PURPOSE: The aim of this prospective study was to compare early clinical outcome, radiological limb alignment, and three-dimensional (3D)-component positioning between conventional and computed tomography (CT)-based patient-specific instrumentation (PSI) in primary mobile-bearing total knee arthroplasty (TKA). METHODS: Two hundred ninety consecutive patients (300 knees) with severe, debilitating osteoarthritis scheduled for TKA were included in this study using either conventional instrumentation (CVI, n = 150) or PSI (n = 150). Patients were clinically assessed before and 2 years after surgery according to the Knee-Society-Score (KSS) and the visual-analog-scale for pain (VAS). Additionally, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford-Knee-Score (OKS) were collected at follow-up. To evaluate accuracy of CVI and PSI, hip-knee-ankle angle (HKA) and 3D-component positioning were assessed on postoperative radiographs and CT. RESULTS: Data of 222 knees (CVI: n = 108, PSI: n = 114) were available for analysis after a mean follow-up of 28.6 ± 5.2 months. At the early follow-up, clinical outcome (KSS, VAS, WOMAC, OKS) was comparable between the two groups. Mean HKA-deviation from the targeted neutral mechanical axis (CVI: 2.2° ± 1.7°; PSI: 1.5° ± 1.4°; p < 0.001), rates of outliers (CVI: 22.2%; PSI: 9.6%; p = 0.016), and 3D-component positioning outliers were significantly lower in the PSI group. Non-outliers (HKA: 180° ± 3°) showed better clinical results than outliers at the 2-year follow-up. CONCLUSIONS: CT-based PSI compared with CVI improves accuracy of mechanical alignment restoration and 3D-component positioning in primary TKA. While clinical outcome was comparable between the two instrumentation groups at early follow-up, significantly inferior outcome was detected in the subgroup of HKA-outliers. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
PURPOSE: The aim of this prospective study was to compare early clinical outcome, radiological limb alignment, and three-dimensional (3D)-component positioning between conventional and computed tomography (CT)-based patient-specific instrumentation (PSI) in primary mobile-bearing total knee arthroplasty (TKA). METHODS: Two hundred ninety consecutive patients (300 knees) with severe, debilitating osteoarthritis scheduled for TKA were included in this study using either conventional instrumentation (CVI, n = 150) or PSI (n = 150). Patients were clinically assessed before and 2 years after surgery according to the Knee-Society-Score (KSS) and the visual-analog-scale for pain (VAS). Additionally, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Oxford-Knee-Score (OKS) were collected at follow-up. To evaluate accuracy of CVI and PSI, hip-knee-ankle angle (HKA) and 3D-component positioning were assessed on postoperative radiographs and CT. RESULTS: Data of 222 knees (CVI: n = 108, PSI: n = 114) were available for analysis after a mean follow-up of 28.6 ± 5.2 months. At the early follow-up, clinical outcome (KSS, VAS, WOMAC, OKS) was comparable between the two groups. Mean HKA-deviation from the targeted neutral mechanical axis (CVI: 2.2° ± 1.7°; PSI: 1.5° ± 1.4°; p < 0.001), rates of outliers (CVI: 22.2%; PSI: 9.6%; p = 0.016), and 3D-component positioning outliers were significantly lower in the PSI group. Non-outliers (HKA: 180° ± 3°) showed better clinical results than outliers at the 2-year follow-up. CONCLUSIONS: CT-based PSI compared with CVI improves accuracy of mechanical alignment restoration and 3D-component positioning in primary TKA. While clinical outcome was comparable between the two instrumentation groups at early follow-up, significantly inferior outcome was detected in the subgroup of HKA-outliers. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
Entities:
Keywords:
3D-component positioning; CT-based cutting block; Clinical and radiological outcome; MyKnee; Patient-specific instrumentation; Total knee arthroplasty
Authors: Ryan M Nunley; Bradley S Ellison; Jinjun Zhu; Erin L Ruh; Stephen M Howell; Robert L Barrack Journal: Clin Orthop Relat Res Date: 2011-12-20 Impact factor: 4.176
Authors: Vincent Y Ng; Jeffrey H DeClaire; Keith R Berend; Bethany C Gulick; Adolph V Lombardi Journal: Clin Orthop Relat Res Date: 2012-01 Impact factor: 4.176
Authors: Kanniraj Marimuthu; Darren B Chen; Ian A Harris; Emma Wheatley; Carl J Bryant; Samuel J MacDessi Journal: J Arthroplasty Date: 2013-12-19 Impact factor: 4.757
Authors: Nienke M Kosse; Petra J C Heesterbeek; Janneke J P Schimmel; Gijs G van Hellemondt; Ate B Wymenga; Koen C Defoort Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-11-28 Impact factor: 4.342
Authors: Omer Slevin; Anna Hirschmann; Filippo F Schiapparelli; Felix Amsler; Rolf W Huegli; Michael T Hirschmann Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-10-12 Impact factor: 4.342
Authors: Vikaesh Moorthy; Jerry Yongqiang Chen; Ming Han Lincoln Liow; Pak Lin Chin; Shi-Lu Chia; Ngai Nung Lo; Seng Jin Yeo Journal: Arch Orthop Trauma Surg Date: 2021-01-02 Impact factor: 3.067