Significant differences between manufacturer and surgeon in the accuracy of final component size prediction with CT-based patient-specific instrumentation for total knee arthroplasty

Cucchi, Davide; Menon, Alessandra; Compagnoni, Roberto; Ferrua, Paolo; Fossati, C; Randelli, Pietro

doi:10.1007/s00167-018-4876-8

Cited by 17 publications

(14 citation statements)

References 35 publications

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“…However, in our experience, repeated evaluations and changes are needed both preoperatively (33%) and intraoperatively (58%). This is in agreement with published reports that highlight that significant changes in the technician plan were necessary to obtain an accurate preoperative plan and that intraoperative size changes were common when using PSI 6,34,35 .…”

supporting

confidence: 92%

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

Cucchi

Menon

Aliprandi³

et al. 2019

Orthopaedic Surgery

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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.

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supporting

confidence: 92%

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

Cucchi

Menon

Aliprandi³

et al. 2019

Orthopaedic Surgery

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“…Pietsch et al concluded from a prospective study on 50 cases that surgeons should not blindly accept the MPP because it would require significantly more intra-operative changes (Pietsch et al, 2013). Other prospective studies resulted in the same conclusion (Stronach et al, 2013;Cucchi et al, 2018). Furthermore, Pietsch et al measured the average time taken by the surgeon to correct the MPP, which was found to be 8 min (Pietsch et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty

et al. 2022

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Previous studies have shown that the manufacturer’s default preoperative plans for total knee arthroplasty with patient-specific guides require frequent, time-consuming changes by the surgeon. Currently, no research has been done on predicting preoperative plans for orthopedic surgery using machine learning. Therefore, this study aims to evaluate whether artificial intelligence (AI) driven planning tools can create surgeon and patient-specific preoperative plans that require fewer changes by the surgeon. A dataset of 5409 preoperative plans, including the manufacturer’s default and the plans corrected by 39 surgeons, was collected. Features were extracted from the preoperative plans that describe the implant sizes, position, and orientation in a surgeon- and patient-specific manner. Based on these features, non-linear regression models were employed to predict the surgeon’s corrected preoperative plan. The average number of corrections a surgeon has to make to the preoperative plan generated using AI was reduced by 39.7% compared to the manufacturer’s default plan. The femoral and tibial implant size in the manufacturer’s plan was correct in 68.4% and 73.1% of the cases, respectively, while the AI-based plan was correct in 82.2% and 85.0% of the cases, respectively, compared to the surgeon approved plan. Our method successfully demonstrated the use of machine learning to create preoperative plans in a surgeon- and patient-specific manner for total knee arthroplasty.

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“…He published a correct prediction percentage of 86.7% for the femoral component and 73.3% for the tibial with the Trumatch System (DePuy Orthopaedics, Inc. Warsaw, IN), in 45 cases. 18 We cannot agree with this author's conclusions. According to Cucchi et al's paper, the manufacturer's proposal differed from the final implant in 20.0% of the femoral and 51.1% of the tibial components, and modifications in the preoperative plan were performed for five (11.1%) of the femoral and 23 (51.1%) of the tibial components.…”

Section: Discussionmentioning

confidence: 65%

Planning on CT-Based 3D Virtual Models Can Accurately Predict the Component Size for Total Knee Arthroplasty

2019

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The ability to predict accurate sizing of the implant components for total knee arthroplasty surgery can have several benefits in the operating room, in terms of simplifying the workflow and reducing the number of required instrument trays. Planning on a three-dimensional (3D) virtual model can be used to predict size. The aim of this study was to quantify the accuracy of the surgeon-validated plan prediction on a computed tomography (CT)-based system. The clinical records of 336 cases (267 patients), operated using a CT-based patient-specific instrumentation, have been reviewed for the size of implanted components. Preoperative default planning (according to the preferences of the surgeon) and approved planning have been compared with the size of implanted components for both the femur and tibia. The prosthesis size, preplanned by the manufacturers, was modified by the surgeon during the validation process in 0.9% of cases for the femoral component and in 2.7% of cases for the tibial component. The prosthesis size, preplanned by the surgeon after the validation process, was used in 95.8% for the femur and 92.6% for the tibia. Concordance on the size of the surgeon-validated plan and the finally implanted size was perfect for both, the femoral (κ = 0.951; 95% confidence interval [CI]: 0.92–0.98) and the tibial component (κ = 0.902; 95% CI: 0.86–0.94). The most frequent change of size (51%) was an increase by one size of the planned tibial component. Planning of knee arthroplasty surgery on a 3D virtual, CT-based model is useful to surgeons to help predict the size of the implants to be used in surgery. The system we have used can accurately predict the component size for both the femur and tibia. This study reflects a study of level III evidence.

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Significant differences between manufacturer and surgeon in the accuracy of final component size prediction with CT-based patient-specific instrumentation for total knee arthroplasty

Cited by 17 publications

References 35 publications

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

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

Artificial Intelligence Based Patient-Specific Preoperative Planning Algorithm for Total Knee Arthroplasty

Planning on CT-Based 3D Virtual Models Can Accurately Predict the Component Size for Total Knee Arthroplasty

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