Publication: Computed tomography-based patient-specific
instrumentation loses accuracy with significant
varus preoperative misalignment
Authors
León Muñoz, Vicente Jesús ; López López, Mirian ; Lisón Almagro, Alonso José ; Martínez Martínez, Francisco ; Santonja Medina, Fernando
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Publisher
Thieme Gruppe
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DOI
https://doi.org/10.1055/s-0040-1716381
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info:eu-repo/semantics/article
Description
© 2020 Thieme. This document is the Published Manuscript version of a Published Work that appeared in final form in The Journal of Knee Surgery. To access the final edited and published work see https://doi.org/ 10.1055/s-0040-1716381
Abstract
Patient-specific instrumentation (PSI) has been introduced to simplify and make total
knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed
this study to determine whether the postoperative coronal alignment is related to
preoperative deformity when computed tomography (CT)-based PSI is used for TKA
surgery, and how the PSI approach compares with deformity correction obtained with
conventional instrumentation. We analyzed pre-and post-operative full length standing
hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention
> 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI
group, the mean ( SD) pre-operative HKA angle was 172.09 degrees varus
( 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and
a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was
179.43 degrees varus ( 2.32 degrees) with a maximum varus alignment of
seven degrees and a maximum valgus alignment of six degrees. There has been a
weak correlation among the values of the pre- and postoperative HKA angle. The
adjusted odds ratio (aOR) of postoperative alignment outside the range of
180 3 degrees was significantly higher with a preoperative varus misalignment of
15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p ¼ 0.013). In the
control group (conventional instrumentation), this loss of accuracy occurs with
preoperative misalignment of 10 degrees. Preoperative misalignment below
15 degrees appears to present minimal influence on postoperative alignment when
a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with
preoperative varus misalignment over 15 degrees.
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Citation
The Journal of Knee Surgery, 2022; Vol. 35 (05), pp. 574-582
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