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Custom TKA: what to expect and where do we stand today?

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The concept of custom total knee arthroplasty (TKA) is explored with specific attention to current limitations. Arguments in favor of custom TKA are the anatomic and functional variability we encounter in our patients. The biggest conceptual challenge is to marry the need for correction of deformity with the ambition to stay as close as possible to original anatomy.

Materials and methods

A Pubmed search was performed on the following terms: ‘patient specific implant’, ‘custom made implant’, ‘custom implant’, ‘total knee arthroplasty’ and ‘total knee replacement’. These studies were evaluated for the following intra- and post-operative variables: blood loss, hospital stay, range of motion, patient-reported outcome measures, limb and implant alignment, implant fit, tibiofemoral kinematics, complications and revision rates.

Results

Out of 1117 studies found with the initial search, a total of 17 articles were included in the final analysis. In eight out of the 17 (47%) studies, either the research was commercially funded or one of the authors had a conflict of interest related to the work. 11 out of 17 studies included a control group in their study setup. Of those studies that included a control group, both superior and inferior results compared to off-the-shelf implants have been reported.

Conclusion

Custom knee implants are the next step in matching the geometric features of the prosthesis to the anatomy of the individual patient, after several iterations that added asymmetry and sizes in the existing implants. Several companies have proven that it is feasible to produce these implants in a safe way. An overview of current literature reveals the lack of strong methodological studies that prove the value of this new technology. Custom knee implants face conceptual and practical difficulties, some of which might be overcome with technological advances, such as robotics and artificial intelligence.

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References

  1. Richter P (2016) Official launch of the International Consortium for Personalised Medicine. http://www.icpermed.eu/. Accessed 19 April 2021

  2. Sañudo JR, Vázquez R, Puerta J (2021) Meaning and clinical interest of the anatomical variations in the 21st century. Eur J Anat 7:1–3

    Google Scholar 

  3. Vesalius A, van Calcar JS, Oporinus J (1543). De humani corporis fabrica libri septem. Basilae: ex Ioannis Oporini

  4. Straus WL, Temkin O (1943) Vesalius and the problem of variability. Bull Hist Med 14:609–633

    Google Scholar 

  5. LaPrade RF, Engebretsen AH, Ly TV et al (2007) The anatomy of the medial part of the knee. JBJS 89:2000–2010

    Article  Google Scholar 

  6. Victor JMK, Bassens D, Bellemans J et al (2014) Constitutional varus does not affect joint line orientation in the coronal plane. Clin Orthop Relat Res 472:98–104

    Article  Google Scholar 

  7. Thienpont E, Schwab P-E, Cornu O et al (2017) Bone morphotypes of the varus and valgus knee. Arch Orthop Trauma Surg 137:393–400

    Article  CAS  Google Scholar 

  8. Bonnin MP, Saffarini M, Bossard N et al (2016) Morphometric analysis of the distal femur in total knee arthroplasty and native knees. Bone Jt J 98:49–57

    Article  Google Scholar 

  9. Bellemans J, Carpentier K, Vandenneucker H et al (2010) The John Insall award: both morphotype and gender influence the shape of the knee in patients undergoing TKA. Clin Orthop Relat Res 468:29–36. https://doi.org/10.1007/s11999-009-1016-2

    Article  PubMed  Google Scholar 

  10. Engh GA, Lounici S, Rao AR, Collier MB (2001) In vivo deterioration of tibial baseplate locking mechanisms in contemporary modular total knee components. JBJS 83:1660–1665

    Article  CAS  Google Scholar 

  11. Ivie CB, Probst PJ, Bal AK et al (2014) Improved radiographic outcomes with patient-specific total knee arthroplasty. J Arthroplast 29:2100–2103. https://doi.org/10.1016/j.arth.2014.06.024

    Article  Google Scholar 

  12. Kay AB, Kurtz WB, Martin GM et al (2018) Manipulation rate is not increased after customized total knee arthroplasty. Reconstr Rev. https://doi.org/10.15438/rr.8.1.210

    Article  Google Scholar 

  13. Steinert AF, Sefrin L, Jansen B et al (2020) Patient-specific cruciate-retaining total knee replacement with individualized implants and instruments (iTotalTM CR G2). Oper Orthop Traumatol. https://doi.org/10.1007/s00064-020-00690-8

    Article  PubMed  Google Scholar 

  14. Wheatley B, Nappo K, Fisch J et al (2019) Early outcomes of patient-specific posterior stabilized total knee arthroplasty implants. J Orthop 16:14–18. https://doi.org/10.1016/j.jor.2018.11.003

    Article  PubMed  Google Scholar 

  15. White PB, Ranawat AS (2016) Patient-specific total knees demonstrate a higher manipulation rate compared to “off-the-shelf implants.” J Arthroplast 31:107–111. https://doi.org/10.1016/j.arth.2015.07.041

    Article  Google Scholar 

  16. Zeller IM, Sharma A, Kurtz WB et al (2017) Customized versus patient-sized cruciate-retaining total knee arthroplasty: an in vivo kinematics study using mobile fluoroscopy. J Arthroplast 32:1344–1350. https://doi.org/10.1016/j.arth.2016.09.034

    Article  Google Scholar 

  17. Arnholdt J, Kamawal Y, Horas K et al (2020) Accurate implant fit and leg alignment after cruciate-retaining patient-specific total knee arthroplasty. BMC Musculoskelet Disord 21:699. https://doi.org/10.1186/s12891-020-03707-2

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bonnin MP, Beckers L, Leon A et al (2020) Custom total knee arthroplasty facilitates restoration of constitutional coronal alignment. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06153-8

    Article  PubMed  Google Scholar 

  19. Culler SD, Martin GM, Swearingen A (2017) Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty. Arthroplast Today 3:257–263. https://doi.org/10.1016/j.artd.2017.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kumar P, Elfrink J, Daniels JP et al (2020) Higher component malposition rates with patient-specific cruciate retaining TKA than contemporary posterior stabilized TKA. J Knee Surg. https://doi.org/10.1055/s-0040-1701453

    Article  PubMed  Google Scholar 

  21. Levengood GA, Dupee J (2018) Accuracy of coronal plane mechanical alignment in a customized, individually made total knee replacement with patient-specific instrumentation. J Knee Surg 31:792–796. https://doi.org/10.1055/s-0037-1608946

    Article  PubMed  Google Scholar 

  22. Meheux CJ, Park KJ, Clyburn TA (2019) A retrospective study comparing a patient-specific design total knee arthroplasty with an off-the-shelf design: unexpected catastrophic failure seen in the early patient-specific design. J Am Acad Orthop Surg Glob Res Rev. https://doi.org/10.5435/JAAOSGlobal-D-19-00143

    Article  PubMed  PubMed Central  Google Scholar 

  23. Neginhal V, Kurtz W, Schroeder L (2020) Patient satisfaction, functional outcomes, and survivorship in patients with a customized posterior-stabilized total knee replacement. JBJS Rev 8:e1900104. https://doi.org/10.2106/JBJS.RVW.19.00104

    Article  PubMed  Google Scholar 

  24. Patil S, Bunn A, Bugbee WD et al (2015) Patient-specific implants with custom cutting blocks better approximate natural knee kinematics than standard TKA without custom cutting blocks. Knee 22:624–629. https://doi.org/10.1016/j.knee.2015.08.002

    Article  PubMed  Google Scholar 

  25. Reimann P, Brucker M, Arbab D, Lüring C (2019) Patient satisfaction—a comparison between patient-specific implants and conventional total knee arthroplasty. J Orthop 16:273–277. https://doi.org/10.1016/j.jor.2019.03.020

    Article  PubMed  PubMed Central  Google Scholar 

  26. Schroeder L, Martin G (2019) In vivo tibial fit and rotational analysis of a customized, patient-specific tka versus off-the-shelf TKA. J Knee Surg 32:499–505. https://doi.org/10.1055/s-0038-1653966

    Article  PubMed  Google Scholar 

  27. Schwarzkopf R, Brodsky M, Garcia GA, Gomoll AH (2015) Surgical and functional outcomes in patients undergoing total knee replacement with patient-specific implants compared with “off-the-shelf” implants. Orthop J Sport Med 3:2325967115590379. https://doi.org/10.1177/2325967115590379

    Article  Google Scholar 

  28. Meier M, Zingde S, Steinert A et al (2019) What Is the possible impact of high variability of distal femoral geometry on TKA? A CT data analysis of 24,042 knees. Clin Orthop Relat Res 477:561–570. https://doi.org/10.1097/CORR.0000000000000611

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bonnin MP, de Kok A, Verstraete M et al (2017) Popliteus impingement after TKA may occur with well-sized prostheses. Knee Surg Sports Traumatol Arthrosc 25:1720–1730. https://doi.org/10.1007/s00167-016-4330-8

    Article  PubMed  Google Scholar 

  30. Rivière C, Iranpour F, Auvinet E et al (2017) Alignment options for total knee arthroplasty: a systematic review. Orthop Traumatol Surg Res 103:1047–1056. https://doi.org/10.1016/j.otsr.2017.07.010

    Article  PubMed  Google Scholar 

  31. Bellemans J, Vandenneucker H, Vanlauwe J, Victor J (2010) The influence of coronal plane deformity on mediolateral ligament status: an observational study in varus knees. Knee Surg Sport Traumatol Arthrosc 18:152–156. https://doi.org/10.1007/s00167-009-0903-0

    Article  Google Scholar 

  32. Bellemans J, Vandenneucker H, Victor J, Vanlauwe J (2006) Flexion contracture in total knee arthroplasty. Clin Orthop Relat Res 452:78–82. https://doi.org/10.1097/01.blo.0000238791.36725.c5

    Article  PubMed  Google Scholar 

  33. Meere PA, Schneider SM, Walker PS (2016) Accuracy of balancing at total knee surgery using an instrumented tibial trial. J Arthroplast 31:1938–1942. https://doi.org/10.1016/j.arth.2016.02.050

    Article  Google Scholar 

  34. Zhang J, Ndou WS, Ng N et al (2021) Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06464-4

    Article  PubMed  Google Scholar 

  35. Pondal M, del Ser T (2008) Normative data and determinants for the timed “up and go” test in a population-based sample of elderly individuals without gait disturbances. J Geriatr Phys Ther 31:57–63. https://doi.org/10.1519/00139143-200831020-00004

    Article  PubMed  Google Scholar 

  36. Hortobágyi T, Westerkamp L, Beam S et al (2005) Altered hamstring-quadriceps muscle balance in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 20:97–104. https://doi.org/10.1016/j.clinbiomech.2004.08.004

    Article  Google Scholar 

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  1. Ghent University Hospital, C Heymanslaan 10, 9000, Gent, Belgium

    Jan Victor & Hannes Vermue

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  1. Jan Victor
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Correspondence to Jan Victor.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

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Victor, J., Vermue, H. Custom TKA: what to expect and where do we stand today?. Arch Orthop Trauma Surg 141, 2195–2203 (2021). https://doi.org/10.1007/s00402-021-04038-0

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