Skip to main content
SpringerLink
Log in

Abnormal rate of intraoperative and postoperative implant positioning outliers using “MRI-based patient-specific” compared to “computer assisted” instrumentation in total knee replacement

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to analyze first intraoperative alignment and reason to abandon the use of patient-specific instrumentation using intraoperative CAS measurement, secondly assess by postoperative CT analysis if CI, based on preoperative 3D-MRI data, improved postoperative component positioning (including femoral rotation) and lower limb alignment as compared with results obtained with CAS.

Methods

In this randomized controlled trial, 80 consecutive patients scheduled to undergo TKA were enrolled. Eligible knees were randomized to the group of PSI-TKAs (n = 40) or to the group of CAS-TKAs (n = 40). In the CAS group, CAS determined and controlled cutting block positioning in each plane. In the PSI group, CAS allowed to measure adequacy of intraoperative alignment including femoral component rotation. At 3 months after surgery, implants position were measured and analyzed with full-weight bearing plain radiographs and CT scan.

Results

Intraoperatively, there was a significant difference concerning Sagittal Femoral mechanical, Frontal tibial mechanical angle and tibial slope between the two groups (respectively p = 0.01, p = 0.02, p = 0.046). Custom instrumentation was abandoned intraoperatively in seven knees (17.5 %). Abnormal tibial cuts were responsible of the abandon in three out of seven cases, femoral cut in 1/7 and dual abnormalities in 3/7. Postoperatively, tibial slope outliers percentage was higher in the patient specific instrumentation group with six patients (18.18 %) versus one patient (2.5 %) in the CAS group (p = 0.041).

Conclusion

Patient specific instrumentation was associated with an important number of hazardous cut and a higher rate of outliers in our series and thus should be used with caution as related to. This study is the first to our acknowledgement to compare intra-operative ancillary and implant positioning of PSI-TKA and CAS-TKA. High rate of malposition are sustained by our findings, as such PSI-TKA should be used with caution, by surgeons capable to switch to conventional instrumentation intra-operatively.

Level of evidence

Randomized control trial, Level I.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Akagi M, Matsusue Y, Mata T, Asada Y, Horiguchi M, Iida H, Nakamura T (1999) Effect of rotational alignment on patellar tracking in total knee arthroplasty. Clin Orthop Relat Res 366:155–163

    Article  Google Scholar 

  2. Anouchi YS, Whiteside LA, Kaiser AD, Milliano MT (1993) The effects of axial rotational alignment of the femoral component on knee stability and patellar tracking in total knee arthroplasty demonstrated on autopsy specimens. Clin Orthop Relat Res 287:170–177

    Google Scholar 

  3. Asada S, Mori S, Matsushita T, Nakagawa K, Tsukamoto I, Akagi M (2014) Comparison of MRI- and CT-based patient-specific guides for total knee arthroplasty. Knee 21(6):1238–1243

    Article  PubMed  Google Scholar 

  4. Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183

    Google Scholar 

  5. Barrett WP, Mason JB, Moskal JT, Dalury DF, Oliashirazi A, Fisher DA (2011) Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty. J Arthroplasty 26:1273.e1–1284.e1

    Article  Google Scholar 

  6. Beldame J, Boisrenoult P, Beaufils P (2010) Pin track induced fractures around computer-assisted TKA. Orthop Traumatol Surg Res 96:249–255

    Article  CAS  PubMed  Google Scholar 

  7. Bellemans J, Robijns F, Duerinckx J, Banks S, Vandenneucker H (2005) The influence of tibial slope on maximal flexion after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 13:193–196

    Article  CAS  PubMed  Google Scholar 

  8. Berger RA, Crossett LS, Jacobs JJ, Rubash HE (1998) Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 356:144–153

    Article  Google Scholar 

  9. Bonutti P, Dethmers D, Stiehl JB (2008) Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res 466:1499–1502

    Article  PubMed  PubMed Central  Google Scholar 

  10. Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop 36:1589–1593

    Article  PubMed  PubMed Central  Google Scholar 

  11. Del Gaizo DJ, Della Valle CJ (2011) Instability in primary total knee arthroplasty. Orthopedics 34:e519–e521

    PubMed  Google Scholar 

  12. Engh GA, Petersen TL (1990) Comparative experience with intramedullary and extramedullary alignment in total knee arthroplasty. J Arthroplasty 5:1–8

    Article  CAS  PubMed  Google Scholar 

  13. Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty 27:1177–1182

    Article  PubMed  Google Scholar 

  14. Heyse TJ, Tibesku CO (2014) Improved femoral component rotation in TKA using patient-specific instrumentation. Knee 21:268–271

    Article  PubMed  Google Scholar 

  15. 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 Joint Surg Br 93:629–633

    Article  CAS  PubMed  Google Scholar 

  16. Klatt BA, Goyal N, Austin MS, Hozack WJ (2008) Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty 23:26–29

    Article  PubMed  Google Scholar 

  17. Koch PP, Müller D, Pisan M, Fucentese SF (2013) Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique. Knee Surg Sports Traumatol Arthrosc 21:2200–2205

    Article  CAS  PubMed  Google Scholar 

  18. Lombardi AV, Berend KR, Berend ME, Della Valle CJ, Engh GA, Fitz W, Hurst JM, Jinnah RH, Lonner JH, Macaulay WB, Repicci JA, Scuderi GR (2012) Current controversies in partial knee arthroplasty. Instr Course Lect 61:347–381

    PubMed  Google Scholar 

  19. Lustig S, Fleury C, Goy D, Neyret P, Donell ST (2011) The accuracy of acquisition of an imageless computer-assisted system and its implication for knee arthroplasty. Knee 18:15–20

    Article  CAS  PubMed  Google Scholar 

  20. Lustig S, Scholes CJ, Oussedik SI, Kinzel V, Coolican MRJ, Parker DA (2013) Unsatisfactory accuracy as determined by computer navigation of VISIONAIRE patient-specific instrumentation for total knee arthroplasty. J Arthroplasty 28:469–473

    Article  PubMed  Google Scholar 

  21. Michaut M, Beaufils P, Galaud B, Abadie P, Boisrenoult P, Fallet L (2008) Rotational alignment of femoral component with computed-assisted surgery (CAS) during total knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 94:580–584

    Article  CAS  PubMed  Google Scholar 

  22. Miller MC, Berger RA, Petrella AJ, Karmas A, Rubash HE (2001) Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res 392:38–45

    Article  Google Scholar 

  23. Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470:99–107

    Article  PubMed  Google Scholar 

  24. Novicoff WM, Saleh KJ, Mihalko WM, Wang X-Q, Knaebel H-P (2010) Primary total knee arthroplasty: a comparison of computer-assisted and manual techniques. Instr Course Lect 59:109–117

    PubMed  Google Scholar 

  25. Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL (2012) Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res 470:895–902

    Article  PubMed  Google Scholar 

  26. Olcott CW, Scott RD (1999) The ranawat award. Femoral component rotation during total knee arthroplasty. Clin Orthop Relat Res 367:39–42

    Article  Google Scholar 

  27. Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson J-N (2013) Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 21:2213–2219

    Article  PubMed  Google Scholar 

  28. Pitto RP, Graydon AJ, Bradley L, Malak SF, Walker CG, Anderson IA (2006) Accuracy of a computer-assisted navigation system for total knee replacement. J Bone Joint Surg Br 88(5):601–605

    Article  CAS  PubMed  Google Scholar 

  29. Roh YW, Kim TW, Lee S, Seong SC, Lee MC (2013) Is TKA using patient-specific instruments comparable to conventional TKA? A randomized controlled study of one system. Clin Orthop Relat Res 471:3988–3995

    Article  PubMed  PubMed Central  Google Scholar 

  30. Scholes C, Sahni V, Lustig S, Parker DA, Coolican MRJ (2014) Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation. Knee Surg Sports Traumatol Arthrosc 22:660–665

    Article  PubMed  Google Scholar 

  31. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  Google Scholar 

  32. Spencer BA, Mont MA, McGrath MS, Boyd B, Mitrick MF (2009) Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop 33:1571–1575

    Article  PubMed  Google Scholar 

  33. Thienpont E (2014) Letter to the editor Lustig et al entitled “unsatifactory accuracy as determined by computer navigation of visionaire patient-specific instrumentation for total knee arthroplasty”. J Arthroplasty 29:247–248

    Article  PubMed  Google Scholar 

  34. Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J (2009) How precise can bony landmarks be determined on a CT scan of the knee? Knee 16:358–365

    Article  CAS  PubMed  Google Scholar 

  35. Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J (2014) Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res 472:263–271

    Article  PubMed  Google Scholar 

  36. Wiles A.D, Thompson D.G, Frantz D.D (2004). In:Proceedings of the SPIE 5367, medical imaging: visualization, image-guided procedures, and display, p. 421

  37. Woolson ST, Harris AHS, Wagner DW, Giori NJ (2014) Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 96:366–372

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

P. Beaufils is educational consultant for Zimmer and Smith & Nephew. N. Pujol is educational consultant for Zimmer. M. Ollivier, Q. Tribot-Laspiere, J. Amzallag and P. Boisrenoult declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Versailles Hospital Center, 78150, Le Chesnay, France

    M. Ollivier, Q. Tribot-Laspiere, J. Amzallag, P. Boisrenoult, N. Pujol & P. Beaufils

  2. Clinique Drouot, 20 rue Laffitte, 75009, Paris, France

    J. Amzallag

Authors
  1. M. Ollivier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Q. Tribot-Laspiere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Amzallag
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Boisrenoult
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Pujol
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Beaufils
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Pujol.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ollivier, M., Tribot-Laspiere, Q., Amzallag, J. et al. Abnormal rate of intraoperative and postoperative implant positioning outliers using “MRI-based patient-specific” compared to “computer assisted” instrumentation in total knee replacement. Knee Surg Sports Traumatol Arthrosc 24, 3441–3447 (2016). https://doi.org/10.1007/s00167-015-3645-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3645-1

Keywords

Search

Navigation