Advertisement

Design improvement in patient-specific instrumentation for total knee arthroplasty improved the accuracy of the tibial prosthetic alignment in the coronal and axial planes

  • Kazumasa Yamamura
  • Yukihide MinodaEmail author
  • Ryo Sugama
  • Yoichi Ohta
  • Suguru Nakamura
  • Hideki Ueyama
  • Hiroaki Nakamura
KNEE
  • 67 Downloads

Abstract

Purpose

The accuracy of patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) is still controversial, especially in the tibial prosthesis. It was hypothesized that the design modification of PSI improved the tibial prosthetic alignment and reduced the associated complications. The aim of this study was to compare the accuracy of a conventional PSI with that of a newly designed PSI for total knee arthroplasty (TKA) using a new three-dimensional (3D) measurement method.

Methods

Thirty TKAs each using the conventional and newly designed PSIs were studied. The postoperative 3D-computed tomography (3D CT) image was superimposed on the preoperative 3D CT plan. The absolute differences in the tibial prosthetic alignment between the preoperative and postoperative 3D CT images were directly measured in the coronal, sagittal, and axial planes. Knees in which the difference in the prosthetic alignment was > 3° were considered deviations.

Results

The new PSI showed less mean absolute differences and lower rate of deviations than the conventional PSI in the coronal and axial planes (p = 0.045 and p = 0.004, respectively). The deviations (> 3°) of the tibial prosthesis using the conventional PSI were 27, 30, and 63% and of those using the new PSI were 0, 20, and 20% in the coronal, sagittal, and axial planes, respectively.

Conclusions

This is the first report to evaluate the effect of improvement in PSI design on the postoperative alignment using 3D method, and it clearly showed that the modification significantly improved the accuracy of alignment and reduced the deviations.

Level of evidence

Therapeutic study, case–control study, Level III.

Keywords

Total knee arthroplasty Patient-specific instrumentation Three-dimensional evaluation Prosthetic alignment 

Notes

Compliance with ethical standards

Conflict of interest

Author YM has received research Grants and speaker honorarium from MicroPort.

Ethical approval

This study was approved by the institutional review board of Osaka City University Graduate School of Medicine and Faculty of Medicine (ID number 1992).

Informed consent

All patients provided informed consent.

References

  1. 1.
    Abdel MP, Parratte S, Blanc G, Ollivier M, Pomero V, Viehweger E et al (2014) No benefit of patient-specific instrumentation in TKA on functional and gait outcomes: a randomized clinical trial. Clin Orthop Relat Res 472:2468–2476CrossRefGoogle Scholar
  2. 2.
    Abdel MP, von Roth P, Hommel H, Perka C, Pfitzner T (2015) Intraoperative navigation of patient-specific instrumentation does not predict final implant position. J Arthroplasty 30:564–566CrossRefGoogle Scholar
  3. 3.
    Anderl W, Pauzenberger L, Kolblinger R, Kiesselbach G, Brandl G, Laky B et al (2016) Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 24:102–111CrossRefGoogle Scholar
  4. 4.
    Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP (2013) Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 21:2206–2212CrossRefGoogle Scholar
  5. 5.
    Boonen B, Schotanus MG, Kort NP (2012) Preliminary experience with the patient-specific templating total knee arthroplasty. Acta Orthop 83:387–393CrossRefGoogle Scholar
  6. 6.
    Chen JY, Yeo SJ, Yew AK, Tay DK, Chia SL, Lo NN et al (2014) The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:630–635CrossRefGoogle Scholar
  7. 7.
    Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty 24:39–43CrossRefGoogle Scholar
  8. 8.
    Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRefGoogle Scholar
  9. 9.
    Fu Y, Wang M, Liu Y, Fu Q (2012) Alignment outcomes in navigated total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 20:1075–1082CrossRefGoogle Scholar
  10. 10.
    Hafez MA, Chelule KL, Seedhom BB, Sherman KP (2006) Computer-assisted total knee arthroplasty using patient-specific templating. Clin Orthop Relat Res 444:184–192CrossRefGoogle Scholar
  11. 11.
    Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Jt Surg Br 93:629–633CrossRefGoogle Scholar
  12. 12.
    Howell SM, Kuznik K, Hull ML, Siston RA (2008) Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 31:857–863CrossRefGoogle Scholar
  13. 13.
    Jiang J, Kang X, Lin Q, Teng Y, An L, Ma J et al (2015) Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics 38:e305–e313CrossRefGoogle Scholar
  14. 14.
    Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Jt Surg Br 89:471–476CrossRefGoogle Scholar
  15. 15.
    Kuriyama S, Hyakuna K, Inoue S, Tamaki Y, Ito H, Matsuda S (2014) Tibial rotational alignment was significantly improved by use of a CT-navigated control device in total knee arthroplasty. J Arthroplasty 29:2352–2356CrossRefGoogle Scholar
  16. 16.
    Kwon OR, Kang KT, Son J, Suh DS, Heo DB, Koh YG (2017) Patient-specific instrumentation development in TKA: 1st and 2nd generation designs in comparison with conventional instrumentation. Arch Orthop Trauma Surg 137:111–118CrossRefGoogle Scholar
  17. 17.
    Lee YS, Lee BK, Lee SH, Park HG, Jun DS, do Moon H (2013) Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 21:2542–2547CrossRefGoogle Scholar
  18. 18.
    Leeuwen JA, Grogaard B, Nordsletten L, Rohrl SM (2015) Comparison of planned and achieved implant position in total knee arthroplasty with patient-specific positioning guides. Acta Orthop 86:201–207CrossRefGoogle Scholar
  19. 19.
    Liu HX, Shang P, Ying XZ, Zhang Y (2016) Shorter survival rate in varus-aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2663–2671CrossRefGoogle Scholar
  20. 20.
    Lombardi AV Jr, Berend KR, Ng VY (2011) Neutral mechanical alignment: a requirement for successful TKA: affirms. Orthopedics 34:e504–e506Google Scholar
  21. 21.
    Marimuthu K, Chen DB, Harris IA, Wheatley E, Bryant CJ, MacDessi SJ (2014) A multi-planar CT-based comparative analysis of patient-specific cutting guides with conventional instrumentation in total knee arthroplasty. J Arthroplasty 29:1138–1142CrossRefGoogle Scholar
  22. 22.
    Matsuda S, Miura H, Nagamine R, Urabe K, Hirata G, Iwamoto Y (2001) Effect of femoral and tibial component position on patellar tracking following total knee arthroplasty: 10-year follow-up of Miller-Galante I knees. Am J Knee Surg 14:152–156Google Scholar
  23. 23.
    Maus U, Marques CJ, Scheunemann D, Lampe F, Lazovic D, Hommel H et al (2018) No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 26:2788–2796CrossRefGoogle Scholar
  24. 24.
    Mizu-Uchi H, Matsuda S, Miura H, Higaki H, Okazaki K, Iwamoto Y (2009) Three-dimensional analysis of computed tomography-based navigation system for total knee arthroplasty: the accuracy of computed tomography-based navigation system. J Arthroplasty 24:1103–1110CrossRefGoogle Scholar
  25. 25.
    Murakami AM, Hash TW, Hepinstall MS, Lyman S, Nestor BJ, Potter HG (2012) MRI evaluation of rotational alignment and synovitis in patients with pain after total knee replacement. J Bone Jt Surg Br 94:1209–1215CrossRefGoogle Scholar
  26. 26.
    Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Jt Surg Br 92:1238–1244CrossRefGoogle Scholar
  27. 27.
    Okamoto S, Mizu-Uchi H, Okazaki K, Hamai S, Tashiro Y, Nakahara H et al (2016) Two-dimensional planning can result in internal rotation of the femoral component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:229–235CrossRefGoogle Scholar
  28. 28.
    Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson JN (2013) Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 21:2213–2219CrossRefGoogle Scholar
  29. 29.
    Silva A, Sampaio R, Pinto E (2014) Patient-specific instrumentation improves tibial component rotation in TKA. Knee Surg Sports Traumatol Arthrosc 22:636–642CrossRefGoogle Scholar
  30. 30.
    Thienpont E, Schwab PE, Fennema P (2017) Efficacy of patient-specific instruments in total knee arthroplasty: a systematic review and meta-analysis. J Bone Jt Surg Am 99:521–530CrossRefGoogle Scholar
  31. 31.
    Vince KG (2012) The stiff total knee arthroplasty: causes and cures. J Bone Jt Surg Br 94:103–111CrossRefGoogle Scholar
  32. 32.
    Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 299:31–43Google Scholar
  33. 33.
    Yamamura K, Minoda Y, Mizokawa S, Ohta Y, Sugama R, Nakamura S et al (2017) Novel alignment measurement technique for total knee arthroplasty using patient specific instrumentation. Arch Orthop Trauma Surg 137:401–407CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Kazumasa Yamamura
    • 1
  • Yukihide Minoda
    • 1
    Email author
  • Ryo Sugama
    • 1
  • Yoichi Ohta
    • 1
  • Suguru Nakamura
    • 1
  • Hideki Ueyama
    • 1
  • Hiroaki Nakamura
    • 1
  1. 1.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsakaJapan

Personalised recommendations