Elsevier

The Journal of Arthroplasty

Volume 29, Issue 2, February 2014, Pages 343-347
The Journal of Arthroplasty

In-Vivo Alignment Comparing Patient Specific Instrumentation with both Conventional and Computer Assisted Surgery (CAS) Instrumentation in Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2013.06.029Get rights and content

Abstract

Patient specific instrumentation (PSI) was developed to increase total knee arthroplasty (TKA) accuracy and efficiency. The study purpose was to compare immediate post-operative mechanical alignment, achieved using PSI, with conventional and computer assisted surgery (CAS) instruments in high volume TKA practices. This prospective, multicenter, non-randomized study accrued 66 TKA patients using PSI. A computed tomography (CT) based algorithm was used to develop the surgical plan. Sixty-two percent were females, 99% were diagnosed with osteoarthritis, average age at surgery was 66 years, and 33 was the average body mass index. A historical control group was utilized that underwent TKA using conventional instruments (n = 86) or CAS (n = 81), by the same set of surgeons. Postoperative mechanical alignment was comparable across the groups. Operative time mean and variance were significant.

Section snippets

Materials and Methods

Between October 2009 and December 2010, 78 primary TKA subjects were prospectively enrolled using TruMatch Personalized Solutions (DePuy Synthes, Warsaw, IN). TruMatch Personalized Solutions (TM) consists of disposable, customized patient specific instrumentation (PSI). TM utilizes a full length CT scan, which measures mechanical alignment, bone deficiencies and bone morphology. A Web-based case submission is performed, followed by digital surgical planning. The surgeon may adjust the design

Results

The TM group was demonstrated to be non-inferior to the conventional group for the primary endpoint of absolute value of mechanical axis alignment with a non-inferiority P value < 0.001. The ANCOVA retained one significant covariate: patient weight (P = 0.002). Least squares means adjusted for this significant covariate provided absolute mechanical alignment values of 2.15° for TM and 2.14° for conventional. Morbidly obese TM patients had a large absolute mechanical axis alignment (mean = 5.33, SD = 

Discussion

The literature contains few reports on the use of patient specific instrumentation in total knee arthroplasty. Hozack et al reported on 4 patients who underwent the use of patient specific instrumentation [16]. That report was quite negative with regard to the use of a particular type of patient specific instrumentation for total knee arthroplasty.

Lombardi et al presented results on 54 TKAs done with patient specific instrumentation created using magnetic resonance imaging. Radiographic

References (18)

There are more references available in the full text version of this article.

Cited by (58)

  • Population-based effect of total knee arthroplasty alignment on simulated tibial bone remodeling

    2020, Journal of the Mechanical Behavior of Biomedical Materials
  • Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides

    2020, Academic Radiology
    Citation Excerpt :

    In conclusion, the potential cost-savings for using 3D printed models and surgical guides for patients’ operative care can be substantial. The present study used previously published data (9,15–44) to illustrate the potential value 3D printing can offer in terms of reducing the number of operating room minutes, using studies published with maxillofacial and orthopedic focuses. Studies to validate these analyses using single- and multiple institutional data are needed given the heterogeneity of sources used for analysis.

  • Ambient intelligence for health environments

    2016, Journal of Biomedical Informatics
View all citing articles on Scopus

The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.06.029.

View full text