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- Title
Revision of partial knee to total knee arthroplasty with use of patient-specific instruments results in acceptable femoral rotation.
- Authors
Schotanus, Martijn G. M.; Thijs, Elke; Boonen, B.; Kerens, B.; Jong, B.; Kort, Nanne P.
- Abstract
<bold>Purpose: </bold>Patient-specific instruments (PSI) were initially developed for the alignment of both total knee- (TKA) and partial knee arthroplasty (PKA). We hypothesize that CT-based PSI for PKA-to-TKA revision surgery can restore biomechanical limb alignment and prosthetic component positioning in vivo as calculated pre-operatively, resulting in a limited percentages of outliers.<bold>Methods: </bold>An imaging analysis was performed using CT-based 3D measurement methods based on a pre- and post-revision CT scan. Imaging data were gathered on 10 patients who were operated for PKA-to-TKA revision with the use of PSI based on CT imaging. The planned femur and tibia component position in vivo were compared with the pre-revision planned component position. Outliers were defined as deviations >3.0° from pre-revision planned position for the individual implant components. Adjustments (e.g. resection level and implant size) during surgery were recorded.<bold>Results: </bold>The HKA axis was restored accurately in all patients with a mean post-operative HKA axis of 178.1° (1.4°). Five femoral (2 varus, 2 internal rotation and 1 extension) and 14 tibial guides (2 varus, 6 anterior slope, 3 internal rotation and 3 external rotation) on a total of 60 outcome measures were identified as outliers. During surgery, an intraoperative tibial resection of 2 mm extra was performed in three patients. In 80 and 70% for, respectively, the femur and tibia, the surgeon-planned size was implanted during surgery. All patient-specific guides fitted well in all patients. No intraoperative or post-operative complications related to surgery were registered.<bold>Conclusions: </bold>This study introduced a unique new concept regarding PSI, PKA-to-TKA revision surgery. Based on the results, we were unable to fully confirm our hypothesis. PSI as a "new" tool for PKA-to-TKA revision surgery appears to be an accurate tool for the alignment of the TKA femur component. The tibial guide seems more susceptible to errors, resulting in a substantial percentage of outliers.<bold>Level Of Evidence: </bold>Prospective cohort study, Level II.
- Subjects
TOTAL knee replacement; KNEE surgery; COMPUTED tomography; FEMUR injuries; OSTEOARTHRITIS treatment; FEMUR surgery; TIBIA surgery; ARTIFICIAL joints; BONE diseases; FEMUR; JOINT diseases; KINEMATICS; KNEE; LONGITUDINAL method; REOPERATION; ROTATIONAL motion; TIBIA; COMPUTER-assisted surgery; EQUIPMENT & supplies
- Publication
Knee Surgery, Sports Traumatology, Arthroscopy, 2018, Vol 26, Issue 6, p1656
- ISSN
0942-2056
- Publication type
Academic Journal
- DOI
10.1007/s00167-017-4674-8