Abstract:

BACKGROUND: In clinical application, Picture Archiving and Communication System gradually replaces the traditional preoperative planning mode of acetate template measurement on film, which can accurately obtain the parameters needed in the operation of total knee arthroplasty.

OBJECTIVE: To evaluate the usage of Picture Archiving and Communication System in planning and assessment pre- and post-operatively in total knee arthroplasty.

METHODS: Severe knee osteoarthritis patients who undertook total knee arthroplasty in Wuxi People’s Hospital affiliated to Nanjing Medical University from March 2016 to March 2018 were included in the study. The patients were randomly divided into two groups. In the trial group (n=32), osteotomy was performed by Picture Archiving and Communication System, and then patients were implanted with knee prosthesis. In the control group (n=32), the osteotomy was performed according to the X-ray film, and then the artificial knee joint prosthesis was implanted. The trajectory of the tibia was tested during the operation. Anteroposterior and lateral X-ray films of the knee and the whole length films of the lower limbs were reexamined postoperatively. Tibial plateau inclination angle and valgus or varus angle were measured through Picture Archiving and Communication System. Recovery of lower limb alignment was assessed. Hospital for special surgery knee score on the affected side was analyzed to evaluate the recovery of joint function at postoperative 1, 3 and 12 months. This study was approved by the Ethics Committee of Wuxi People’s Hospital affiliated to Nanjing Medical University.

RESULTS AND CONCLUSION: (1) The satisfaction rate of lower limb alignment and the excellent and good rate of patellar movement trajectory were higher in the trial group than in the control group (100%, 91%; 100%, 94%, P < 0.05). There was no significant difference between the two groups in the satisfaction rate of osteotomy (P > 0.05). (2) Hospital for special surgery knee score was higher in the trial group than in the control group at postoperative 1 and 3 months [(80.5±9.06), (74.0±6.42), P < 0.05; (89.5±4.11), (82.5±6.09), P < 0.05]. There was no significant difference in the score at postoperative 12 months (P > 0.05). (3) No complications or adverse reactions related to implant occurred after operation. (4) Results indicated that personal osteotomy data can be obtained through Picture Archiving and Communication System in the total knee arthroplasty so as to improve the accuracy of osteotomy, better correct the lower limb alignment, obtain excellent patellar trajectory, and obtain better early curative effect of operation. The follow-up results within 1 year were satisfactory. The long-term effect remains to be further observed.

Key words: digital, picture, total knee arthroplasty, preoperative plan, postoperative assessment, lower limb alignment, patellar trajectory, posterior inclination angle of tibia prosthesis, knee joint score