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Revision of partial knee to total knee arthroplasty with use of patient-specific instruments results in acceptable femoral rotation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patient-specific instruments (PSI) were initially developed for the alignment of both total knee- (TKA) and partial knee arthroplasty (PKA). We hypothesize that CT-based PSI for PKA-to-TKA revision surgery can restore biomechanical limb alignment and prosthetic component positioning in vivo as calculated pre-operatively, resulting in a limited percentages of outliers.

Methods

An imaging analysis was performed using CT-based 3D measurement methods based on a pre- and post-revision CT scan. Imaging data were gathered on 10 patients who were operated for PKA-to-TKA revision with the use of PSI based on CT imaging. The planned femur and tibia component position in vivo were compared with the pre-revision planned component position. Outliers were defined as deviations >3.0° from pre-revision planned position for the individual implant components. Adjustments (e.g. resection level and implant size) during surgery were recorded.

Results

The HKA axis was restored accurately in all patients with a mean post-operative HKA axis of 178.1° (1.4°). Five femoral (2 varus, 2 internal rotation and 1 extension) and 14 tibial guides (2 varus, 6 anterior slope, 3 internal rotation and 3 external rotation) on a total of 60 outcome measures were identified as outliers. During surgery, an intraoperative tibial resection of 2 mm extra was performed in three patients. In 80 and 70% for, respectively, the femur and tibia, the surgeon-planned size was implanted during surgery. All patient-specific guides fitted well in all patients. No intraoperative or post-operative complications related to surgery were registered.

Conclusions

This study introduced a unique new concept regarding PSI, PKA-to-TKA revision surgery. Based on the results, we were unable to fully confirm our hypothesis. PSI as a “new” tool for PKA-to-TKA revision surgery appears to be an accurate tool for the alignment of the TKA femur component. The tibial guide seems more susceptible to errors, resulting in a substantial percentage of outliers.

Level of evidence

Prospective cohort study, Level II.

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Acknowledgements

The authors would like to thank Mr. K. Chellaoui for his expertise and work on measuring the radiographic alignments with the use of shape-match technology.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology Zuyderland Medical Center, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands

    Martijn G. M. Schotanus, Elke Thijs, B. Boonen & Nanne P. Kort

  2. AZ St Maarten, Mechelen, Belgium

    B. Kerens

  3. Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands

    B. Jong

Authors
  1. Martijn G. M. Schotanus
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  2. Elke Thijs
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  3. B. Boonen
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  4. B. Kerens
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  5. B. Jong
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  6. Nanne P. Kort
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Contributions

MGMS: Designed the study, gathered and analyzed all the data, wrote the initial draft of the manuscript and managed the study; ET: Analyzed the data, wrote and revised the manuscript; BB: Ensured the accuracy of the data, revised the manuscript; BK, BJ: Designed the study, ensured the accuracy of the data and revised the manuscript; NPK: Conceived the study and revised the manuscript.

Corresponding author

Correspondence to Martijn G. M. Schotanus.

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Conflict of interest

One author (NK) is a paid consultant for Zimmer Biomet, Europe. The other authors certify that they have no commercial associations (e.g. consultancies, stock ownership, equity interest and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted manuscript.

Funding

No funding was received for this study.

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For this type of study formal consent is not required.

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For this type of study informed consent is not required.

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Schotanus, M.G.M., Thijs, E., Boonen, B. et al. Revision of partial knee to total knee arthroplasty with use of patient-specific instruments results in acceptable femoral rotation. Knee Surg Sports Traumatol Arthrosc 26, 1656–1661 (2018). https://doi.org/10.1007/s00167-017-4674-8

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  • DOI: https://doi.org/10.1007/s00167-017-4674-8

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