Top

International Orthopaedics

Published in:

01-12-2020 | Original Paper

Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial

Authors: Song Ke, Tianfei Ran, Yongqin He, Mingrui Lv, Xin Song, Yuanyuan Zhou, Yuan Xu, Min Wang

Published in: International Orthopaedics | Issue 12/2020

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.

Kim SJ, Bamne A, Song YD, Kang YG, Kim TK (2015) Patients still wish for key improvements after total knee arthroplasty. Knee Surg Relat Res 27(1):24–33. https://doi.org/10.5792/ksrr.2015.27.1.24CrossRefPubMedPubMedCentral

Choi YJ, Ra HJ (2016) Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 28(1):1–15. https://doi.org/10.5792/ksrr.2016.28.1.1CrossRefPubMedPubMedCentral

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(4):560–569. https://doi.org/10.1016/j.arth.2008.02.018CrossRef

Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clinical orthopaedics and related research (404):7-13. doi:https://doi.org/10.1097/00003086-200211000-00003

Abdel MP, Ollivier M, Parratte S, Trousdale RT, Berry DJ, Pagnano MW (2018) Effect of postoperative mechanical axis alignment on survival and functional outcomes of modern total knee arthroplasties with cement: a concise follow-up at 20 years. J Bone Joint Surg Am 100(6):472–478. https://doi.org/10.2106/jbjs.16.01587CrossRefPubMed

MacDessi SJ, Jang B, Harris IA, Wheatley E, Bryant C, Chen DB (2014) A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty. Knee 21(2):406–409. https://doi.org/10.1016/j.knee.2013.11.004CrossRefPubMed

Li Y, Tian H, Geng X (2018) Effect of the surgical time and coronalmechanical alignment after total knee arthroplasty using computer navigation system, traditionalor 3D printing patient-specific instruments. Zhonghua Yi Xue Za Zhi 98(27):2157–2161. https://doi.org/10.3760/cma.j.issn.0376-2491.2018.27.006CrossRefPubMed

Manzotti A, Cerveri P, De Momi E, Pullen C, Confalonieri N (2010) Relationship between cutting errors and learning curve in computer-assisted total knee replacement. Int Orthop 34(5):655–662. https://doi.org/10.1007/s00264-009-0816-zCrossRefPubMed

Cheng T, Zhang G, Zhang X (2011) Clinical and radiographic outcomes of image-based computer-assisted total knee arthroplasty: an evidence-based evaluation. Surg Innov 18(1):15–20. https://doi.org/10.1177/1553350610382012CrossRefPubMed

10.

Lee WT, Chin PL, Lo NN, Yeo SJ (2015) Short-term outcome after computer-assisted versus conventional total knee arthroplasty: a randomised controlled trial. Journal of orthopaedic surgery (Hong Kong) 23(1):71–75. https://doi.org/10.1177/230949901502300117CrossRef

11.

Jung KA, Lee SC, Ahn NK, Song MB, Nam CH, Shon OJ (2011) Delayed femoral fracture through a tracker pin site after navigated total knee arthroplasty. J Arthroplasty 26 (3):505.e509-505.e511. doi:https://doi.org/10.1016/j.arth.2010.01.006

12.

Hoke D, Jafari SM, Orozco F, Ong A (2011) Tibial shaft stress fractures resulting from placement of navigation tracker pins. J Arthroplasty 26 (3):504.e505-508. doi:https://doi.org/10.1016/j.arth.2010.05.009

13.

Camarda L, D’Arienzo A, Morello S, Peri G, Valentino B, D'Arienzo M (2015) Patient-specific instrumentation for total knee arthroplasty: a literature review. Musculoskelet Surg 99(1):11–18. https://doi.org/10.1007/s12306-014-0339-7CrossRefPubMed

14.

Kwon OR, Kang KT, Son J, Suh DS, Heo DB, Koh YG (2017) Patient-specific instrumentation development in TKA: 1st and 2nd generation designs in comparison with conventional instrumentation. Arch Orthop Trauma Surg 137(1):111–118. https://doi.org/10.1007/s00402-016-2618-2CrossRefPubMed

15.

Chotanaphuti T, Wangwittayakul V, Khuangsirikul S, Foojareonyos T (2014) The accuracy of component alignment in custom cutting blocks compared with conventional total knee arthroplasty instrumentation: prospective control trial. Knee 21(1):185–188. https://doi.org/10.1016/j.knee.2013.08.003CrossRefPubMed

16.

Hamid KS, Matson AP, Nwachukwu BU, Scott DJ, Mather RC 3rd, DeOrio JK (2017) Determining the cost-savings threshold and alignment accuracy of patient-specific instrumentation in total ankle replacements. Foot & ankle international 38(1):49–57. https://doi.org/10.1177/1071100716667505CrossRef

17.

Maus U, Marques CJ, Scheunemann D, Lampe F, Lazovic D, Hommel H, Vogel D, Haunschild M, Pfitzner T (2018) No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 26(9):2788–2796. https://doi.org/10.1007/s00167-017-4741-1CrossRef

18.

Mannan A, Smith TO (2016) Favourable rotational alignment outcomes in PSI knee arthroplasty: a level 1 systematic review and meta-analysis. Knee 23(2):186–190. https://doi.org/10.1016/j.knee.2015.08.006CrossRefPubMed

19.

Yehyawi TM, Callaghan JJ, Pedersen DR, O’Rourke MR, Liu SS (2007) Variances in sagittal femoral shaft bowing in patients undergoing TKA. Clin Orthop Relat Res 464:99–104. https://doi.org/10.1097/BLO.0b013e318157e4a2CrossRefPubMed

20.

Lee JH, Wang SI (2015) Risk of anterior femoral notching in navigated total knee arthroplasty. Clinics in orthopedic surgery 7(2):217–224. https://doi.org/10.4055/cios.2015.7.2.217CrossRefPubMedPubMedCentral

21.

Lesh ML, Schneider DJ, Deol G, Davis B, Jacobs CR, Pellegrini VD Jr (2000) The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am 82(8):1096–1101. https://doi.org/10.2106/00004623-200008000-00005CrossRefPubMed

22.

Ko JH, Han CD, Shin KH, Nguku L, Yang IH, Lee WS, Kim KI, Park KK (2016) Femur bowing could be a risk factor for implant flexion in conventional total knee arthroplasty and notching in navigated total knee arthroplasty. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 24(8):2476–2482. https://doi.org/10.1007/s00167-015-3863-6CrossRef

23.

Gujarathi N, Putti AB, Abboud RJ, MacLean JG, Espley AJ, Kellett CF (2009) Risk of periprosthetic fracture after anterior femoral notching. Acta Orthop 80(5):553–556. https://doi.org/10.3109/17453670903350099CrossRefPubMedPubMedCentral

24.

Singh JA, Jensen M, Lewallen D (2013) Predictors of periprosthetic fracture after total knee replacement: an analysis of 21,723 cases. Acta Orthop 84(2):170–177. https://doi.org/10.3109/17453674.2013.788436CrossRefPubMedPubMedCentral

25.

Mullaji AB, Marawar SV, Mittal V (2009) A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplast 24(6):861–867. https://doi.org/10.1016/j.arth.2008.05.025CrossRef

26.

Yau WP, Chiu KY, Tang WM, Ng TP (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. Journal of orthopaedic surgery (Hong Kong) 15(1):32–36. https://doi.org/10.1177/230949900701500108CrossRef

27.

Minoda Y, Kobayashi A, Iwaki H, Mitsuhiko I, Kadoya Y, Ohashi H, Takaoka K, Nakamura H (2010) The risk of notching the anterior femoral cortex with the use of navigation systems in total knee arthroplasty. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 18(6):718–722. https://doi.org/10.1007/s00167-009-0927-5CrossRef

28.

Minoda Y, Watanabe K, Iwaki H, Takahashi S, Fukui M, Nakamura H (2013) Theoretical risk of anterior femoral cortex notching in total knee arthroplasty using a navigation system. J Arthroplast 28(9):1533–1537. https://doi.org/10.1016/j.arth.2013.02.015CrossRef

29.

Zalzal P, Backstein D, Gross AE, Papini M (2006) Notching of the anterior femoral cortex during total knee arthroplasty characteristics that increase local stresses. J Arthroplast 21(5):737–743. https://doi.org/10.1016/j.arth.2005.08.020CrossRef

30.

Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP (2013) Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 21(10):2206–2212. https://doi.org/10.1007/s00167-013-2620-yCrossRef

31.

León VJ, Lengua MA, Calvo V, Lisón AJ (2017) Use of patient-specific cutting blocks reduces blood loss after total knee arthroplasty. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 27(2):273–277. https://doi.org/10.1007/s00590-016-1893-5CrossRef

32.

Chan WC, Pinder E, Loeffler M (2016) Patient-specific instrumentation versus conventional instrumentation in total knee arthroplasty. Journal of orthopaedic surgery (Hong Kong) 24(2):175–178. https://doi.org/10.1177/1602400211CrossRef

Title: Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial
Authors: Song Ke
Tianfei Ran
Yongqin He
Mingrui Lv
Xin Song
Yuanyuan Zhou
Yuan Xu
Min Wang
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04779-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2020

Patient care modifications and hospital regulations during the COVID-19 crisis created inequality and functional hazard for patients with orthopaedic trauma

War surgery in Afghanistan: a model for mass causalities in terror attacks?

Comparison of different bone graft with arthroscopy-assisted arthrodesis for the treatment of traumatic arthritis of the subtalar joint

Classic publications and scientometrics in orthopaedics

Prevalence of femoro-acetabular impingement in non-arthritic patients with hip pain: a meta-analysis

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review