Errors in Calculating Anterior–Posterior Tibial Contact Locations in Total Knee Arthroplasty Using Three-Dimensional Model to Two-Dimensional Image Registration in Radiographs: An In Vitro Study of Two Methods

2017 ◽  
Vol 139 (12) ◽  
Author(s):  
Derrick S. Ross ◽  
Stephen M. Howell ◽  
Maury L. Hull
Keyword(s):  
Total Knee Arthroplasty ◽  
Image Registration ◽  
Knee Arthroplasty ◽  
Three Dimensional ◽  
Force Sensor ◽  
Point Method ◽  
Two Dimensional ◽  
Single Plane ◽  
Total Knee ◽  
Anterior Posterior

Knowledge of anterior–posterior (A-P) tibial contact locations provides an objective assessment of the relative motion of the tibia on the femur following total knee arthroplasty (TKA), which can be used to compare the effects of different components, surgical techniques, and alignment goals on knee function in vivo. Both the lowest point method and the penetration method have been used to calculate A-P tibial contact locations using three-dimensional (3D) model to two-dimensional (2D) image registration. The primary objective of this study was to quantify errors in calculating the A-P tibial contact location using the lowest point and penetration methods because the errors in calculating the A-P tibial contact locations using these two methods are unknown. The A-P tibial contact locations were calculated with the two methods and simultaneously measured with a tibial force sensor in ten fresh-frozen cadaveric knee specimens with a TKA. Single-plane radiographs of the knee specimens were acquired at 0 deg, 30 deg, 60 deg, and 90 deg of flexion in neutrally, internally, and externally rotated orientations. While the radiographs were exposed, reference A-P tibial contact locations were simultaneously collected using the tibial force sensor to be compared to the calculated A-P tibial contact locations. The overall root-mean-squared-errors (RMSEs) in the A-P tibial contact location calculated with the lowest point method, the penetration method with penetration, and penetration method without penetration were 5.5 mm, 3.6 mm, and 8.9 mm, respectively. The overall RMSE was lowest for the penetration method with penetration, making it the superior method for calculating A-P tibial contact locations.

Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

2018 ◽  
Vol 32 (07) ◽  
pp. 642-648 ◽  
Author(s):  
J. R. T. Pietrzak ◽  
F. E. Rowan ◽  
B. Kayani ◽  
M. J. Donaldson ◽  
S. S. Huq ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Three Dimensional ◽  
Two Dimensional ◽  
Robot Assisted ◽  
Ct Guided ◽  
Digital Templating ◽  
Preoperative Ct ◽  
Total Knee

AbstractPatient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (χ 2: 17.965; odds ratio [OR]: 24.957, 3.250–191.661; p < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively (χ 2: 36.436; OR: 33.480, 7.400–151.481; p < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652–0.890; p < 0.001) for the femur and 0.833 (0.717–0.911; p < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.

Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty

2020 ◽  
Author(s):  
Mehmet Emin Simsek ◽  
Mustafa Akkaya ◽  
Safa Gursoy ◽  
Özgür Kaya ◽  
Murat Bozkurt
Keyword(s):  
Total Knee Arthroplasty ◽  
Surface Area ◽  
Knee Arthroplasty ◽  
Tibial Plateau ◽  
Slope Angle ◽  
Three Dimensional ◽  
Tibial Slope ◽  
Total Knee ◽  
Lateral Plateau ◽  
Gender Groups

AbstractThis study aimed to investigate whether overhang or underhang around the tibial component that occurs during the placement of tibial baseplates was affected by different slope angles of the tibial plateau and determine the changes in the lateral and medial plateau diameters while changing the slope angle in total knee arthroplasty. Three-dimensional tibia models were reconstructed using the computed tomography scans of 120 tibial dry bones. Tibial plateau slope cuts were performed with 9, 7, 5, 3, and 0 degrees of slope angles 2-mm below the subchondral bone in the deepest point of the medial plateau. Total, lateral, and medial tibial plateau areas and overhang/underhang rates were measured at each cut level. Digital implantations of the asymmetric and symmetric tibial baseplates were made on the tibial plateau with each slope angles. Following the implantations, the slope angle that prevents overhang or underhang at the bone border and the slope angle that has more surface area was identified. A significant increase was noted in the total tibial surface area, lateral plateau surface area, and lateral anteroposterior distance, whereas the slope cut angles were changed from 9 to 0 degrees in both gender groups. It was found that the amount of posteromedial underhang and posterolateral overhang increased in both the asymmetric and symmetric tibial baseplates when the slope angle was changed from 0 to 9 degrees. Although the mediolateral diameter did not change after the proximal tibia cuts at different slope angles, the surface area and anteroposterior diameter of the lateral plateau could change, leading to increased lateral plateau area. Although prosthesis designs are highly compatible with the tibial surface area, it should be noted that the component overhangs, especially beyond the posterolateral edge, it can be prevented by changing the slope cut angle in males and females.

The Influence of an Anterior-Posterior Gliding Mobile Bearing on Range of Motion After Total Knee Arthroplasty

2004 ◽  
Vol 86 (10) ◽  
pp. 2257-2262 ◽  
Author(s):  
Christian Aigner ◽  
Reinhard Windhager ◽  
Michael Pechmann ◽  
Peter Rehak ◽  
Klaus Engeleke
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Mobile Bearing ◽  
Total Knee ◽  
Anterior Posterior

scholarly journals Finite-element analysis of the proximal tibial sclerotic bone and different alignment in total knee arthroplasty

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ye-Ran Li ◽  
Yu-Hang Gao ◽  
Chen Yang ◽  
Lu Ding ◽  
Xuebo Zhang ◽  
...  
Keyword(s):  
Finite Element ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Plateau ◽  
Three Dimensional ◽  
Genu Varum ◽  
Sclerotic Bone ◽  
Dimensional Measurements ◽  
Tibial Cut ◽  
Total Knee

Abstract Background Despite potential for improving patient outcomes, studies using three-dimensional measurements to quantify proximal tibial sclerotic bone and its effects on prosthesis stability after total knee arthroplasty (TKA) are lacking. Therefore, this study aimed to determine: (1) the distribution range of tibial sclerotic bone in patients with severe genu varum using three-dimensional measurements, (2) the effect of the proximal tibial sclerotic bone thickness on prosthesis stability according to finite-element modelling of TKA with kinematic alignment (KA), mechanical alignment (MA), and 3° valgus alignment, and (3) the effect of short extension stem augment utilization on prosthesis stability. Methods The sclerotic bone in the medial tibial plateau of 116 patients with severe genu varum was measured and classified according to its position and thickness. Based on these cases, finite-element models were established to simulate 3 different tibial cut alignments with 4 different thicknesses of the sclerotic bone to measure the stress distribution of the tibia and tibial prosthesis, the relative micromotion beneath the stem, and the influence of the short extension stem on stability. Results The distribution range of proximal tibial sclerotic bone was at the anteromedial tibial plateau. The models were divided into four types according to the thickness of the sclerotic bone: 15 mm, 10 mm, 5 mm, and 0 mm. The relative micromotion under maximum stress was smallest after MA with no sclerotic bone (3241 μm) and largest after KA with 15 mm sclerotic bone (4467 μm). Relative micromotion was largest with KA and smallest with MA in sclerotic models with the same thickness. Relative micromotion increased as thickness of the sclerotic bone increased with KA and MA (R = 0.937, P = 0.03 and R = 0.756, P = 0.07, respectively). Relative micromotion decreased with short extension stem augment in the KA model when there was proximal tibial sclerotic bone. Conclusions The influence of proximal tibial sclerotic bone on prosthesis’s stability is significant, especially with KA tibial cut. Tibial component’s short extension stem augment can improve stability.

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