Accuracy of manual instrumentation of tibial cutting guide in total knee arthroplasty (original) (raw)
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Purpose The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary TKA. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation. Methods A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation. Following surgical exposure the PSI cutting guides were placed on the joint surface and alignment assessed using the navigation tracker. The difference between in-theatre data and the pre-operative plan was recorded and analysed. Results The error between in-theatre measurements and pre-operative plan for the femoral and tibial components exceeded 3° for 3% and 17% of the sample respectively, while the error for total coronal alignment exceeded 3° for 27% of the sample. Conclusion The present results indicate that alignment with Zimmer PSI cutting blocks, assessed by imageless navigation, does not match the pre-operative plan in a proportion of cases. To prevent unnecessary increases in the incidence of malalignment in primary TKR, it is recommended that these devices should not be used without objective verification of alignment, either in real-time or with post-operative imaging. Further work is required to identify the source of discrepancies and validate these devices prior to routine use.
International Orthopaedics, 2014
Purpose The accelerometer-based system is a portable surgical navigation system for TKA that does not require the use of a large computer console for registration and alignment feedback as required in computer-assisted surgery (CAS). The purpose of this prospective study was to determine the accuracy of the accelerometer-based system in the tibial component positioning and also to evaluate clinical outcomes. Methods Between December 2011 and July 2012, a total of 53 consecutive patients with primary gonarthrosis were prospectively enrolled for unilateral TKA using a handheld surgical navigation system to perform the tibial resection. Preoperatively and postoperatively, patients were asked to fill out a visual analogue scale for pain (VAS) and a knee injury and osteoarthritis outcome score (KOOS). Standing anteroposterior (AP) hip-knee-ankle (HKA) and lateral knee-toankle radiographs were performed to determine the varus/ valgus alignment and the posterior slope of the tibial components relative to the mechanical axis. Results The mean duration of follow-up was 23 months. Average preoperative VAS was 8.3±0.67, which significantly improved to a mean 1.2±0.57 at final follow up (P<0.001). All scores significantly increased compared with pre-operative scores, except for the KOOS sport component (P=0.075) and quality of life (P=0.19). Intra-operatively, the average reading provided by the system with regard to varus/valgus alignment before performing the tibial resection was 0.55°±0.43. The average postoperative radiographic alignment of the tibial component in the coronal plane was 0.65°±0.59 of deviation by the ideal alignment (P>0.05). Conclusion This study demonstrates that the OrthAlign navigation system combines the accuracy of the computerassisted surgery systems with the ease of use and familiarity of the traditional instruments while avoiding the drawbacks of the CAS technique and disadvantages of conventional IM femoral alignment systems. The system could demonstrate an improvement in the incidence of outliers in final coronal alignment, as compared with a patient-specific cutting guide.
Journal of Bone and Joint Surgery-british Volume, 2013
Introduction From pre-operative planning to final implant cementation, total knee arthroplasty (TKA) can be defined by a succession of individual steps, each presenting potential errors that can result in devices being implanted outside the desired range of alignment. Our study used an image-free computer-assisted orthopedic surgery (CAOS) guidance system (Exactech GPS, Blue-Ortho, Grenoble, FR) to evaluate alignment discrepancies occurring during different steps of a typical TKA procedure. Materials and methods: A surgical profile was established to define resection parameters and steps for proximal tibial and distal femoral cuts (see Figure 1A) to be made on seven synthetic knee models (MITA, Medical Models, Bristol, UK). First, the guidance system was used to acquire pre-identified landmarks. Next, a cutting block was adjusted to match the resection targets and then fixed to the bone using locking pins. Bone cuts were performed and then checked. Data was collected from the guidan...
The Journal of Arthroplasty, 2013
total knee arthroplasty patient-specific instrumentation navigation accuracy This investigation evaluated the Smith and Nephew VISIONAIRE patient-specific cutting block (PSCB) system for total knee arthroplasty. A consecutive series of 60 patients was recruited. Intraoperative computer navigation was used to evaluate the accuracy of the cutting blocks in the coronal and sagittal planes for the tibia, as well as rotational plane for the femur. The PSCB would have placed 79.3% of the sample within ±3°of the preoperative plan in the coronal plane, while the rotational and sagittal alignment results within ±3°w ere 77.2% and 54.5% respectively. The VISIONAIRE PSCB system achieved unacceptable accuracy when assessed by computer navigation. There might be many sources of error, but caution is recommended before using this system routinely without objective verification of alignment.
Revista Brasileira de Ortopedia (English Edition), 2015
Objectives: To evaluate the results obtained through using an intramedullary or extramedullary guide for sectioning the tibia in total knee arthroplasty procedures, with a view to identifying the accuracy of these guides and whether one might be superior to the other. Methods: This was a randomized double-blind prospective study on 41 total knee arthroplasty procedures performed between August 2011 and March 2012. The angle between the base of the tibial component and the mechanical axis of the tibia was measured during the immediate postoperative period by means of radiography in anteroposterior view on the tibia that encompassed the knee and ankle. Results: There was no demographic difference between the two groups evaluated. The mean alignment of the tibial component in the patients of group A (intramedullary) was 90.3 • (range: 84-97 •). In group B (extramedullary), it was 88.5 • (range: 83-94 •). Conclusion: In our study, we did not find any difference regarding the precision or accuracy of either of the guides. Some patients present an absolute or relative contraindication against using one or other of the guides. However, for the other cases, neither of the guides was superior to the other one.
The accuracy of bony resection from patient-specific guides during total knee arthroplasty
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2016
In patient-specifically instrumented (PSI) total knee arthroplasty, the correlation between the pre-operative surgical plan, accuracy of the cutting block, and intra-operative resection size is unclear. The aim of this study was to evaluate the ability to accurately execute the PSI surgical plan and to add to the merging information with respect to this technology with the hypothesis that the PSI blocks would demonstrate good accuracy with regard to the bony thickness of the resections. One hundred and thirty TKAs using PSI (MRI/long-leg radiographs) were retrospectively analysed. All surgeries were conducted via similar surgical approach and technique, with resection performed after guide placement and alignment assessment. The bony cut thicknesses of the medial (MTP) and lateral tibial plateau (LTP), distal medial (DM), distal lateral (DL), posterior medial (PM) and posterior lateral (PL) femur were measured with a vernier calliper. The measured resection thickness was subtracted ...
Computerised and technical navigation in total knee-arthroplasty
Journal of Orthopaedics and Traumatology, 2005
The objective of the study was to evaluate the precision, concordance, practicability and the early clinical outcome of the use of a computerised navigation system in a comparative study with a group of 100 patients. Two groups of 50 patients each underwent implantation of a bicondylar knee prosthesis either by means of the freehand navigation system or by means of technical instrumentation. We found that the computerised navigation system provided a higher precision than the technically instrumented implantation: 94% of the prostheses implanted with the navigation system have an alignment within a range of -3° to 3° on of the Mikulicz line. Only 46% of the patients operated by means of the technical instrumentation reached this aspired result. Furthermore, the navigation system showed smaller ranges in the deviation of the aspired alignment. The radiological and computer-modeled alignment values differed both pre- and postoperatively, but to a larger extent before surgery. The varus or valgus deviations of the axis were more distinct radiologically under the weight of the patient’s body than in the computer model. The clinical outcome examined by the use of the HSS score after a mean followup of 7 months is good in both groups, and without significant differences. On average, the duration of surgery was 13 minutes longer in the computerised navigation group. We conclude that the benefit of the computerised navigation system is represented by the high improvement of precision. Achieving early clinical results identical to those in the technical instrumentation group, we expect a reduction of aseptic loosening in the computerised navigation group.
Improved tibial cutting accuracy in knee arthroplasty
Medical Engineering & Physics, 2004
Initial stability and development of long-term fixation for cementless tibial components at the knee both depend on the accuracy of fit between implanted components and prepared bone surfaces.
Advances in orthopedics, 2013
Customized patient instrumentation (CPI) combines preoperative planning with customized cutting jigs to position and align implants during total knee arthroplasty (TKA). We compared postoperative implant alignment of patients undergoing surgery with CPI to traditional TKA instrumentation for accuracy of implant placement. Twenty-five consecutive TKAs using CPI were analyzed. Preoperative CT scans of the lower extremities were segmented using a computer program. Limb alignment and mechanical axis were computed. Virtual implantation of computer-aided design models was done. Postoperative coronal and sagittal view radiographs were obtained. Using 3D image-matching software, relative positions of femoral and tibial implants were determined. Twenty-five TKAs implanted using traditional instrumentation were also analyzed. For CPI, difference in alignment from the preoperative plan was calculated. In the CPI group, the mean absolute difference between the planned and actual femoral placeme...
J Bone Joint Surg Am, 2011
BACKGROUND: Optimal alignment of the prosthesis in total knee arthroplasty results in improved patient outcomes. The goal of this study was to determine the most accurate technique for component alignment in total knee arthroplasty by comparing computer-assisted surgery with two conventional techniques involving use of an intramedullary guide for the femur and either an intramedullary or an extramedullary guide for the tibia. METHODS: One hundred and seven patients were randomized prior to surgery to one of three arms: computer-assisted surgery for both the femur and the tibia (the computer-assisted surgery group), intramedullary guides for both the femur and the tibia (the intramedullary guide group), and an intramedullary guide for the femur and an extramedullary guide for the tibia (the extramedullary guide group). Measurements of alignment on hip-to-ankle radiographs and computed tomography (CT) scans made three months after surgery were evaluated. The operative times and complications were compared among the three groups. RESULTS: The coronal tibiofemoral angle demonstrated, on average, less malalignment in the computer-assisted surgery group (1.91°) than in the extramedullary (3.22°) and intramedullary (2.59°) groups (p = 0.007). The coronal tibiofemoral angle was >3° of varus or valgus deviation in 19% (seven) of the thirty-six patients treated with computer-assisted surgery compared with 38% (thirteen) of the thirty-four in the extramedullary guide group and 36% (thirteen) of the thirty-six in the intramedullary guide group (p = 0.022). The increase in accuracy with computer-assisted surgery came at a cost of increased operative time. The operative time for the computer-assisted surgery group averaged 107 minutes compared with eighty-three and eighty minutes, respectively, for the surgery with the extramedullary and intramedullary guides (p < 0.0001). There was no significant difference in any of the outcomes between the intramedullary and extramedullary guide groups. CONCLUSIONS: This study provides evidence that the implant alignment with computer-assisted total knee arthroplasty, as measured with radiography and computed tomography, is significantly improved compared with that associated with conventional surgery with intramedullary or extramedullary guides. This finding adds to the body of evidence showing an improved radiographic outcome with computer-assisted surgery compared with that following conventional total knee arthroplasty.