Patient‐specific Instrumentation Affects Rotational Alignment of the Femoral Component in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Abstract

Objective To evaluate whether patient‐specific instrumentation (PSI) improve the accuracy of femoral component rotational alignment with respect to conventionally‐implanted total knee arthroplasty (TKA). Methods Twenty‐four patients were randomized to receive a TKA implanted with PSI or conventional instrumentation. Implant orientation was compared on Computed Tomography (CT). Surgical time, recuts, and component size variations from planning were recorded. Preoperative and postoperative Oxford knee score and visual analogue scale were compared to assess clinical outcomes. Results Femoral components implanted with patient‐specific instrumentation were aligned with greater external rotation than those implanted with conventional instrumentation ( P = 0.022). No significant differences were found in surgical times, number of recuts, and clinical outcomes. Surgeon modifications from the planned size were necessary in 58% of PSI cases. Conclusion Femoral components implanted with PSI had greater external rotation than with conventional instrumentation. Surgeons must carefully evaluate component sizes when using PSI, both in planning and during surgery.

Comparison of Kinematic Alignment and Mechanical Alignment in Total Knee Arthroplasty: A Meta‐analysis of Randomized Controlled Clinical Trials

“…Although the goal of KA‐TKA is to restore normal knee kinematics or prearthritic kinematics and restore the patient to previous functional levels, the concern for increased risk of patellofemoral instability and polyethylene wear was raised 29, 30, 43–45 . Ishikawa et al 46 .…”

Software Solution Integrated in Three-Dimensional Technologies for Preoperative Planning of Tibial Plateau Fractures

“…Reconstruction of tibial plateau fractures can be supported by 3D technologies [4], in order to minimize surgery [5], as both visual and printed models provide tactile feedback and in-depth information about anatomical and pathological conditions [6,7]. Threedimensional (3D) technologies allow for optimal results in reducing fractures [8], identifying the correct alignment [9], fixing with screws [10,11], reducing the duration of surgery, blood loss and radiation exposure [12], as well as and improving mechanical alignment in total knee replacement [13,14,15], which is facilitated by patient-specific implants that fit perfectly and provide unlimited geometric mobility [16]. Post mortem computed tomography can also be used to assess complex trauma to victims [17].…”

Integration of Three-dimensional Technologies in Orthopedics: A Tool for Preoperative Planning of Tibial Plateau Fractures

“…In particular, the reconstruction of the tibial plateau fractures can be supported by 3D technologies, with the aim of minimizing the intervention ( 13 ), as visual and printed models are capable to provide both tactile feedback and tangible depth information about anatomic and pathologic states ( 14 , 15 ), to obtain optimal fixation results with screws ( 16 , 17 ), to reduce the surgical time, the blood loss and the radiation exposure ( 18 ), to improve the mechanical alignment in total knee replacement ( 19 , 20 , 21 ), to support a patient-specific implant that fits perfectly and has unlimited geometric mobility ( 22 ).…”