Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?
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- 1 March 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 470 (3), 895-902
- https://doi.org/10.1007/s11999-011-2222-2
Abstract
Coronal alignment may impact clinical outcome and survivorship in TKA. Patient-specific instrumentation has been developed to restore mechanical or kinematic axis and potentially reduce component malpositioning. Although it is clear these instruments add cost, it is unclear whether they improve alignment. We determined whether the mean coronal alignment after TKA performed with conventional versus patient-specific instrumentation better restored the mechanical and kinematic axes and whether there were more outliers with one of the two methods. We retrospectively evaluated 150 primary TKAs performed for osteoarthritis: Group 1 (n = 50) conventional instrumentation; Group 2 (n = 50) patient-specific instrumentation restoring the mechanical axis; Group 3 (n = 50) patient-specific instrumentation restoring the kinematic axis, and measured femorotibial angle, hip-knee-ankle angle, and the zone of the mechanical axis from scout CT images taken 0 to 6 weeks postoperatively. The mean femorotibial angle differed between the groups: Group 1 had the greatest varus mean alignment and most varus outliers. The mean hip-knee angle was similar between Groups 1 and 2, with Group 3 having greater valgus mean alignment and the most valgus outliers. For the zone of the mechanical axis, Groups 1 and 2 had similar percentages of outliers (40% versus 32%), whereas Group 3 had a greater number of outliers (64%) that were valgus. TKAs with patient-specific instrumentation restoring the mechanical axis had a similar number of outliers as conventional instrumentation with both groups having more varus outliers than TKAs with patient-specific instrumentation restoring kinematic axis, which had more valgus outliers. Therefore, additional studies are needed to determine whether patient-specific instrumentation improves clinical function or patient satisfaction and whether their routine use can be justified in primary TKA. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Keywords
This publication has 47 references indexed in Scilit:
- Editorial: What is Varus or Valgus Knee Alignment?Clinical Orthopaedics and Related Research, 2010
- Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studiesInternational Orthopaedics, 2010
- Patient Satisfaction after Total Knee Arthroplasty: Who is Satisfied and Who is Not?Clinical Orthopaedics and Related Research, 2010
- Is there an injury epidemic in girls' sports?British Journal of Sports Medicine, 2009
- Sex Differences in “Weightlifting” Injuries Presenting to United States Emergency RoomsJournal of Strength & Conditioning Research, 2009
- Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignmentInternational Orthopaedics, 2008
- Assessment and validation of CT scanogram to compare per-operative and post-operative mechanical axis after navigated total knee replacementInternational Orthopaedics, 2008
- AN ABJS BEST PAPERClinical Orthopaedics and Related Research, 2007
- The Impact of Major Trauma: Quality-of-Life Outcomes Are Worse in Women than in Men, Independent of Mechanism and Injury SeverityThe Journal of Trauma and Acute Care Surgery, 2004
- Estrogen receptor α gene haplotype is associated with radiographic osteoarthritis of the knee in elderly men and womenArthritis & Rheumatism, 2003