J Knee Surg 2017; 30(08): 822-828
DOI: 10.1055/s-0036-1597980
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Study of 3D Imaging and 3D Printing Technique for Patient-Specific Instrumentation in Total Knee Arthroplasty

Bing Qiu
1   Department of Joint, Guizhou Orthopedic Hospital, Guiyang, China
,
Fei Liu
2   Department of R and D, Arigin Medical Co., Ltd., Shanghai, China
,
Bensen Tang
1   Department of Joint, Guizhou Orthopedic Hospital, Guiyang, China
,
Biyong Deng
1   Department of Joint, Guizhou Orthopedic Hospital, Guiyang, China
,
Fang Liu
1   Department of Joint, Guizhou Orthopedic Hospital, Guiyang, China
,
Weimin Zhu
1   Department of Joint, Guizhou Orthopedic Hospital, Guiyang, China
,
Dong Zhen
1   Department of Joint, Guizhou Orthopedic Hospital, Guiyang, China
,
Mingyuan Xue
2   Department of R and D, Arigin Medical Co., Ltd., Shanghai, China
,
Mingjiao Zhang
2   Department of R and D, Arigin Medical Co., Ltd., Shanghai, China
› Author Affiliations
Further Information

Publication History

25 May 2016

06 December 2016

Publication Date:
25 January 2017 (online)

Abstract

Patient-specific instrumentation (PSI) was designed to improve the accuracy of preoperative planning and postoperative prosthesis positioning in total knee arthroplasty (TKA). However, better understanding needs to be achieved due to the subtle nature of the PSI systems. In this study, 3D printing technique based on the image data of computed tomography (CT) has been utilized for optimal controlling of the surgical parameters. Two groups of TKA cases have been randomly selected as PSI group and control group with no significant difference of age and sex (p > 0.05). The PSI group is treated with 3D printed cutting guides whereas the control group is treated with conventional instrumentation (CI). By evaluating the proximal osteotomy amount, distal osteotomy amount, valgus angle, external rotation angle, and tibial posterior slope angle of patients, it can be found that the preoperative quantitative assessment and intraoperative changes can be controlled with PSI whereas CI is relied on experience. In terms of postoperative parameters, such as hip-knee-ankle (HKA), frontal femoral component (FFC), frontal tibial component (FTC), and lateral tibial component (LTC) angles, there is a significant improvement in achieving the desired implant position (p < 0.05). Assigned from the morphology of patients' knees, the PSI represents the convergence of congruent designs with current personalized treatment tools. The PSI can achieve less extremity alignment and greater accuracy of prosthesis implantation compared against control method, which indicates potential for optimal HKA, FFC, and FTC angles.

 
  • References

  • 1 Cavaignac E, Pailhé R, Laumond G. , et al. Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty: a meta-analysis. Int Orthop 2015; 39 (08) 1541-1552
  • 2 Mannan A, Smith TO. Favourable rotational alignment outcomes in PSI knee arthroplasty: a level 1 systematic review and meta-analysis. Knee 2016; 23 (02) 186-190
  • 3 Hansen DC, Kusuma SK, Palmer RM, Harris KB. Robotic guidance does not improve component position or short-term outcome in medial unicompartmental knee arthroplasty. J Arthroplasty 2014; 29 (09) 1784-1789
  • 4 Jiang J, Kang X, Lin Q. , et al. Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics 2015; 38 (04) e305-e313
  • 5 Banerjee S, Cherian JJ, Elmallah RK, Jauregui JJ, Pierce TP, Mont MA. Robotic-assisted knee arthroplasty. Expert Rev Med Devices 2015; 12 (06) 727-735
  • 6 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
  • 7 Roche M. Robotic-assisted unicompartmental knee arthroplasty: the MAKO experience. Clin Sports Med 2014; 33 (01) 123-132
  • 8 Liow MH, Chin PL, Tay KJ, Chia SL, Lo NN, Yeo SJ. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch™ ROBODOC® surgical system. Singapore Med J 2014; 55 (10) 529-534
  • 9 Calliess T, Ettinger M, Windhagen H. [Computer-assisted systems in total knee arthroplasty. Useful aid or only additional costs] [in German]. Orthopade 2014; 43 (06) 529-533
  • 10 Watters TS, Mather III RC, Browne JA, Berend KR, Lombardi Jr AV, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv 2011; 20 (02) 112-116
  • 11 Xiao J, Wang C, Zhu L. , et al. Improved method for planning intramedullary guiding rod entry point in total knee arthroplasty. Arch Orthop Trauma Surg 2014; 134 (05) 693-698
  • 12 Lonner JH. Robotically assisted unicompartmental knee arthroplasty with a handheld image-free sculpting tool. Orthop Clin North Am 2016; 47 (01) 29-40
  • 13 Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplasty 2016; 31 (10) 2353-2363
  • 14 Shang P, Zhang L, Hou Z. , et al. Morphometric measurement of the patella on 3D model reconstructed from CT scan images for the southern Chinese population. Chin Med J (Engl) 2014; 127 (01) 96-101
  • 15 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
  • 16 Novak EJ, Silverstein MD, Bozic KJ. The cost-effectiveness of computer-assisted navigation in total knee arthroplasty. J Bone Joint Surg Am 2007; 89 (11) 2389-2397
  • 17 Kornilov N, Kulyaba T, Petukhov A, Ignatenko V, Thienpont E. Computer navigation helps achieving appropriate gap balancing and restoration of alignment in total knee arthroplasty for fixed valgus knee osteoarthritis irrespective of the surgical approach. Acta Orthop Belg 2015; 81 (04) 673-681
  • 18 Conteduca F, Iorio R, Mazza D, Ferretti A. Patient-specific instruments in total knee arthroplasty. Int Orthop 2014; 38 (02) 259-265
  • 19 Fu H, Wang J, Zhou S. , et al. No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3288-3295
  • 20 Teeny SM, Krackow KA, Hungerford DS, Jones M. Primary total knee arthroplasty in patients with severe varus deformity. A comparative study. Clin Orthop Relat Res 1991; (273) 19-31
  • 21 Leone WA, Elson LC, Anderson CR. A systematic literature review of three modalities in technologically assisted TKA. Adv Orthop 2015; 2015: 719091
  • 22 Camarda L, D'Arienzo A, Morello S, Peri G, Valentino B, D'Arienzo M. Patient-specific instrumentation for total knee arthroplasty: a literature review. Musculoskelet Surg 2015; 99 (01) 11-18
  • 23 Hsu AR, Kim JD, Bhatia S, Levine BR. Effect of training level on accuracy of digital templating in primary total hip and knee arthroplasty. Orthopedics 2012; 35 (02) e179-e183
  • 24 Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2016; DOI: 10.1007/s00167-016-4136-8.
  • 25 Jauregui JJ, Cherian JJ, Kapadia BH. , et al. Patient-specific instrumentation in total knee arthroplasty. J Knee Surg 2014; 27 (03) 177-183
  • 26 Chua KHZ, Chen Y, Lingaraj K. Navigated total knee arthroplasty: is it error-free?. Knee Surg Sports Traumatol Arthrosc 2014; 22 (03) 643-649
  • 27 Kniesel B, Konstantinidis L, Hirschmüller A, Südkamp N, Helwig P. Digital templating in total knee and hip replacement: an analysis of planning accuracy. Int Orthop 2014; 38 (04) 733-739
  • 28 Sassoon A, Nam D, Nunley R, Barrack R. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res 2015; 473 (01) 151-158
  • 29 Yan CH, Chiu KY, Ng FY, Chan PK, Fang CX. Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3637-3645
  • 30 Zhu M, Chen JY, Chong HC. , et al. Outcomes following total knee arthroplasty with CT-based patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 2015; DOI: 10.1007/s00167-015-3803-5.
  • 31 Lachiewicz PF, Henderson RA. Patient-specific instruments for total knee arthroplasty. J Am Acad Orthop Surg 2013; 21 (09) 513-518
  • 32 Hamilton WG, Parks NL, Saxena A. Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty 2013; 28 (8, Suppl): 96-100
  • 33 Barrack RL, Ruh EL, Williams BM, Ford AD, Foreman K, Nunley RM. Patient specific cutting blocks are currently of no proven value. J Bone Joint Surg Br 2012; 94 (11, Suppl A): 95-99
  • 34 Mattei L, Pellegrino P, Calò M, Bistolfi A, Castoldi F. Patient specific instrumentation in total knee arthroplasty: a state of the art. Ann Transl Med 2016; 4 (07) 126
  • 35 Noble Jr JW, Moore CA, Liu N. The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 2012; 27 (01) 153-155
  • 36 Molicnik A, Naranda J, Dolinar D. Patient-matched instruments versus standard instrumentation in total knee arthroplasty: a prospective randomized study. Wien Klin Wochenschr 2015; 127 (Suppl. 05) S235-S240
  • 37 Renson L, Poilvache P, Van den Wyngaert H. Improved alignment and operating room efficiency with patient-specific instrumentation for TKA. Knee 2014; 21 (06) 1216-1220
  • 38 Venkatesan M, Mahadevan D, Ashford RU. Computer-assisted navigation in knee arthroplasty: a critical appraisal. J Knee Surg 2013; 26 (05) 357-361