scholarly journals Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides

2017 ◽  
Vol 23 ◽  
pp. 6168-6173 ◽  
Author(s):  
Murat Çalbıyık
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Cutting Guides ◽  
Total Knee

scholarly journals Patient-specific cutting guides for total knee arthroplasty

2017 ◽  
Author(s):  
Samuel MacDessi ◽  
Kanniraj Marimuthu ◽  
Venkatesan S Kumar ◽  
Darren Chen ◽  
Ian A Harris
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Cutting Guides ◽  
Total Knee

scholarly journals Intra-Operative Experience using Magnetic Resonance Imaging (MRI) Based Patient Specific Cutting Guides during Total Knee Arthroplasty

2016 ◽  
Vol 9 (2) ◽  
pp. 22-26
Author(s):  
Ryan K. Albrecht ◽  
Alexander C.M. Chong ◽  
Paul H. Wooley ◽  
Tarun Bhargava
Keyword(s):  
Total Knee Arthroplasty ◽  
Magnetic Resonance ◽  
Knee Arthroplasty ◽  
Total Joint Replacement ◽  
Tibial Slope ◽  
New Technique ◽  
Patient Specific ◽  
Cutting Guides ◽  
Total Knee ◽  
Operative Experience

Background. The incidence of malalignment in total knee arthroplasty(TKA) using conventional instrument has beenreported as high as 25%. A relatively new TKA system involvesthe use of a preoperative magnetic resonance image(MRI) to obtain accurate implant placement more consistently.For broad acceptance of this new technique, it iscrucial to analyze the initial intra-operative experience. Thespecific aim of this study was to evaluate the initial intra-operativeexperience of a single surgeon using this new technique. Methods. A total of 15 knees (12 patients: 6 female and 6male) were reviewed from TKA procedures using the selectedmanufacturer’s patient specific cutting guides between January2011 and April 2013 at a single institution. Patient demographicand specific parameters and intra-operative alterationsof component positioning were recorded and evaluated.Results. The preoperative plan was able to predict correctly thesize of the implanted femoral component in 87% (n = 13) andtibial component in 80% (n = 12) of the cases. However, 60% (n= 9) of cases required additional intra-operative corrections onfemoral resection, and 73% (n = 11) required an additional 2 - 4mm correction on the tibial proximal resection. Twenty percent(n = 3) required additional tibial varus/valgus correction, butthere were no tibial slope corrections for any of the 15 cases. Conclusions. The initial intra-operative experience of a singlesurgeon using current patient specific cutting guides for a selectedmanufacturer to align femoral and tibial components duringTKA has raised some concerns. We agreed with previous studiesthat caution should be taken when using patient specific cuttingguides without supportive data. The findings of this study providedadditional evidence to contest the accuracy of patient specificcutting guides with respect to the initial experience of an orthopaedicsurgeon who is trained in total joint replacement. Theresults provided more evidence to assist orthopaedic surgeonsin the decision of whether to use these patient specific systemsversus conventional TKA methods. KS J Med 2016;9(2):22-26.

scholarly journals What is the “safe zone” for transition of coronal alignment from systematic to a more personalised one in total knee arthroplasty? A systematic review

2022 ◽  
Author(s):  
Benjamin L. Schelker ◽  
Andrej M. Nowakowski ◽  
Michael T. Hirschmann
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Safe Zone ◽  
Patient Specific ◽  
Mechanical Alignment ◽  
Implant Survival ◽  
Total Knee ◽  
Alignment Strategy

Abstract Purpose In total knee arthroplasty (TKA), implants are increasingly aligned based on emerging patient-specific alignment strategies, such as unrestricted kinematic alignment (KA), according to their constitutional limb alignment (phenotype alignment), which results in a large proportion of patients having a hip-knee angle (HKA) outside the safe range of ± 3° to 180° traditionally considered in the mechanical alignment strategy. The aim of this systematic review is to investigate whether alignment outside the safe zone of ± 3° is associated with a higher revision rate and worse clinical outcome than alignment within this range. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane and World of Science, with search terms including synonyms and plurals for “total knee arthroplasty”, “alignment”, “outlier”, “malalignment”, “implant survival” and “outcome”. Five studies were identified with a total number of 927 patients and 952 implants. The Oxford Knee Score (OKS) and the WOMAC were used to evaluate the clinical outcome. The follow-up period was between 6 months and 10 years. Results According to HKA 533 knees were aligned within ± 3°, 47 (8.8%) were varus outliers and 121 (22.7%) were valgus outliers. No significant differences in clinical outcomes were found between implants positioned within ± 3° and varus and valgus outliers. Likewise, no significant differences were found regarding revision rates and implant survival. Conclusion The universal use of the “safe zone” of ± 3° derived from the mechanical alignment strategy is hardly applicable to modern personalised alignment strategies in the light of current literature. However, given the conflicting evidence in the literature on the risks of higher revision rates and poorer clinical outcomes especially with greater tibial component deviation, the lack of data on the outcomes of more extreme alignments, and regarding the use of implants for KA TKA that are actually designed for mechanical alignment, there is an urgent need for research to define eventual evidence-based thresholds for new patient-specific alignment strategies, not only for HKA but also for FMA and TMA, also taking into account the preoperative phenotype and implant design. It is of utmost clinical relevance for the application of modern alignment strategies to know which native phenotypes may be reproduced with a TKA. Level of evidence IV.

scholarly journals Comparison of Postoperative Coronal Leg Alignment in Customized Individually Made and Conventional Total Knee Arthroplasty

2021 ◽  
Vol 11 (6) ◽  
pp. 549
Author(s):  
Felix Wunderlich ◽  
Maheen Azad ◽  
Ruben Westphal ◽  
Thomas Klonschinski ◽  
Patrick Belikan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Weight Bearing ◽  
Postoperative Outcome ◽  
Patient Specific ◽  
Target Zone ◽  
Leg Alignment ◽  
Conventional Instrumentation ◽  
Cutting Guides ◽  
Total Knee

Neutral coronal leg alignment is known to be important for postoperative outcome in total knee arthroplasty (TKA). Customized individually made implants (CIM) instrumented with patient-specific cutting guides are an innovation aiming to increase the precision and reliability of implant positioning and reconstruction of leg alignment. We aimed to compare reconstruction of the hip–knee–ankle angle (HKA) of the novel CIM system iTotal™ CR G2 (ConforMIS Inc.) to a matched cohort of the off-the-shelf (OTS) knee replacement system Vanguard™ CR (Zimmer Biomet). Retrospective analysis of postoperative coronal full-leg weight-bearing radiographs of 562 TKA (283 CIM TKA, 279 OTS TKA) was conducted. Via a medical planning software, HKA and rotation of the leg were measured in postoperative radiographs. HKA was then adjusted for rotational error, and 180° ± 3° varus/valgus was defined as the target zone HKA. Corrected postoperative HKA in the CIM group was 179.0° ± 2.8° and 179.2° ± 3.1° in the OTS group (p = 0.34). The rate of outliers, outside of the ±3° target zone, was equal in both groups (32.9%). Our analysis showed that TKA using patient-specific cutting guides and implants and OTS TKA implanted with conventional instrumentation resulted in equally satisfying restoration of the coronal leg alignment with less scattering in the CIM group.

scholarly journals Accuracy of bone resection in total knee arthroplasty using CT assisted-3D printed patient specific cutting guides

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 29 ◽  
Author(s):  
Ikram Nizam ◽  
Ashish V. Batra
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Surgical Patient ◽  
Bone Resection ◽  
Patient Specific Instrumentation ◽  
Medial Pivot ◽  
Cutting Guides ◽  
3D Printed ◽  
Total Knee

Introduction: We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed Tomography (CT) scans can accurately predict each of the femoral and tibial resections performed through 3D printed cutting guides. The technique helps in optimization of component positioning determined by accurate bone resection and hence overall alignment thereby reducing errors. Methods: Prophecy evolution medial pivot patient specific instrumented knee replacement systems were used for end stage arthrosis in all consecutive cases over a period of 20 months by a single surgeon. All resections (4 femoral and 2 tibial) were measured using a vernier callipers intraoperatively. These respective measurements were then compared with the preoperative CT predicted bone resection surgical plan to determine margins of errors that were categorized into 7 groups (0 mm to ≥2.6 mm). Results: A total of 3618 measurements (averaged to 1206) were performed in 201 knees (105 right and 96 left) in 188 patients (112 females and 76 males) with an average age of 67.72 years (44 to 90 years) and average BMI of 32.3 (25.1 to 42.3). 94% of all collected resection readings were below the error margin of ≤1.5 mm of which 90% showed resection error of ≤1 mm. Mean error of different resections were ≤0.60 mm (P ≤ 0.0001). In 24% of measurements there were no errors or deviations from the templated resection (0.0 mm). Conclusion: The 3D printed cutting blocks with slots for jigs accurately predict bone resections in patient specific instrumentation total knee arthroplasty which would directly affect component positioning.

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