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Kim KK, Song J. Accuracy of Patient-Specific Instrument for Cylindrical Axis Implementation in Kinematically Aligned Total Knee Arthroplasty. Clin Orthop Surg 2023; 15:760-769. [PMID: 37811500 PMCID: PMC10551691 DOI: 10.4055/cios22147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 10/10/2023] Open
Abstract
Background In kinematically aligned total knee arthroplasty (KA-TKA), the cylindrical axis (CA) is very important in restoring the native joint line and kinematics of the pre-arthritic knee. This study aimed to determine the accuracy of patient-specific instrument (PSI) for restoring the CA for femoral bone resection in KA-TKA. Methods Thirty KA-TKAs were performed using a computed tomography (CT)-based PSI system. Data from preoperative CT were reconstructed into three-dimensional (3D) models using 3D-planning software. The CA was created by connecting the centers of each virtual sphere to the medial and lateral femoral condyles using computer software. Femoral bone resection of the distal and posterior condyles was performed parallel to the sagittal planes of the CA. The thickness of the CA-referenced bone resection was determined based on the thickness necessary for the respective regions of the femoral component. The PSI was manufactured to locate the guide pin for a conventional cutting block. The accuracy of PSI for KA-TKA was evaluated as the absolute error between the preoperatively predicted thickness and the intraoperative measurements in each of the four regions, as well as the difference in error between distal-medial (DM) and posterior-medial (PM) and between distal-lateral (DL) and posterior-lateral (PL). Results The differences in thickness of bone cut in the DM, DL, PM, and PL were 0.79 ± 0.39 mm (range, -1.20 to 1.50), 0.70 ± 0.42 mm (range, -1.50 to 1.50), 0.80 ± 0.46 mm (range, -0.80 to 1.50), and 0.75 ± 0.47 mm (range, -2.10 to 1.40), respectively. There was no significant difference in the thickness error between DM and PM (p = 0.959) and between DL and PL (p = 0.812). Conclusions In KA-TKA, PSI was effective for accurate femoral bone resection based on virtually planned thickness.
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Affiliation(s)
- Kwang-Kyoun Kim
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
- Konyang University Myunggok Medical Research Institute, Daejeon, Korea
| | - Jaehwang Song
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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Kizaki K, Shanmugaraj A, Yamashita F, Simunovic N, Duong A, Khanna V, Ayeni OR. Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis. BMC Musculoskelet Disord 2019; 20:561. [PMID: 31759392 PMCID: PMC6875166 DOI: 10.1186/s12891-019-2940-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Total knee arthroplasty using patient-specific instrumentation (TKA-PSI), which are disposable cutting block guides generated to fit each patient's 3-dimensional knee anatomy, has been developed to treat patients with end-stage osteoarthritis of the knee. Surrogate markers such as radiographic malalignment have been well investigated, however, patient-important outcomes are not well examined to elucidate the efficacy of TKA-PSI. The aim of this review is to determine if TKA-PSI improves patient-reported outcome measures (PROM), surgery time, blood loss, transfusion and complications (e.g. surgical site infection, deep venous thrombosis, and revision TKA). METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ongoing clinical trials. For PROMs, surgery time, blood loss, and transfusion rate, we included randomized controlled trials (RCT) comparing TKA-PSI and standard TKA to treat osteoarthritis of the knee. For complications, we also included non-randomized comparative studies (non-RCT). RESULTS This review includes 38 studies, 24 of which were RCT and 14 of which were non-RCT. These included a total of 3487 patients. The predominant population in the included studies highly reflected the general population, with 62% being female, aged over 60 and having end-stage osteoarthritis of the knee. TKA-PSI did not improve PROMs as compared to standard TKA for less than 1-year (mean difference 0.48, 95% confidence interval (CI) -1.92-0.97 in the Oxford knee score, mean 3-month follow-up) and for 1-year or more (mean difference 0.25, 95%CI - 4.39-4.89 in the WOMAC score, mean 29-month follow-up). TKA-PSI did not reduce surgery time (mean difference - 3.09 min, 95%CI -6.73-0.55). TKA-PSI decreased blood loss with a small effect size corresponding to a 0.4 g/dl hemoglobin decrease (95%CI 0.18-0.88), but did not decrease transfusion rate (risk difference - 0.04, 95%CI -0.09-0.01). TKA-PSI did not reduce complication rates (risk difference 0.00, 95%CI - 0.01-0.01 in the composite outcome). CONCLUSIONS TKA-PSI does not improve patient-reported outcome measures, surgery time, and complication rates as compared to standard TKA. TKA-PSI decreases blood loss with a small effect, which is not enough to reduce transfusion rate.
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Affiliation(s)
- Kazuha Kizaki
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.,Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Fumiharu Yamashita
- Department of Orthopaedic surgery and rheumatology, Kyoto Shimogamo Hospital, 17 Shimogamo, Kyoto, 606-0866, Japan
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.,Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Olufemi R Ayeni
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada. .,Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
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Kim K, Kim J, Lee D, Lim S, Eom J. The Accuracy of Alignment Determined by Patient-Specific Instrumentation System in Total Knee Arthroplasty. Knee Surg Relat Res 2019; 31:19-24. [PMID: 30871288 PMCID: PMC6425897 DOI: 10.5792/ksrr.18.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 01/21/2023] Open
Abstract
Purpose The aim of this study is to assess the accuracy of alignment determined by patient-specific instrumentation system in total knee arthroplasty (TKA). Materials and Methods Twenty-seven TKAs using patient-specific instrument were reviewed. The intraoperative pin location determined by the patient-specific guide was recorded using imageless navigation software. Data recorded included tibial coronal alignment and posterior slope, femoral coronal alignment and sagittal alignment, and transepicondylar axis. A discrepancy within ±3° in each plane was considered an acceptable result. Results On the tibia, an acceptable alignment was obtained in 24 (88.1%) in the coronal plane and 21 (77.8%) in the sagittal plane. On the femur, a satisfactory alignment was obtained in 25 (92.6%) in the coronal plane and 24 (88.1%) in the sagittal plane. Based on the transepicondylar axis, a satisfactory alignment was obtained in 23 (85.1%). Conclusions Satisfactory alignment was obtained in more than 85% of each plane of the femur and in the coronal plane of the tibia and relative to the transepicondylar axis. Sufficeint experience and precise preoperative planning are required to improve the accuracy of sagittal alignment of the tibia.
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Affiliation(s)
| | - Jungsung Kim
- Medical Engineering, Konyang University College of Medicine, Daejeon, Korea
| | | | - Sohui Lim
- Medical Engineering, Konyang University College of Medicine, Daejeon, Korea
| | - Jiyoon Eom
- Medical Engineering, Konyang University College of Medicine, Daejeon, Korea
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