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Accuracy of Implant Placement Utilizing Customized Patient Instrumentation in Total Knee Arthroplasty

DOI: 10.1155/2013/891210

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Customized patient instrumentation (CPI) combines preoperative planning with customized cutting jigs to position and align implants during total knee arthroplasty (TKA). We compared postoperative implant alignment of patients undergoing surgery with CPI to traditional TKA instrumentation for accuracy of implant placement. Twenty-five consecutive TKAs using CPI were analyzed. Preoperative CT scans of the lower extremities were segmented using a computer program. Limb alignment and mechanical axis were computed. Virtual implantation of computer-aided design models was done. Postoperative coronal and sagittal view radiographs were obtained. Using 3D image-matching software, relative positions of femoral and tibial implants were determined. Twenty-five TKAs implanted using traditional instrumentation were also analyzed. For CPI, difference in alignment from the preoperative plan was calculated. In the CPI group, the mean absolute difference between the planned and actual femoral placements was 0.67° in the coronal plane and 1.2° in the sagittal plane. For tibial alignment, the mean absolute difference was 0.9° in the coronal plane and 1.3° in the sagittal plane. For traditional instrumentation, difference from ideal placement for the femur was 1.5° in the coronal plane and 2.3° in the sagittal plane. For the tibia, the difference was 1.8° in the coronal plane. CPI achieved accurate implant positioning and was superior to traditional TKA instrumentation. 1. Introduction Accurate alignment and positioning of implants in total knee arthroplasty (TKA) is an important goal of the procedure. Numerous studies have demonstrated a high frequency of implant malalignment in TKA, regardless of the surgical techniques utilized [1–7]. The innovation cycle of TKA has mirrored this fundamental concept. Initially, free-hand surgical cuts were performed prior to the placement of implant components. Subsequently, mechanical alignment guides were devised based on bony or external landmarks, and predetermined angular or measured resections were performed. More recently, image-guided or imageless computer navigation systems have been developed to guide the surgical procedure and ultimate component alignment. The most recent innovation in TKA is customized patient instrumentation (CPI), which has been introduced as a next generation technology in an effort to further improve the accuracy and precision of surgical technique, implant placement, and alignment. The concept of CPI revolves around the use of preoperatively obtained imaging studies such as plain radiographs, magnetic


[1]  K. E. Teter, D. Bregman, and C. W. Colwell Jr., “The efficacy of intramedullary femoral alignment in total knee replacement,” Clinical Orthopaedics and Related Research, no. 321, pp. 117–121, 1995.
[2]  S. Patil, D. D. D'Lima, J. M. Fait, and C. W. Colwell Jr., “Improving tibial component coronal alignment during total knee arthroplasty with use of a tibial planing device,” Journal of Bone and Joint Surgery A, vol. 89, no. 2, pp. 381–387, 2007.
[3]  H. Mizu-uchi, S. Matsuda, H. Miura, H. Higaki, K. Okazaki, and Y. Iwamoto, “The effect of ankle rotation on cutting of the tibia in total knee arthroplasty,” Journal of Bone and Joint Surgery A, vol. 88, no. 12, pp. 2632–2636, 2006.
[4]  M. R. Reed, W. Bliss, J. L. Sher, K. P. Emmerson, S. M. G. Jones, and P. F. Partington, “Extramedullary or intramedullary tibial alignment guides: a randomized, prospective trial of radiological alignment,” Journal of Bone and Joint Surgery B, vol. 84, no. 6, pp. 858–860, 2002.
[5]  H. E. Cates, M. A. Ritter, E. M. Keating, and P. M. Faris, “Intramedullary versus extramedullary femoral alignment systems in total knee replacement,” Clinical Orthopaedics and Related Research, no. 286, pp. 32–39, 1993.
[6]  J. Y. Jenny, U. Clemens, S. Kohler, H. Kiefer, W. Konermann, and R. K. Miehlke, “Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses,” Journal of Arthroplasty, vol. 20, no. 7, pp. 832–839, 2005.
[7]  G. Matziolis, D. Krocker, U. Weiss, S. Tohtz, and C. Perka, “A prospective, randomized study of computer-assisted and conventional total knee arthroplasty: three-dimensional evaluation of implant alignment and rotation,” Journal of Bone and Joint Surgery A, vol. 89, no. 2, pp. 236–243, 2007.
[8]  W. G. Blakeney, R. J. K. Khan, and S. J. Wall, “Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial,” Journal of Bone and Joint Surgery A, vol. 93, no. 15, pp. 1377–1384, 2011.
[9]  R. M. Nunley, B. S. Ellison, J. Zhu, E. L. Ruh, S. M. Howell, and R. L. Barrack, “Do patient-specific guides improve coronal alignment in total knee arthroplasty?” Clinical Orthopaedics and Related Research, vol. 470, no. 3, pp. 895–902, 2012.
[10]  V. Y. Ng, J. H. DeClaire, K. R. Berend, B. C. Gulick, and A. V. Lombardi Jr., “Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA,” Clinical Orthopaedics and Related Research, vol. 470, no. 1, pp. 99–107, 2012.
[11]  D. White, K. L. Chelule, and B. B. Seedhom, “Accuracy of MRI vs CT imaging with particular reference to patient specific templates for total knee replacement surgery,” International Journal of Medical Robotics and Computer Assisted Surgery, vol. 4, no. 3, pp. 224–231, 2008.
[12]  M. A. Ritter, P. M. Faris, E. M. Keating, and J. B. Meding, “Postoperative alignment of total knee replacement: its effect on survival,” Clinical Orthopaedics and Related Research, no. 299, pp. 153–156, 1994.
[13]  M. E. Berend, M. A. Ritter, J. B. Meding et al., “Tibial component failure mechanisms in total knee arthroplasty,” Clinical Orthopaedics and Related Research, no. 428, pp. 26–34, 2004.
[14]  H. Mizu-uchi, S. Matsuda, H. Miura, K. Okazaki, Y. Akasaki, and Y. Iwamoto, “The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system,” Journal of Bone and Joint Surgery B, vol. 90, no. 8, pp. 1025–1031, 2008.
[15]  H. Mizu-uchi, C. W. Colwell Jr., S. Matsuda, C. Flores-Hernandez, Y. Iwamoto, and D. D. D'Lima, “Effect of total knee arthroplasty implant position on flexion angle before implant-bone impingement,” Journal of Arthroplasty, vol. 26, no. 5, pp. 721–727, 2011.


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