Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthrop
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ORIGINAL PAPER
Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial Song Ke 1
&
Tianfei Ran 1 & Yongqin He 1 & Mingrui Lv 1 & Xin Song 1 & Yuanyuan Zhou 1 & Yuan Xu 1 & Min Wang 1
Received: 6 March 2020 / Accepted: 2 July 2020 # SICOT aisbl 2020
Abstract Purpose Patient-specific instrumentation (PSI) was usually applied in total knee arthroplasty (TKA) to acquire a favourable alignment. We hypothesized that using PSI had a potential risk of notching in the anterior femoral cortex, because the femoral component may be placed in an overextension position due to the distal femoral sagittal anteversion. The aim of this study was to figure out the relationship between the notch and the distal femoral sagittal anteversion in PSI-assisted TKA. Methods One hundred thirty-one patients who were to undergo total knee arthroplasty (TKA) were randomly divided into conventional instrumentation (CI) group and PSI group. The computed tomography (CT) data of lower extremities was collected and imported to the Mimics software to reconstruct the three-dimensional (3D) bone image of the femur. The angle between distal femoral anatomic axis (DFAA) and femoral mechanical axis (FMA) on sagittal plane was defined as distal femoral sagittal anteverted angle (DFSAA) and measured. The number of notch intra-operative and post-operative was recorded. Then, we calculated the incidence of the notch and analyzed its relationship with DFSAA. Results The average DFSAA of 262 femurs is 2.5° ± 1.5° (range, 0.0°–5.7°). When DFSAA ≥ 3°, the incidence of notch was 7.10% in CI group and 33.30% in PSI group, respectively, which shows significant statistical difference in the two groups (P = 0.016 < 0.05). When DFSAA < 3°, the incidence of notch was 6.50% in CI group and 5.30% in PSI group, respectively, which shows no significant statistical difference in the two groups (P = 0.667 > 0.05). Conclusion DFSAA could be taken as an indicator to predict the notch when performing TKA assisted with PSI. Especially when the DFSAA ≥ 3°, the risk of notch could be markedly increased. Keywords Total knee arthroplasty . Patient-specific instrumentation . Anterior femoral cortex notch . Sagittal femoral bowing
Song Ke and Tianfei Ran contributed equally to this work. Level of evidence III, clinically case-controlled study * Min Wang [email protected]
Xin Song [email protected]
Song Ke [email protected]
Yuanyuan Zhou [email protected]
Tianfei Ran [email protected] Yongqin He [email protected] Mingrui Lv [email protected]
Yuan Xu [email protected] 1
Department of Orthopaedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing 400037 China
International Orthopaedics (SICOT)
Introduction Total knee arthroplasty (TKA) is a widely used and important surgical option in the treatment of end-stage knee osteoarthritis (KOA) or other serious knee diseases. TKA can correct deformity and relieve pain by restoring li
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