Operative efficiency and accuracy of patient‐specific cutting guides in total knee replacement

Nankivell, Mark; West, Graeme; Pourgiezis, Nicholas

doi:10.1111/ans.12906

Cited by 13 publications

(22 citation statements)

References 7 publications

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“…Apart from orthopedics (guides for knee arthroplasties), 3D-printed surgical guides were also used in neurosurgery, dental surgery, spinal surgery, and maxillofacial surgery. 28 of the 53 studies that mentioned reduced operation room time also supported this claim with numbers or statistics [ 39 , 74 , 81 , 84 , 118 , 131 , 132 , 135 , 136 , 140 , 141 , 145 , 151 , 152 , 162 , 175 , 177 , 181 , 190 , 194 , 196 , 200 , 207 , 210 – 212 , 219 ]. Increased procedural time was seen in seven papers, of which five supported this with numbers or statistics [ 62 , 73 , 125 , 143 , 153 , 161 , 225 ].…”

Section: Resultsmentioning

confidence: 87%

3D-printing techniques in a medical setting: a systematic literature review

et al. 2016

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BackgroundThree-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes.MethodsThree major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans.Results227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure.Conclusion3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12938-016-0236-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 87%

3D-printing techniques in a medical setting: a systematic literature review

et al. 2016

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“…Some researchers smartly came up with a way to study PSI accuracy without using X-ray measurement. In these studies, the amount of bony resection was measured and compared with planned osteotomy [18][19][20][21][22]. However, the results of these studies were covered with controversy.…”

Section: Introductionmentioning

confidence: 99%

The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

Liang

Yang

Wang

et al. 2021

BioMed Research International

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Purpose. Bony resection is the primary step during total knee arthroplasty. The accuracy of bony resection was highly addressed because it was deemed to have a good relationship with mechanical line. Patient-specific instruments (PSI) were invented to copy the bony resection references from the preoperative surgical plan during a total knee arthroplasty (TKA); however, the accuracy still remains controversial. This study was aimed at finding out the accuracy of the bony resection during PSI-assisted TKA. Methods. Forty-two PSI-assisted TKAs (based on full-length leg CT images) were analyzed retrospectively. Resected bones of every patient were given a CT scan, and three-dimensional radiographs were reconstructed. The thickness of each bony resection was measured with the three-dimensional radiographs and recorded. The saw blade thickness (1.27 mm) was added to the measurements, and the results represented intraoperative bone resection thickness. A comparison between intraoperative bone resection thickness and preoperatively planned thickness was conducted. The differences were calculated, and the outliers were defined as >3 mm. Results. The distal femoral condyle had the most accurate bone cuts with the smallest difference (median, 1.0 mm at the distal medial femoral condyle and 0.8 mm at the distal lateral femoral condyle) and the least outliers (none at the distal medial femoral condyle and 1 (2.4%) at the distal lateral femoral condyle). The tibial plateau came in second (median difference, 0.8 mm at the medial tibial plateau and 1.4 mm at the lateral tibial plateau; outliers, none at the medial tibial plateau and 1 (2.6%) at the lateral tibial plateau). Regardless of whether the threshold was set to >2 mm (14 (17.9%) at the tibial plateau vs. 12 (14.6%) at the distal femoral condyle, p > 0.05 ) or >3 mm (1 (1.3%) at the tibial plateau vs. 1 (1.2%) at the distal femoral condyle, p > 0.05 ), the accuracy of tibial plateau osteotomy was similar to that of the distal femoral condyle. Osteotomy accuracy at the posterior femoral condyle and the anterior femoral condyle were the worst. Outliers were up to 6 (15.0%) at the posterior medial femoral condyle, 5 (12.2%) at the posterior lateral femoral condyle, and 6 (15.8%) at the anterior femoral condyle. The percentages of overcut and undercut tended to 50% in most parts except the lateral tibial plateau. At the lateral tibial plateau, the undercut percentage was twice that of the overcut. Conclusion. The tibial plateau and the distal femoral condyle share a similar accuracy of osteotomy with PSI. PSI have a generally good accuracy during the femur and tibia bone resection in TKA. PSI could be a kind of user-friendly tool which can simplify TKA with good accuracy. Level of Evidence. This is a Level IV case series with no comparison group.

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“…The available literature is not consistent with respect to the reduction in operative room time with PSI [ 3 , 5 , 6 , 24 – 26 ]. We believe that the reasons for this absence of published information include relatively limited surgical experience and problems in guide design.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that PSI guides used during primary TKA improve operative room efficiency with fewer outliers [ 3 , 4 ]. In contrast, other data has shown only a marginal improvement in operative room efficiency in PSI compared to similar arthroplasties performed with CI [ 5 , 6 ]. This difference may be due to a lack of surgical experience and the relatively small number of patients studied to date.…”

Section: Introductionmentioning

confidence: 92%

The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

Kwon

Kang

Son

et al. 2017

BioMed Research International

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This retrospective study was to determine if patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM) tibial guide (group 1, n = 48), PSI with EM tibial guide (group 2, n = 68), and conventional instrumentation (CI) group (group 3, n = 50). Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9 ± 13.6 min) compared to the CI group (group 3, 82.8 ± 24.9 min) (P < 0.001). However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3 ± 18.8 min). This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

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Operative efficiency and accuracy of patient‐specific cutting guides in total knee replacement

Cited by 13 publications

References 7 publications

3D-printing techniques in a medical setting: a systematic literature review

3D-printing techniques in a medical setting: a systematic literature review

The Bony Resection Accuracy with Patient-Specific Instruments during Total Knee Arthroplasty: A Retrospective Case Series Study

The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

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