Prosthesis size in total knee arthroplasty predicted using digital pre-operative plan

doi:10.3969/j.issn.2095-4344.2014.40.007

Abstract

Abstract:

BACKGROUND: Differences of knee anthropometry between individuals are significant, while preoperative templating is not accurate in predicting the prosthesis size.

OBJECTIVE: To improve the accuracy of pre-operative plan in predicting the prosthesis size in total knee arthroplasty using digital technologies.

METHODS: Between January 2013 and May 2004, 50 patients (20 men and 30 women; aged 54-82 years; mean age, 67.8 years) received primary total knee arthroplasty for osteoarthritis and were retrospectively analyzed. According to the treatment, the patients were divided into two groups. The digital group, a series of 21 patients, underwent 64-row MDCT before total knee replacement. CT images were imported into Mimics, and three-dimensional models of femur and tibia were reconstructed. Then, computer-aided design files of different sizes of prostheses provided by the manufacturers were imported into Mimics, too. Surgical simulation of osteotomy and prostheses implantation were performed in Mimics, component size was determined by the contour of distal femur and proximal tibia. The control group, a series of 29 patients, underwent primary total knee arthroplasty using conventional approaches. The agreement between preoperative plan and the actual prosthesis size was assessed during the surgery. Postoperative X-ray of low limb was taken to evaluate the accuracy of sizing and the efficacy of digital technologies was assessed.

RESULTS AND CONCLUSION: The intraoperative and postoperative evaluation showed inaccurate sizing of femoral and tibial components in 1 case in digital group and in 11 cases in conventional group. The accuracy of prediction was 95% in digital group and 62% in conventional group, with significant differences between the two groups (P < 0.05). Four overhanging and two notching cases were observed in conventional group, but none in digital group. The digital technologies provide an effective means for accurate prediction of prosthesis size and personalized surgical simulation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, knee, computer-assisted design, tibia, femur

CLC Number:

R318

Hu Han-sheng, Wang Jing-cheng, Xiong Chuan-zhi, Yan Lian-qi, Wang Qiang, Chen Gang. Prosthesis size in total knee arthroplasty predicted using digital pre-operative plan[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6432-6437.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，50例患者均获得随访，最长随访时间15个月，全部进入结果分析，无脱落。 2.2 患者治疗时间及术中出血量数字化组患者平均住院时间短于常规组患者，差异有显著性意义(P < 0.05)；数字化组患者平均手术时间短于常规组患者，差异有显著性意义(P < 0.05)；数字化组平均术中出血量小于常规组患者，差异有显著性意义(P < 0.05，表1)。 2.3 术后X射线观察结果至随访结束，两组假体均无松动、假体周围骨折等现象。 2.4 假体尺寸预测的结果数字化组21例患者中除了1例患者术中未能安装模拟手术所确定型号的假体，其余20例患者实际安装的假体型号均与术前设计相同，数字化组预测准确率为95%。常规组29例患者中有18例假体尺寸与术前预测一致，常规组预测准确率为62%，两组差异有显著性意义(P < 0.05)。数字化组术中观察及术后X射线片均显示假体与膝关节截骨面的匹配度良好，匹配率100%，常规组有6例患者出现假体与截骨面不完全匹配(4例患者假体悬挂，2例患者股骨前皮质过度切割)，匹配率79%，2组差异有显著性意义(P < 0.05，表2)。数字化组3例参与研究的医生各自完成模拟手术后，选择的假体型号高度一致，21例中有17例患者的3次模拟手术结果完全一致，4例患者的2次模拟手术结果一致，未见3次模拟手术结果均不一致的患者。1例未能安装术前设计确定假体的患者，原因是膝关节屈曲挛缩严重，为纠正屈曲畸形、平衡屈伸间隙，术中不得不增加股骨远端截骨，从而改变了截骨面的形态、尺寸，导致假体型号变化。 2.5 膝关节置换后疗效评价两组患者术后6周随访时根据Kss标准评价膝关节置换后疗效，结果显示，数字化组优11例，良6例，优良率为81%；常规组优13例，良7例，优良率69%，两组差异无显著性意义(P > 0.05，表2)。 2.6 不良事件 50例患者均无感染、切口皮肤坏死、血管神经损伤、血栓形成、假体周围骨折等并发症发生。在随访期间假体稳定性良好。"

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