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Inadequacy of computed tomography for pre-operative planning of patellofemoral arthroplasty

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

Abstract

Purpose

To evaluate the accuracy of preoperative planning for patellofemoral arthroplasty (PFA) by comparing: (1) virtual implant positioning simulated on pre-operative images versus (2) real implant positioning from post-operative images.

Methods

The authors prospectively studied 15 patients that received a PFJ implant (Tornier, Montbonnot France). A pre-operative planning software was established to determine the size and position of the trochlear component. Pre-operative scans were used to perform virtual implantations by two different operators, which were then compared to the post-operative scans to calculate errors (ε) in implant positioning and intra-class correlation coefficients (ICC) for intra- and inter-observer repeatability.

Results

Analysis was performed for 13 patients, for whom agreement between virtual and real surgery was excellent for anteroposterior (AP) position (ICC = 0.84; ε max = 3.5 mm), fair for proximodistal (PD) position (ICC = 0.50; ε max  = 9.5 mm), and poor for mediolateral (ML) position (ICC = 0.07; ε max = 9.0 mm). It was fair for flexum–recurvatum (FR) alignment (ICC = 0.53; ε max = 8.2°), poor for varus–valgus (VV) alignment (ICC = 0.34; ε max = 10.0°), and internal–external (IE) rotation (ICC = 0.34; ε max = 10.6°).

Conclusions

Pre-operative planning was insufficiently accurate to follow intra-operatively, the greatest errors being angular alignment (VV and FR). The clinical relevance of these findings is that PFA is difficult to plan pre/operatively due to non-visibility of cartilage on CT scans and to trochlear dysplasia in most cases.

Level of evidence

Prospective evaluation of operative tools on consecutive patients, Level III.

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Author information

Authors and Affiliations

  1. ReSurg SA, 35 ch. de la Vuarpillière, 1260, Nyon, Switzerland

    Mo Saffarini

  2. Department of Mechanical and Mechatronic Engineering Stellenbosch University, Private Bag X1, Matieland, 7600, Stellenbosch, South Africa

    Jacobus H. Müller & Kyung Jin Cho

  3. Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France

    Giuseppe La Barbera, Cécile Toanen & David Dejour

  4. Orthopaedic Research Laboratory, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands

    Gerjon Hannink

Authors
  1. Mo Saffarini
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  2. Jacobus H. Müller
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  3. Giuseppe La Barbera
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  4. Gerjon Hannink
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  5. Kyung Jin Cho
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  6. Cécile Toanen
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  7. David Dejour
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Correspondence to Mo Saffarini.

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Saffarini, M., Müller, J.H., La Barbera, G. et al. Inadequacy of computed tomography for pre-operative planning of patellofemoral arthroplasty. Knee Surg Sports Traumatol Arthrosc 26, 1485–1492 (2018). https://doi.org/10.1007/s00167-017-4474-1

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  • DOI: https://doi.org/10.1007/s00167-017-4474-1

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