Dataset Information

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study.

ABSTRACT:

Background

Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery.

Questions/purposes

The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV).

Methods

After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests.

Results

Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1° of neutral for both groups, although statistically different (p?=?0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) (p?=?0.004); PSI resulted in significantly more outliers (>6°; p?=?0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p?=?0.023).

Conclusion

NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patient-reported outcomes and TKA survivorship is controversial and should be the focus of future research.

SUBMITTER: Steinhaus ME

PROVIDER: S-EPMC5026651 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Publications

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study.

Steinhaus Michael E ME McLawhorn Alexander S AS Richardson Shawn S SS Maher Patrick P Mayman David J DJ

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20160229 3

<h4>Background</h4>Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery.<h4>Questions/purposes</h4>The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV).<h4>Methods</h4>After IRB approval, 49 consecutive PSI TKAs (40 ...[more]

PMID: 27703415

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Project description:BackgroundThe coronal plane alignment of the knee (CPAK) classification was first developed using long leg radiographs (LLR) and has since been reported using image-based and imageless robotic total knee arthroplasty (TKA) systems. However, the correspondence between imageless robotics and LLR-derived CPAK parameters has yet to be investigated. This study therefore examined the differences in CPAK parameters determined with LLR and imageless robotic navigation using either generic or optimized cartilage wear assumptions.MethodsMedial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were determined from the intraoperative registration data of 61 imageless robotic TKAs using either a generic 2 mm literature-based wear assumption (Navlit) or an optimized wear assumption (Navopt) found using an error minimization algorithm. MPTA and LDFA were also measured from preoperative LLR by two observers and intraclass correlation coefficients (ICCs) were calculated. MPTA, LDFA, joint line obliquity (JLO), and arithmetic hip-knee-ankle angle (aHKA) were compared between the robotic and the average LLR measurements over the two observers.ResultsICCs between observers for LLR were over 0.95 for MPTA, LDFA, JLO, and aHKA, indicating excellent agreement. Mean CPAK differences were not significant between LLR and Navlit (all differences within 0.6°, P > 0.1) or Navopt (all within 0.1°, P > 0.83). Mean absolute errors (MAE) between LLR and Navlit were: LDFA = 1.4°, MPTA = 2.0°, JLO = 2.1°, and aHKA = 2.7°. Compared to LLR, the generic wear classified 88% and the optimized wear classified 94% of knees within one CPAK group. Bland-Altman comparisons reported good agreement for LLR vs. Navlit and Navopt, with > 95% and > 91.8% of measurements within the limits of agreement across all CPAK parameters, respectively.ConclusionsImageless robotic navigation data can be used to calculate CPAK parameters for arthritic knees undergoing TKA with good agreement to LLR. Generic wear assumptions determined MPTA and LDFA with MAE within 2° and optimizing wear assumptions showed negligible improvement.

Project description:PurposeTo describe a strategy for coronal alignment using a computed tomography (CT) based custom total knee arthroplasty (TKA) system, and to evaluate the agreement between the planned and postoperative Hip-Knee-Ankle (HKA) angle, Femoral Mechanical Angle (FMA) and Tibial Mechanical Angle (TMA).MethodsFrom a consecutive series of 918 primary TKAs, 266 (29%) knees received CT-based posterior-stabilized cemented custom TKA. In addition to a preoperative CT-scan, pre- and post-operative radiographs of weight-bearing long leg, anterior-posterior and lateral views of the knee were obtained, on which the FMA, TMA and HKA angles were measured. CT-based three-dimensional (3D) models enabled to correct for cases with bony wear by referring to the non-worn areas and to estimate the native pre-arthritic angles. The alignment technique aimed to preserve or restore constitutional alignment (CA) within predetermined limits, by defining a 'target zone' based on three criteria: 1) a ± 3° (range 87°-93°) primary tolerance for the femoral and tibial resections; 2) a ± 2° secondary tolerance for component obliquity, extending the bounds for FMA and TMA (range 85°-95°); 3) a planned HKA angle range of 175°-183°. Agreement between preoperative, planned and postoperative measurements of FMA, TMA and HKA angle were calculated using intra-class correlation coefficients (ICC).ResultsPreoperative radiograph and CT-scan measurements revealed that, respectively, 73 (28%) and 103 (40%) knees were in the 'target zone', whereas postoperative radiographs revealed that 217 (84%) TKAs were in the 'target zone'. Deviation from the planned angles were - 0.5° ± 1.8° for FMA, - 0.5° ± 1.8° for TMA, and - 1.1° ± 2.1° for HKA angle. Finally, the agreement between the planned and achieved targets, indicated by ICC, were good for FMA (0.701), fair for TMA (0.462) and fair for HKA angle (0.472).ConclusionUsing this strategy for coronal alignment, 84% of custom TKAs were within the 'target zone' for FMA, TMA and HKA angles. These findings support the concepts of emerging personalized medicine technologies, and emphasise the importance of accurate strategies for preoperative planning, which are key to achieving satisfactory 'personalised alignment' that can further be improved by customisation of implant components.Level of evidenceIV.

Dataset Information

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study.

Background

Questions/purposes

Methods

Results

Conclusion

Publications

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study.

Similar Datasets

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