Preoperative planning of total knee arthroplasty: reliability of axial alignment using a three-dimensional planning approach

Tiefenboeck, Stefan; Sesselmann, Stefan; Taylor, Dominic; Forst, Raimund; Seehaus, Frank

doi:10.1177/02841851211029076

Cited by 10 publications

(8 citation statements)

References 32 publications

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“…Poor t is often associated with complications such as loosening of the prosthesis and functional impairment [4,8,24] . Although using X-ray images to establish a two-dimensional model is quick and cheap, it cannot effectively forecast the trend of knee alignment in patients [5,25] . The three-dimensional model demonstrates a high level of accuracy in predicting the actual implant size, with some studies reporting accuracy rates of up to 100%.…”

Section: Analysis Of the T Of The Knee Sizesmentioning

confidence: 99%

Assessment of Preoperative Planning and Intraoperative Accuracy of the AIKNEE System for Total Knee Arthroplasty

Lan,

2023

Preprint

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Background The aim of this retrospective study was to evaluate the effectiveness and accuracy of the AIKNEE system in preoperative planning and intraoperative alignment for total knee arthroplasty (TKA). Methods A total of 64 patients were planned preoperatively by the AIKNEE system, including the measurement of mechanical femorotibial angle (mFTA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA) using three-dimensional reconstructed images. Intraoperatively, the actual prosthesis size and alignment were compared to the planned parameters. Postoperative outcomes, including pain levels, range of motion (ROM), and Knee Scoring System (KSS) scores, were assessed after surgery. Statistical analyses were performed to evaluate the correlation between alignment deviations and postoperative function. Results The AIKNEE system accurately predicted the prosthesis size in thirty-one of femoral cases (48%) and forty-seven of tibial cases (73%). Deviations of mFTA, LDFA, and MPTA from the target value were within 3° in 88%, 92%, and 95% of cases, respectively. A significant improvement was observed in postoperative pain, ROM, and KSS scores (p < 0.001). Correlation analysis revealed that greater deviations in mFTA and LDFA were associated with increased pain (p = 0.004, 0.047) and lower KSS scores (p = 0.027). Conclusion The AIKNEE system demonstrated promising results in predicting prosthesis size and achieved alignment within the desired range in a majority of cases. Postoperative outcomes, including pain levels and functional improvement, were favorable.

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Section: Analysis Of the T Of The Knee Sizesmentioning

confidence: 99%

Assessment of Preoperative Planning and Intraoperative Accuracy of the AIKNEE System for Total Knee Arthroplasty

Lan,

2023

Preprint

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“…These provide basic tools to measure distances, angles, etc. More complex software like mediCAD® (mediCAD Hectec GmbH, Altdorf, Germany) allow for sophisticated measurements and orthopedic planning like knee replacements (Tiefenboeck et al 2021). However, these tools have limited capacities for anonymization, are desktop based, and are not well suited for analysis by multiple analyzers.…”

Section: Available Toolsmentioning

confidence: 99%

TYCHE Study: Implementation of a web-based tool for orthopedic image analysis, score validation, and research

Schippers

Meurer

Schnetz

et al. 2022

Preprint

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Introduction : Image analysis plays a central role in orthopedics but comes along with many challenges like anonymization, bias, usability, and efficient analysis by multiple independent analyzers, etc. Tyche is a lightweight, browser-based program that addresses the challenges mentioned above by displaying images anonymized, in random order and facilitating the analysis by multiple analyzers. The goal of this study was to validate Tyche for the use of orthopedic images by comparing it with a validated standard program for orthopedic planning. Method : One hundred three anterior-posterior pelvic radiographs were selected from our database and analyzed separately by five experienced orthopedic surgeons using both Tyche and validated software, mediCAD® (mediCAD Hectec GmbH, Altdorf, Germany). Common orthopedic measurement modalities (length, angle, area) and a score (Kellgren & Lawrence) were determined. Methods were compared using Pearson's correlation coefficients and Bland-Altman-Plots. A short video explaining Tyche can be found at www.tyche.expert/explain. Results : All one hundred three radiographs were analyzed five times using both Tyche mediCAD®. Significant correlations ranging from r = 0.77 (angle-measurements) to r=0.99 (area-measurements) were found between the two programs for all measurements. Bland-Altman-Plots confirmed the non-inferiority of either method. Images were analyzed significantly faster using Tyche. No obvious transmission errors were found in results using Tyche compared to those from mediCAD®. Conclusion : None of the currently available tools addresses all challenges in image analysis like anonymization, subjectivity, bias, and usability. Here we tested a new browser-based program, Tyche, by comparing results with a validated tool. In summary, results correlated significantly between the two methods. However, using Tyche, results were acquired faster, under complete anonymization, and with fewer transmission errors. We conclude that Tyche is a validated tool for orthopedic image analysis. For the first time, a validated browser-based tool enables independent analyzers worldwide to conduct efficient, multicenter, and randomized imaging studies and score validations.

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“…Since the ellipses could represent the sagittal femoral condylar shape, the centers of the condylar ellipse line (CEL) may have a special anatomical correlation with the SEA. Two epicondylar axes have been described in the literature: the clinical epicondylar axis (CEA) and the SEA 18,19 . The CEA connects the medial and lateral prominences of both epicondyles 18 .…”

Section: Introductionmentioning

confidence: 99%

“…Two epicondylar axes have been described in the literature: the clinical epicondylar axis (CEA) and the SEA 18,19 . The CEA connects the medial and lateral prominences of both epicondyles 18 . The SEA connects the most prominent point of the lateral epicondyles and the deepest point of the sulcus on the medial epicondyles 19,20 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the femoral condylar ellipse line and the surgical epicondylar axis: 3D measurement by MRI scans in healthy Chinese people

Zhang

Liu

Fan

et al. 2023

Orthopaedic Surgery

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Objective:The sagittal shapes of the femoral condyles were thought to consist of circles. However, the line connecting the centers of circles was not consistent with the surgical epicondylar axis (SEA) which was commonly used in surgery. Recently, ellipses have been proposed as an alternative method to represent the sagittal femoral condylar shape. Does the condylar ellipse line (CEL) coincide with the SEA in 3D MRI reconstruction analysis?Methods: From May to August 2021, a total of 80 healthy subjects were scanned by MRI on the right knee in this retrospective study. The ellipses on the most distal slices of the medial and lateral condyles were determined. A line connecting the centers of the medial and lateral ellipses was the CEL. A line connecting the deepest point of the medial sulcus and the most prominent point of the lateral epicondyle was the SEA. Angular measurement of the SEA and the CEL relative to the posterior condylar line (PCL) and the distal condylar line (DCL) was performed on an axial and coronal view of the 3D model, respectively. Measurements were compared between males and females by using the independent-samples t-test.Pearson correlation was used to analyze the relationship between SEA-PCL and CEL-PCL, SEA-DCL, and CEL-DCL.Results: On the axial view, the mean SEA-CEL was 0.35 AE 0.96 . SEA-PCL (2.91 AE 1.40 ) had a high correlation with CEL-PCL (3.27 AE 1.11 ) (r = 0.731, p < 0.001). On the coronal view, the mean coronal SEA-CEL was 1.35 AE 1.13 . SEA-DCL (1.35 AE 1.13 ) had a low correlation with CEL-DCL (0.18 AE 0.84 ) (r = 0.319, p = 0.007). On the sagittal view, the outlet points of the CEL on the medial and lateral epicondyles were anatomically located in the anteroinferior direction to the SEA.Conclusions: CEL traversed the medial and lateral epicondyles, which has a mean deviation of 0.35 with SEA on axial view and a mean deviation of 0.18 with DCL on coronal view. This study suggested that the ellipse approach is an improved scheme for representing the femoral condylar shape.

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Preoperative planning of total knee arthroplasty: reliability of axial alignment using a three-dimensional planning approach

Cited by 10 publications

References 32 publications

Assessment of Preoperative Planning and Intraoperative Accuracy of the AIKNEE System for Total Knee Arthroplasty

Assessment of Preoperative Planning and Intraoperative Accuracy of the AIKNEE System for Total Knee Arthroplasty

TYCHE Study: Implementation of a web-based tool for orthopedic image analysis, score validation, and research

Comparison of the femoral condylar ellipse line and the surgical epicondylar axis: 3D measurement by MRI scans in healthy Chinese people

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