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Rotational component alignment in patient-specific total knee arthroplasty compared with conventional cutting instrument

  • Original Article • KNEE - ARTHROPLASTY
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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.

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Acknowledgements

Our institution provided the funding for this study. We thank Dr. Bob Taylor for reviewing the linguistic content of the article. We also thank all participants for providing the data used in this study.

Funding

This study was funded by Thammasat University.

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Authors and Affiliations

  1. Department of Orthopaedics, Thammasat University, 99 Moo 18, Khlong Nueng, Khlong Luang, Pathumthani, 12120, Thailand

    Nuttawut Chanalithichai, Nattapol Tammachote, Chane Jitapunkul & Supakit Kanitnate

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  1. Nuttawut Chanalithichai
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  2. Nattapol Tammachote
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Correspondence to Nattapol Tammachote.

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Nuttawut Chanalithichai, Nattapol Tammachote, Chane Jitapunkul and Supakit Kanitnate declared that they have no conflicts of interest. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

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Investigation performed at Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.

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Chanalithichai, N., Tammachote, N., Jitapunkul, C. et al. Rotational component alignment in patient-specific total knee arthroplasty compared with conventional cutting instrument. Eur J Orthop Surg Traumatol 29, 1297–1304 (2019). https://doi.org/10.1007/s00590-019-02423-5

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