Kinematically Aligned Total Knee Arthroplasty with Patient-Specific Instrument

Kim, Kwang Kyoun; Howell, Stephen M.; Won, Ye Yeon

doi:10.3349/ymj.2020.61.3.201

Cited by 14 publications

(14 citation statements)

References 52 publications

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“…The design of PSI was based on full-length computed tomography (CT) of the lower extremities, whereas the surgical technique of calipered KA followed the technique recommended by Howell et al [ 22 ]. Regardless of which assistant alignment instrument was used, an articular surface-based bone cut approach was adopted [ 9 ]. A Vernier caliper was used to measure the thickness of the resected bone pieces of the distal femoral condyles, posterior condyles, and tibial plateau.…”

Section: Methodsmentioning

confidence: 99%

Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: a retrospective clinical study

Wang

Liang

Zhang

et al. 2021

BMC Musculoskelet Disord

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Background A mismatch between the femoral component and trochlear resection surface is observed in kinematically aligned total knee arthroplasty (KA-TKA) when conventional prostheses are employed. This mismatch is mainly manifested in the undercoverage of the lateral trochlear resection surface. The aim of the present study was to assess the relationship between the mismatch and the alignment parameters of the tibiofemoral joint. Methods Forty-five patients (52 knees) who underwent KA-TKA in our hospital were included. Patient-specific instrumentation was used in 16 patients (16 knees), and conventional instruments with calipers and other special tools were employed in the other 29 patients (36 knees). The widths of the exposed resection bone surface at the middle (MIDexposure) and distal (DISexposure) levels on the lateral trochlea were measured as dependent variables, whereas the hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and transepicondylar axis angle (TEAA) were measured as independent variables. Correlation analysis and subsequent linear regression were conducted among the dependent variables and various alignment parameters of the tibiofemoral joint. Results The incidence of undercoverage of the lateral trochlear resection surface was 86.5 % with MIDexposure and DISexposure values of 2.3 (0–6 mm) and 2.0 (0–5 mm), respectively. The widths of the two levels of exposed bone resection were significantly correlated with mLDFA and HKAA but were not related to TEAA. Conclusions The undercoverage of the trochlear resection surface in KA-TKA is mainly correlated with the degree of valgus of the distal femoral joint line. The current study suggests that this correlation should be considered in the development of KA-specific prostheses.

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Section: Methodsmentioning

confidence: 99%

Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: a retrospective clinical study

Wang

Liang

Zhang

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…The design of PSI was based on full-length computed tomography (CT) of lower extremities, while the surgical technique of Calipered-KA followed the technique recommended by Howell et al [14]. No matter which assistant alignment instrument was used, articular surface-based bone cut approach is adopted [7]. A Vernier caliper was used to measure the thickness of the resected bone pieces of the distal femoral condyles, posterior condyles, and tibial plateau.…”

Section: Surgical Plansmentioning

confidence: 99%

“…Therefore, some studies supposed that the surgical technical requirements of MA are related to the high dissatisfaction rate of patients after TKA [2][3][4] . Kinematical alignment (KA) is dedicated to restoring the anatomical geometry of the tibiofemoral joint and the laxity of the joint to that which it would have been before the onset of arthritis [5], and abandoning the "neutral" alignment of the MA, it has attracted widespread attention in recent years [6][7][8].…”

mentioning

confidence: 99%

The Insufficient Coverage of Lateral Trochlear Resection is Correlated to the Tibiofemoral Alignment Parameters in Kinematically Aligned TKA: A Retrospective Clinical Study

Wang¹,

Liang²,

Zhang³

et al. 2020

Preprint

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Background: The mismatching of the femoral component and trochlear resection surface is very common in kinematically aligned total knee arthroplasty (KA-TKA) when conventional prostheses are employed. This mismatching is mainly manifested in the insufficient coverage of the bone cut surface of the lateral trochlea. The aim of present study is to explore whether this mismatch is related to the alignment parameters of the tibiofemoral joint. Methods: 45 patients (52 knees) who underwent KA-TKA in our hospital were included. There were 16 patients (16 knees) received surgery using patient specific instrumentations, and conventional instruments with caliper and other special tools were employed in the other 29 patients (36 knees). The widths of exposed resection bone surface at the middle (MIDexposure) and distal (INFexposure) levels on the lateral trochlear were measured as dependent variables, while the hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and transepicondylar axis angle (TEAA) were measured as independent variables. Correlation analysis and subsequent linear regression were conducted among the dependent variables and various alignment parameters of the tibiofemoral joint. Results: The incidence of insufficient coverage of the lateral trochlear cut bone surface was 86.5%, with MIDexposure and INFexposure being 2.3 (0-6mm) and 2.0 (0-5mm), respectively. The widths of two levels of exposed bone resection were significantly correlated to mLDFA and HKA, but were not related to TEAA. Conclusions: the insufficient coverage of trochlear resection surface in KA-TKA is negatively correlated with the degrees of valgus of the distal femoral joint line and the degrees of varus of the knee. The present study suggest that in the development of KA-specific prostheses, attention should be paid to the effects of tibiofemoral alignment parameters on the prosthetic matching of the trochlear resection surface.

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“…It was mandatory to compensate for the thickness of the articular cartilage by 2mm in the CTbased PSI design. Articular surface-based rather than tibio-femoral exion axis-based PSI design was employed in this study 10 .…”

Section: Design and Manufacturing Of Psimentioning

confidence: 99%

“…As a three dimensional alignment method, KA has strict requirements for bone cutting accuracy 4,7 , a variety of computer-aided alignment tools, such as patient-speci c instrumentation (PSI), navigation and even robotic assistant surgery, were used to improve the accuracy of bone resection and components implantation [8][9][10][11][12] . PSI plays the role of positioning tools or jigs, which help in executing surgeries with more accuracy, lesser operative time and minimal invasive purposes.…”

Section: Introductionmentioning

confidence: 99%

Surgeon Dominated Design Can Improve the Accuracy of Patient-specific Instruments in Kinematically Aligned TKA

Wang¹,

Liang²,

Zhang³

et al. 2020

Preprint

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Precise bone resection is mandatory for kinematically aligned total knee arthroplasty（KA-TKA). Patient-specific instrumentation (PSI) has been applied to improve the accuracy of bone resection in TKA for many years. The purpose of this study was to investigate whether surgeons’ domination in PSI design can improve accuracy in KA-TKA. A total of 24 patients (24 knees) who underwent KA-TKA in our institution were assigned into engineer designed PSI group (10 knees) and surgeon designed PSI group (14 knees). The bone resection discrepancies of every key facets were used to evaluate the accuracy of PSI in bone resection, while the absolute differences of joint line orientation before and after surgery were used to evaluate the accuracy of PSI in joint line restoration. The overall discrepancy of bone resection was reduced by surgeon designed PSI compared to engineer designed PSI by 0.33mm (P<0.001). Surgeon designed PSI could reduce the outliers in terms of relative discrepancies in bone resection as well. Moreover, surgeon designed PSI could significantly improve the accuracy of PSI in the restoration of the joint line (p=0.01). This study indicate that the dominance of surgeons in both PSI design and subsequent surgical operation should be emphasized in efforts to improve the accuracy of PSI.

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Kinematically Aligned Total Knee Arthroplasty with Patient-Specific Instrument

Cited by 14 publications

References 52 publications

Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: a retrospective clinical study

Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: a retrospective clinical study

The Insufficient Coverage of Lateral Trochlear Resection is Correlated to the Tibiofemoral Alignment Parameters in Kinematically Aligned TKA: A Retrospective Clinical Study

Surgeon Dominated Design Can Improve the Accuracy of Patient-specific Instruments in Kinematically Aligned TKA

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