Abstract
Patient-specific total knee arthroplasty (TKA) is a copy of the bony knee morphology based on a pre-op computer tomography (CT). The images are segmented in 3D and software is utilized through a proprietary process to generate individual total knee implants to recreate the articulating surfaces. The distal condylar valgus angle of the prosthesis is matched anatomically to the distal femur and reversely matched on the tibia with a thicker lateral insert. The implant, a set of patient-specific jigs (PSJ), which are 3D printed in nylon, and a detailed surgical plan are sent to the hospital in one box. The system is available with one solid or two separated medial and lateral PE inserts. There is a cruciate retaining (CR) and posterior stabilized (PS) version available, including various insert thicknesses. The system allows the addition of two different cemented stem extensions if needed at the time of surgery.
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Slamin JE, Bojarski RA, Parsley BS (2012) Optimizing knee femoral component strength and bone preservation with finite element analysis. In: Poster # 1042, ORS annual meeting, San Francisco
Kurtz WB, Slamin JE, Doody SW (2016) Bone preservation in a novel patient specific total knee replacement. Reconstr Rev. https://doi.org/10.15438/rr.6.1.133
Michaut M, Beaufils P, Galaud B, Abadie P, Boisrenoult P, Fallet L (2008) Rotational alignment of femoral component with computer-assisted surgery (CAS) during total knee arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 94(6):580–584. https://doi.org/10.1016/j.rco.2008.03.038
Victor J (2009) Rotational alignment of the distal femur: a literature review. Orthop Traumatol Surg Res 95(5):365–372. https://doi.org/10.1016/j.otsr.2009.04.011
Victor J, Van Doninck D, Labey L, Innocenti B, Parizel PM, Bellemans J (2009) How precise can bony landmarks be determined on a CT scan of the knee? Knee 16(5):358–365. https://doi.org/10.1016/j.knee.2009.01.001
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ (2007) National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Jt Surg Br 89(7):893–900. https://doi.org/10.1302/0301-620X.89B7.19091
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468(1):57–63. https://doi.org/10.1007/s11999-009-1119-9
Noble PC, Conditt MA, Cook KF, Mathis KB (2006) The John Insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43. https://doi.org/10.1097/01.blo.0000238825.63648.1e
Mahoney OM, Kinsey T (2010) Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Jt Surg Am 92(5):1115–1121. https://doi.org/10.2106/JBJS.H.00434
Vaidya SV, Ranawat CS, Aroojis A, Laud NS (2000) Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplast 15(1):79–85. https://doi.org/10.1016/s0883-5403(00)91285-3
Ranawat CS (1986) The patellofemoral joint in total condylar knee arthroplasty. Pros and cons based on five- to ten-year follow-up observations. Clin Orthop Relat Res 205:93–99
Meccia BA, Cates H, Anderle M, Hamel W, Sharma W, Komistek R (2015) In vivo kinematics for customized, individually made vs. traditional TKA during a chair rise and deep knee bend activity. In: ORS annual meeting, Poster 0237, Las Vegas March 24–28
Zeller IM, Kurtz WB, Ta MD, Dessinger GM, Sharma A, Komistek RD (2017) In-vivo kinematics for patients implanted with a customized, patient- specific posterior stabilized total knee arthroplasty vs. traditional patient sized off-the-shelf TKA during activities of daily living. In: Annual spring meeting, 28th & 29th March. British Association for Surgery of the Knee, London, p 16. Abstract no. 0105
Zeller I, Sharma A, Kurtz WB, Anderle MR, Komistek RD (2017) Customized versus patient-sized cruciate retaining total knee arthroplasty: an in vivo kinematics study using mobile fluoroscopy. J Arthroplast 32(4):1344–1350. https://doi.org/10.1016/j.arth.2016.09.034
Hutt JR, LeBlanc MA, Masse V, Lavigne M, Vendittoli PA (2016) Kinematic TKA using navigation: surgical technique and initial results. Orthop Traumatol Surg Res 102(1):99–104. https://doi.org/10.1016/j.otsr.2015.11.010
Schwechter EM, Fitz W (2012) Design rationale for customized TKA: a new idea or revisiting the past? Curr Rev Musculoskelet Med 5(4):303–308. https://doi.org/10.1007/s12178-012-9143-x
Levengood GA, Dupee J (2018) Accuracy of coronal plane mechanical alignment in a customized, individually made total knee replacement with patient-specific instrumentation. J Knee Surg 31(8):792–796. https://doi.org/10.1055/s-0037-1608946
Arbab D, Reimann P, Brucker M, Bouillon B, Lüring C (2018) Alignment in total knee arthroplasty—a comparison of patient-specific implants with the conventional technique. Knee 25(5):882–887. https://doi.org/10.1016/j.knee.2018.05.017
Rivière C, Harman C, Boughton O, Cobb J (2020) The kinematic alignment technique for total knee arthroplasty. In: Rivière C, Vendittoli P-A (eds) Personalized hip and knee joint replacement. Springer International Publishing, Cham, pp 175–195
Thienpont E, Parvizi J (2016) A new classification for the varus knee. J Arthroplast 31(10):2156–2160. https://doi.org/10.1016/j.arth.2016.03.034
Howell SM, Hull ML (2012) Kinematically aligned TKA with MRI-based cutting guides. In: Thienpont E (ed) Improving accuracy in knee arthroplasty. Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, pp 207–2132
Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG (2014) A randomised controlled trial of kinematically and mechanically aligned total knee re- placements: two-year clinical results. Bone Jt J 96-B:907–913. https://doi.org/10.1302/0301-620X.96B7.32812
Waterson HB, Clement ND, Eyres KS, Mandalia VI, Toms AD (2016) The early outcome of kinematic versus mechanical alignment in total knee arthroplasty: a prospective randomised control trial. Bone Jt J 98-B(10):1360–1368. https://doi.org/10.1302/0301-620X.98B10.36862
Meier M, Zingde S, Steinert A, Kurtz W, Koeck F, Beckmann J (2019) What is the possible impact of high variability of distal femoral geometry on TKA? A CT data analysis of 24,042 knees. Clin Orthop Relat Res 477(3):561–570. https://doi.org/10.1097/CORR.0000000000000611
Asseln M, Grothues SAGA, Radermacher K (2021) Relationship between the form and function of implant design in total knee replacement. J Biomech 119:110296. https://doi.org/10.1016/j.jbiomech.2921.110296
Cobb JP, Dixon H, Dandachli W, Iranpour F (2008) The anatomical tibial axis: reliable rotational orientation in knee replacement. J Bone Jt Surg Br 90(8):1032–1038. https://doi.org/10.1302/0301-620X.90B8.19905
Bédard M, Vince KG, Redfern J, Collen SR (2011) Internal rotation of the tibial component is frequent in stiff total knee arthroplasty. Clin Orthop Relat Res 469(8):2346–2355. https://doi.org/10.1007/s11999-011-1889-8
Nicoll D, Rowley DI (2010) Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Jt Surg Br 92(9):1238–1244. https://doi.org/10.1302/0301-620X.92B9.23516
Choong PF, Dowsey MM, Stoney JD (2009) Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplast 24:560–569. https://doi.org/10.1016/j.arth.2008.02.018
Fang DM, Ritter MA, Davis KE (2009) Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplast 24(6 Suppl):39–43. https://doi.org/10.1016/j.arth.2009.04.034
Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Jt Surg Br 73:709–714. https://doi.org/10.1302/0301-620X.73B5.1894655
Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156
Vandekerckhove PJ, Lanting B, Bellemans J, Victor J, MacDonald S (2016) The current role of coronal plane alignment in total knee arthroplasty in a preoperative varus aligned population: an evidence based review. Acta Orthop Belg 82:129–142
Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on fifteen-year survival of modern, cemented total knee replacement. J Bone Jt Surg Am 92(12):2143–2149. https://doi.org/10.2106/JBJS.I.01398
Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470(1):45–53. https://doi.org/10.1007/s11999-011-1936-5
MacDessi SJ, Griffiths-Jones W, Chen DB, Griffiths-Jones S, Wood JA, Diwan AD, Harris IA (2020) Restoring the constitutional alignment with a restrictive kinematic protocol improves quantitative soft-tissue balance in total knee arthroplasty: a randomized controlled trial. Bone Jt J 102-B(1):117–124. https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-0674.R2
Neginhal V, Kurtz W, Schroeder L (2020) Patient satisfaction, functional outcomes, and survivorship in patients with a customized posterior-stabilized total knee replacement. JBJS Rev 8(7):e1900104. https://doi.org/10.2106/JBJS.RVW.19.00104
Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57. https://doi.org/10.1097/00003086-199811000-00009
Luyckx L, Luyckx T, Bellemans J, Victor J (2010) Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA. Acta Orthop Belg 76(4):507–512
Mikulak SA, Mahoney OM, Dela Rosa MA, Schmalzried TP (2001) Loosening and osteolysis with the press-fit condylar posterior-cruciate-substituting total knee replacement. J Bone Jt Surg Am 83(3):398–403. https://doi.org/10.2106/00004623-200103000-00012
Culler SD, Martin GM, Swearingen A (2017) Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty. Arthroplast Today 3(4):257–263. https://doi.org/10.1016/j.artd.2017.05.001
O’Connor MI, Blau BE (2019) The economic value of customized versus off-the-shelf knee implants in medicare fee-for-service beneficiaries. Am Health Drug Benefits 12(2):66–73
Fernando N, Chancellor A, Manner P (2021) Custom-designed total knee arthroplasty is cost-effectiveness in comparison to a standard implant. In: ORS annual meeting, paper no. 0980
Namin AT, Jalali MS, Vahdat V, Bedair HS, O’Connor MI, Kamarthi S, Isaacs JA (2019) Adoption of new medical technologies: the case of customized individually made knee implants. Value Health 22(4):423–430. https://doi.org/10.1016/j.jval.2019.01.008
Vermue H, Tack P, Gryson T, Victor J (2021) Can robot-assisted total knee arthroplasty be a cost-effective procedure? A Markov decision analysis. Knee 29:345–352. https://doi.org/10.1016/j.knee.2021.02.004
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Elyse J. Brinkmann: no conflict of interest; Wolfgang Fitz: received stocks, stock options and royalties for intellectual property, paid consultant.
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Brinkmann, E.J., Fitz, W. Custom total knee: understanding the indication and process. Arch Orthop Trauma Surg 141, 2205–2216 (2021). https://doi.org/10.1007/s00402-021-04172-9
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DOI: https://doi.org/10.1007/s00402-021-04172-9