BACKGROUND: Restoring function and alignment when treating knee arthritis with a total knee arthroplasty (TKA) in patients who have an extra-articular deformity (EAD) from a malunion or with retained femoral hardware is a challenge. The normal anatomical landmarks are hard to find and difficult to use to obtain correct alignment. The procedure will be further challenged by angular deformity of the femur or tibia. A retrospective study was performed on a case series of patients with EAD or obliteration of the canal treated with patient-specific instruments (PSI). METHODS: A multicenter retrospective review of 10 patients with multiplanar deformities in which the knee components were aligned with patient-specific instruments was performed. Outcome and alignment were studied. RESULTS: At a mean follow-up of 3.4years, function improved from preoperative as evidenced by a mean increase in the KS pain score of 53 points, KS function score of 48 points and Oxford Score of 28 points (P<0.05). Flexion improved from 94° +/- 11° to 112° +/- 15° (P<0.05). Limb alignment was restored with a mean Hip-Knee-Ankle angle of 179.3° +/- 1.3° (P<0.05). Maximum outliers were 177° to 181°. An average tourniquet time of 75 +/- 9minutes (range, 62-83min) was observed. CONCLUSIONS: The use of patient-specific instrumentation systems to perform TKA in patients without access to the intramedullary canal because of EAD or fixation devices, improved function and restored limb alignment. Mechanical alignment can easily be obtained with this technique by intra-articular correction of deformities under 20°. LEVEL OF EVIDENCE: Level IV.
BACKGROUND: Restoring function and alignment when treating knee arthritis with a total knee arthroplasty (TKA) in patients who have an extra-articular deformity (EAD) from a malunion or with retained femoral hardware is a challenge. The normal anatomical landmarks are hard to find and difficult to use to obtain correct alignment. The procedure will be further challenged by angular deformity of the femur or tibia. A retrospective study was performed on a case series of patients with EAD or obliteration of the canal treated with patient-specific instruments (PSI). METHODS: A multicenter retrospective review of 10 patients with multiplanar deformities in which the knee components were aligned with patient-specific instruments was performed. Outcome and alignment were studied. RESULTS: At a mean follow-up of 3.4years, function improved from preoperative as evidenced by a mean increase in the KS pain score of 53 points, KS function score of 48 points and Oxford Score of 28 points (P<0.05). Flexion improved from 94° +/- 11° to 112° +/- 15° (P<0.05). Limb alignment was restored with a mean Hip-Knee-Ankle angle of 179.3° +/- 1.3° (P<0.05). Maximum outliers were 177° to 181°. An average tourniquet time of 75 +/- 9minutes (range, 62-83min) was observed. CONCLUSIONS: The use of patient-specific instrumentation systems to perform TKA in patients without access to the intramedullary canal because of EAD or fixation devices, improved function and restored limb alignment. Mechanical alignment can easily be obtained with this technique by intra-articular correction of deformities under 20°. LEVEL OF EVIDENCE: Level IV.
Authors: Etienne Cavaignac; Regis Pailhé; Gregoire Laumond; Jérôme Murgier; Nicolas Reina; Jean Michel Laffosse; Emilie Bérard; Philippe Chiron Journal: Int Orthop Date: 2014-10-10 Impact factor: 3.075
Authors: Matthew P Abdel; Sébastien Parratte; Guillaume Blanc; Matthieu Ollivier; Vincent Pomero; Elke Viehweger; Jean-Noël A Argenson Journal: Clin Orthop Relat Res Date: 2014-03-07 Impact factor: 4.176
Authors: M Pietsch; M Hochegger; O Djahani; G Mlaker; M Eder-Halbedl; Th Hofstädter Journal: Arch Orthop Trauma Surg Date: 2021-07-13 Impact factor: 3.067
Authors: Donald W Hohman; Scott R Nodzo; Matthew Phillips; Wofgang Fitz Journal: Knee Surg Sports Traumatol Arthrosc Date: 2014-09-13 Impact factor: 4.342