian Thieringer
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Oral and Cranio-Maxillofacial Surgery, University Hospital of Basel, Basel, Switzerland
| | - Regula Steiger
- Department of Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Mathias Haefeli
- Department of Hand Surgery, Kantonsspital Baden, Basel, Switzerland
| | - Ralf Schumacher
- University of Applied Sciences and Arts Northwestern Switzerland, Basel, Switzerland
| | - Julia Henning
- Department of Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| |
Collapse
|
|
39
|
Anderl W, Pauzenberger L, Kölblinger R, Kiesselbach G, Brandl G, Laky B, Kriegleder B, Heuberer P, Schwameis E. Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:102-11. [PMID: 25326759 DOI: 10.1007/s00167-014-3345-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/18/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of this prospective study was to compare early clinical outcome, radiological limb alignment, and three-dimensional (3D)-component positioning between conventional and computed tomography (CT)-based patient-specific instrumentation (PSI) in primary mobile-bearing total knee arthroplasty (TKA). METHODS Two hundred ninety consecutive patients (300 knees) with severe, debilitating osteoarthritis scheduled for TKA were included in this study using either conventional instrumentation (CVI, n = 150) or PSI (n = 150). Patients were clinically assessed before and 2 years after surgery according to the Knee-Society-Score (KSS) and the visual-analog-scale for pain (VAS). Additionally, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford-Knee-Score (OKS) were collected at follow-up. To evaluate accuracy of CVI and PSI, hip-knee-ankle angle (HKA) and 3D-component positioning were assessed on postoperative radiographs and CT. RESULTS Data of 222 knees (CVI: n = 108, PSI: n = 114) were available for analysis after a mean follow-up of 28.6 ± 5.2 months. At the early follow-up, clinical outcome (KSS, VAS, WOMAC, OKS) was comparable between the two groups. Mean HKA-deviation from the targeted neutral mechanical axis (CVI: 2.2° ± 1.7°; PSI: 1.5° ± 1.4°; p < 0.001), rates of outliers (CVI: 22.2%; PSI: 9.6%; p = 0.016), and 3D-component positioning outliers were significantly lower in the PSI group. Non-outliers (HKA: 180° ± 3°) showed better clinical results than outliers at the 2-year follow-up. CONCLUSIONS CT-based PSI compared with CVI improves accuracy of mechanical alignment restoration and 3D-component positioning in primary TKA. While clinical outcome was comparable between the two instrumentation groups at early follow-up, significantly inferior outcome was detected in the subgroup of HKA-outliers. LEVEL OF EVIDENCE Prospective comparative study, Level II.
Collapse
Affiliation(s)
- Werner Anderl
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
| | - Leo Pauzenberger
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Roman Kölblinger
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Gabriele Kiesselbach
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Georg Brandl
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Brenda Laky
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Bernhard Kriegleder
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Philipp Heuberer
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| | - Eva Schwameis
- Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria
| |
Collapse
|
|
40
|
Gandhi RR, Manzotti A, Confalonieri N, Cerveri P. Comparison of CT-based patient-specific templating and digital radiography templating in total knee arthroplasty. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jajs.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
|
41
|
Smith T, Elson L, Anderson C, Leone W. How are we addressing ligament balance in TKA? A literature review of revision etiology and technological advancement. J Clin Orthop Trauma 2016; 7:248-255. [PMID: 27857498 PMCID: PMC5106479 DOI: 10.1016/j.jcot.2016.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 03/24/2016] [Accepted: 04/07/2016] [Indexed: 01/16/2023] Open
Abstract
Despite technological advances in operative technique and component materials, the total knee arthroplasty (TKA) revision burden, in the United States, has remained static for the past decade. In light of an anticipated exponential increase in annual surgical volume, it is important to thoroughly understand contemporary challenges associated with technologically driven TKA. This descriptive literature review harvested 69 relevant publications to extrapolate patient trends, benefits, costs, and complications associated with computer-assisted surgery, patient specific instrumentation, and intra-operative sensors. Due to additional charges, a steep learning curve, and questionable cost-effectiveness, widespread use of these systems has been limited. Intra-operative sensors are a relatively recent development, and have been shown to improve both soft-tissue balance and overall functional outcomes at a relatively low price and without disrupting operative workflow. The introduction of new technology into the operating suite should be considered carefully, especially with respect to combined clinically efficacy and cost.
Collapse
Affiliation(s)
- Tyler Smith
- Nova Southeastern University, College of Osteopathic Medicine, 3301 College Avenue, Davie, FL 33314, United States
| | - Leah Elson
- OrthoSensor Inc., Department of Clinical Research, 1855 Griffin Road, Dania Beach, FL 33004, United States
| | - Christopher Anderson
- OrthoSensor Inc., Department of Clinical Research, 1855 Griffin Road, Dania Beach, FL 33004, United States,Corresponding author.
| | - William Leone
- Holy Cross Hospital, Leone Center for Orthopedic Care, 1000 NE 56th Street, Fort Lauderdale, FL 33334, United States
| |
Collapse
|
|
42
|
A Systematic Literature Review of Three Modalities in Technologically Assisted TKA. Adv Orthop 2015; 2015:719091. [PMID: 26664755 PMCID: PMC4667026 DOI: 10.1155/2015/719091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/09/2015] [Accepted: 10/12/2015] [Indexed: 01/13/2023] Open
Abstract
In effort to reduce the revision burden of total knee arthroplasty (TKA), industry emphasis has focused on replacing manual techniques—which are subject to variability—with technological implements. Unfortunately, technological innovation often continues before adequate time for critical evaluation has passed. Therefore, the purpose of this descriptive literature review was to collect a large sample of international data and report on the clinical and economic efficacy of three major types of technologically assisted TKA: navigation, patient-specific instrumentation, and sensorized trials.
Collapse
|
|
43
|
Hommel H, Perka C. Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg 2015; 135:1603-8. [PMID: 26315332 DOI: 10.1007/s00402-015-2315-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Combining patient-specific instrumentation (PSI) with a balancer device in total knee arthroplasty (TKA) to achieve functional femoral rotational alignment is a novel technique. The primary goal of this study was to introduce a new method to combine PSI with a gap-balancing technique and to determine the impact of the technique on rotation of the femoral component. MATERIALS AND METHODS Twenty-five primary TKAs (15 women, 10 men) were prospectively studied. All TKAs involved PSI with an associated gap-balancing device. Front plane alignment was performed intraoperatively with the PSI, followed by rectangular, symmetrical extension and creation of a flexion gap using the balancer device to set the femoral rotation. RESULTS Femoral component rotation was between 3° internal and 6° external rotation versus the transepicondylar axis. There were no postoperative signs of patellofemoral dysfunction. In no cases was the resulting joint line displacement >3 mm. The mean elevation was 1.2 ± 0.9 mm (range 0-3). The leg axis was straight in all cases (±3°), at a mean of 1.6° ± 1.0° varus (range 0°-3° varus). CONCLUSIONS PSI was with the gap-balancing technique was successfully used without affecting anatomical alignment. With the balancer device, PSI can be used more widely than techniques based solely on landmarks, as the soft-tissue tension can be taken into account, thus virtually eliminating flexion instabilities.
Collapse
Affiliation(s)
- Hagen Hommel
- Orthopedic Department, Hospital Märkisch Oderland, Section Wriezen, Sonnenburger Weg 3, 16269, Wriezen, Germany.
| | - Carsten Perka
- Center for Musceloskeletal Surgery, Orthopedic Department, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
|
44
|
Goyal N, Patel AR, Yaffe MA, Luo MY, Stulberg SD. Does Implant Design Influence the Accuracy of Patient Specific Instrumentation in Total Knee Arthroplasty? J Arthroplasty 2015; 30:1526-30. [PMID: 25861920 DOI: 10.1016/j.arth.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 02/01/2023] Open
Abstract
PSI software adjusts preoperative planning to accommodate differences in implant design. Such adjustments may influence the accuracy of intraoperative jig placement, bone resection, or component placement. Our purpose was to determine whether implant design influences PSI accuracy. 96 and 123 PSI TKA were performed by a single surgeon using two different implant systems and identical PSI software. Femoral coronal alignment outliers were greater for Implant 1 (23.9% Implant 1 vs. 13.4% Implant 2; P=0.050). Tibial coronal alignment outliers were greater for Implant 2 (10.9% Implant 1 vs. 22.7% Implant 2; P=0.025). There was no difference in overall mechanical axes. Differences in implant design can influence bone resection and component alignment. PSI software rationale must align with surgeons' intraoperative goals.
Collapse
Affiliation(s)
- Nitin Goyal
- Northwestern Feinberg School of Medicine Department of Orthopaedic Surgery, Chicago, Illinois
| | - Anay R Patel
- Northwestern Feinberg School of Medicine Department of Orthopaedic Surgery, Chicago, Illinois
| | - Mark A Yaffe
- Northwestern Feinberg School of Medicine Department of Orthopaedic Surgery, Chicago, Illinois
| | - Michael Y Luo
- Northwestern Feinberg School of Medicine Department of Orthopaedic Surgery, Chicago, Illinois
| | - S David Stulberg
- Northwestern Feinberg School of Medicine Department of Orthopaedic Surgery, Chicago, Illinois; Northshore Orthopaedics, Chicago, Illinois
| |
Collapse
|
|
45
|
Patient-Specific CT-Based Instrumentation versus Conventional Instrumentation in Total Knee Arthroplasty: A Prospective Randomized Controlled Study on Clinical Outcomes and In-Hospital Data. BIOMED RESEARCH INTERNATIONAL 2015; 2015:165908. [PMID: 26301241 PMCID: PMC4537709 DOI: 10.1155/2015/165908] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 07/08/2015] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty (TKA) is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA.
Collapse
|
|
46
|
Rathod PA, Deshmukh AJ, Cushner FD. Reducing blood loss in bilateral total knee arthroplasty with patient-specific instrumentation. Orthop Clin North Am 2015; 46:343-50, ix. [PMID: 26043048 DOI: 10.1016/j.ocl.2015.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) has been introduced to obtain consistent alignment, prevent instrumentation of the medullary canal and improve operating room efficiency. This article compares simultaneous bilateral TKA performed with and without the use of PSI in terms of surgical time; blood loss and transfusion requirements; length-of-stay, early thromboembolic events and complication rates. There was a trend to reduced total blood loss (as measured by drop in hemoglobin values) and lower transfusion rate after surgery. Further research in the form of high quality randomized trials and cost-benefit analyses may help in further consolidation of these findings.
Collapse
Affiliation(s)
- Parthiv A Rathod
- NYU Hospital for Joint Diseases, Woodhull Hospital, NYU Langone Medical Center, New York, NY, USA.
| | - Ajit J Deshmukh
- VA New York Harbor Healthcare System, NYU Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY, USA
| | - Fred D Cushner
- Southside Hospital, North Shore LIJ Health System, New York, NY, USA
| |
Collapse
|
|
47
|
Goyal N, Stulberg SD. Evaluating the Precision of Preoperative Planning in Patient Specific Instrumentation: Can a Single MRI Yield Different Preoperative Plans? J Arthroplasty 2015; 30:1250-3. [PMID: 25762454 DOI: 10.1016/j.arth.2015.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/31/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023] Open
Abstract
If PSI preoperative planning were perfectly precise, a single MRI would give rise to one preoperative plan. Our purpose was to determine whether a single MRI inputted into two different PSI software yielded differences in preoperative alignment determination, component sizing, and bone resection within the preoperative plan. This prospective comparative study evaluated 40 preoperative plans generated by two PSI software given identical MRI. Femoral and tibial component sizes differed between software in 37.5% and 30.0% of cases, respectively. The maximum difference in bone resection between software ranged from 2.2mm to 5.1mm. Surgeons should be prepared to intraoperatively deviate from PSI selected size by 1 size. It may be necessary to fine tune soft tissue balancing when using a PSI system.
Collapse
Affiliation(s)
- Nitin Goyal
- Northwestern Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, Illinois
| | - S David Stulberg
- Northwestern Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, Illinois; Northshore Orthopaedics, Chicago, Illinois
| |
Collapse
|
|
48
|
Mannan A, Smith TO, Sagar C, London NJ, Molitor PJA. No demonstrable benefit for coronal alignment outcomes in PSI knee arthroplasty: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2015; 101:461-8. [PMID: 25802069 DOI: 10.1016/j.otsr.2014.12.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/01/2014] [Accepted: 12/15/2014] [Indexed: 02/02/2023]
Abstract
AIM A systematic review and meta-analysis of clinical studies assessing alignment outcomes in patient-specific instrumented (PSI) knee arthroplasty was conducted. MATERIALS AND METHODS PRISMA compliant data was extracted from literature databases up to January 2014. RESULTS Twenty-six studies met the inclusion criteria, reporting a total of 1792 knees. Twenty-three studies reported alignment outcomes in the coronal plane, 11 in the sagittal plane. In all but three series, MRI was the preoperative imaging modality. Range of mean postoperative alignment (hip-knee-ankle [HKA] angle) was 176.5 to 181.70. The proportion of three degrees of outliers showed an overall mean of 18.6%. In total, fifteen studies compared alignment outcomes between standard and PSI. From these, four studies showed significantly higher accuracy of coronal plane alignment with PSI (HKA angle). Meta-analysis of seven high-quality comparative studies demonstrated no significant increased accuracy in postoperative mechanical axis (HKA angle) with PSI. Subgroup meta-analysis of both femoral and tibial rotation was not feasible due to a low number of inclusive high-quality series. CONCLUSIONS PSI knee arthroplasty is shown not to confer increased accuracy in reconstituting the postoperative mechanical axis. Further studies are required to demonstrate both clinical and radiological alignment outcomes in PSI knee arthroplasty with focus upon tibial and femoral rotation.
Collapse
Affiliation(s)
- A Mannan
- Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, DN15 7BH North Lincolnshire, UK.
| | - T O Smith
- University of East Anglia, Norwich, UK
| | - C Sagar
- Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, DN15 7BH North Lincolnshire, UK
| | - N J London
- Harrogate District Hospital, Lancaster Park Road, HG2 7SX Harrogate, UK
| | - P J A Molitor
- Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, DN15 7BH North Lincolnshire, UK
| |
Collapse
|
|
49
|
Haefeli M, Schaefer DJ, Schumacher R, Müller-Gerbl M, Honigmann P. Titanium template for scaphoid reconstruction. J Hand Surg Eur Vol 2015; 40:526-33. [PMID: 25167978 DOI: 10.1177/1753193414549008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 07/15/2014] [Indexed: 02/03/2023]
Abstract
Reconstruction of a non-united scaphoid with a humpback deformity involves resection of the non-union followed by bone grafting and fixation of the fragments. Intraoperative control of the reconstruction is difficult owing to the complex three-dimensional shape of the scaphoid and the other carpal bones overlying the scaphoid on lateral radiographs. We developed a titanium template that fits exactly to the surfaces of the proximal and distal scaphoid poles to define their position relative to each other after resection of the non-union. The templates were designed on three-dimensional computed tomography reconstructions and manufactured using selective laser melting technology. Ten conserved human wrists were used to simulate the reconstruction. The achieved precision measured as the deviation of the surface of the reconstructed scaphoid from its virtual counterpart was good in five cases (maximal difference 1.5 mm), moderate in one case (maximal difference 3 mm) and inadequate in four cases (difference more than 3 mm). The main problems were attributed to the template design and can be avoided by improved pre-operative planning, as shown in a clinical case.
Collapse
Affiliation(s)
- M Haefeli
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland Hand Surgery, Kantonsspital Baden, Baden, Switzerland
| | - D J Schaefer
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - R Schumacher
- University of Applied Sciences of Northwestern, Switzerland
| | - M Müller-Gerbl
- Institute of Anatomy, University Basel, Basel, Switzerland
| | - P Honigmann
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
|
50
|
Rapid prototyping for in vitro knee rig investigations of prosthetized knee biomechanics: comparison with cobalt-chromium alloy implant material. BIOMED RESEARCH INTERNATIONAL 2015; 2015:185142. [PMID: 25879019 PMCID: PMC4388012 DOI: 10.1155/2015/185142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/27/2014] [Indexed: 12/24/2022]
Abstract
Retropatellar complications after total knee arthroplasty (TKA) such as anterior knee pain and subluxations might be related to altered patellofemoral biomechanics, in particular to trochlear design and femorotibial joint positioning. A method was developed to test femorotibial and patellofemoral joint modifications separately with 3D-rapid prototyped components for in vitro tests, but material differences may further influence results. This pilot study aims at validating the use of prostheses made of photopolymerized rapid prototype material (RPM) by measuring the sliding friction with a ring-on-disc setup as well as knee kinematics and retropatellar pressure on a knee rig. Cobalt-chromium alloy (standard prosthesis material, SPM) prostheses served as validation standard. Friction coefficients between these materials and polytetrafluoroethylene (PTFE) were additionally tested as this latter material is commonly used to protect pressure sensors in experiments. No statistical differences were found between friction coefficients of both materials to PTFE. UHMWPE shows higher friction coefficient at low axial loads for RPM, a difference that disappears at higher load. No measurable statistical differences were found in knee kinematics and retropatellar pressure distribution. This suggests that using polymer prototypes may be a valid alternative to original components for in vitro TKA studies and future investigations on knee biomechanics.
Collapse
|