Total knee arthroplasty based on the assistance of three-dimensional-printing personalized surgical navigation template

doi:10.3969/j.issn.2095-4344.2015.48.004

Abstract

Abstract:

BACKGROUND: With significantly individual differences in the anatomy of the knee joint, traditional total knee replacement is difficult to accurately predict the position of locating limb alignment, size of the prosthesis and osteotomy amount of patients during operation.
OBJECTIVE: To investigate the clinical effect of total knee replacement based on the assistance of medical image reconstruction, computer-aided design technology and 3D-printing personalized surgical navigation template.
METHODS: Medical image data of patients were collected using CT or magnetic resonance scanning equipment. The three-dimensional reconstruction of the bone was conducted by two-dimensional medical image processing technology. The navigation template was designed by computer-aided design technology. The personalized surgical navigation templates were produced by 3D printing technology, and the clinical total knee replacement was conducted. The postoperative results were evaluated using imageology.
RESULTS AND CONCLUSION: Arigin 3D Pro (Arigin Medical Co., Ltd.) can accurately reconstruct a three-dimensional model of the lower limb bones. The three-dimensional design software Arigin Surgical Templating by their independent research and development can precisely pinpoint related lower limb axis, including limb alignment, rotation axis of the femur and osteotomy reference point. The personalized navigation template we researched and produced for knee surgery fitted tightly with femoral condyle and tibial plateau bone anatomy during operation,
without significant movement. The deviation of patients’ limb alignment was less than 3° after total knee replacement.

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

CLC Number:

R318

Qiu Bing, Zhang Ming-jiao, Tang Ben-sen, Deng Bi-yong, Li Di-chen, Liu Fei. Total knee arthroplasty based on the assistance of three-dimensional-printing personalized surgical navigation template[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(48): 7731-7735.

Figures/Tables 1

References

[1] Mahaluxmivala J, Bankes M, Nicolai P, et al. The effect of surgeon experience on component positioning in 673 Press Fit Condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty. 2001;16(5): 635-640.

[2] Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty. 2009;24(4): 560-569.

[3] Ng VY, DeClaire JH, Berend KR, et al. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res. 2012;470(1): 99-107.

[4] Krishnan S, Dawood A, Richards R, et al. A review of rapid prototyped surgical guides for patient-specific total knee replacement. J Bone Joint Surg. 2012;94(11): 1457-1461.

[5] Minns R, Bibb R, Banks R, et al. The use of a reconstructed three-dimensional solid model from CT to aid the surgical management of a total knee arthroplasty: a case study. Med Eng Phys. 2003;25(6): 523-526.

[6] Silva DN, De Oliveira MG, Meurer E, et al. Dimensional error in selective laser sintering and 3D-printing of models for craniomaxillary anatomy reconstruction. J Craniomaxillofac Surg. 2008;36(8): 443-449.

[7] Lombardi Jr AV, Berend KR, Adams JB, et al. Patient-specific approach in total knee arthroplasty. Orthopedics. 2008;31(9): 927.

[8] Jenny JY, Boeri C. Computer-assisted implantation of total knee prostheses: A case-control comparative study with classical instrumentation. Comput Aided Surg. 2001;6(4): 217-220.

[9] Lustig S, Scholes CJ, Oussedik SI, et al. Unsatisfactory accuracy as determined by computer navigation of VISIONAIRE patient-specific instrumentation for total knee arthroplasty. J Arthroplasty. 2013;28 (3): 469-473.

[10] Victor J, Dujardin J, Vandenneucker H, et al. Patient-Specific Guides Do Not Improve Accuracy in Total Knee Arthroplasty. Clin Orthop Relat Res. 2014;472(1):263-271.

[11] MacDessi SJ, Jang B, Harris IA, et al. A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty. Knee. 2014;21(2): 406-409.

[12] Klatt BA, Goyal N, Austin MS, et al. Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty. 2008;23 (1): 26-29.

[13] Conteduca F, Iorio R, Mazza D, et al. Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop. 2012;36 (8): 1589-1593.

[14] 滕勇,王臻,李涤尘,等.应用快速成型技术复制人体骨骼模型与假肢制造设计的意义[J].中国临床康复, 2003,7(26):3556-3557.

[15] 刘非,李涤尘,卢秉恒,等. 基于反求工程的个体匹配化骨骼制造方法的研究[J]. 西安交通大学学报, 2002, 36(9):938-942.

[16] 刘亚雄,贺健康,秦勉,等.定制型钛合金植入物的光固化3D打印及精密铸造[J]. 稀有金属材料与工程, 2014, 43(S1):103-106.

[17] 秦勉,刘亚雄,贺健康,等.数字化设计与3-D打印技术在个性化医疗中的应用[J]. 中国修复重建外科杂志, 2014, 28(3):286-291.

[18] 张维杰,连芩,李涤尘,等.基于3-D打印技术的软骨修复及软骨下骨重建[J].中国修复重建外科杂志, 2014, 28(3):318-324.

[19] 张文友,贺健康,李翔,等.基于3-D打印技术的韧带-骨复合支架制造与体内植入研究[J].中国修复重建外科杂志, 2014, 28(3): 314-317.

[20] 刘亚雄,贺健康,连芩,等.西安交大个性化医用内置物的增材制造及应用[A].第15届全国特种加工学术会议论文集(下)[C]. 2013.

[21] 连芩,李涤尘,乔莎,等.钛板下颌假体的柔性化三维曲面展开与快速冲压成形工艺研究[A].第15届全国特种加工学术会议论文集(下) [C]. 2013.

[22] 李涤尘,刘葳,卢秉恒,等.定制化柔性钛下颌骨替代物的有限元优化分析及动物实验[A].第三届北京国际康复论坛论文集[C]. 2008.

[23] 刘亚雄,李涤尘,卢秉恒,等.基于快速原型的定制型复合人工下颌骨[A].第三届中国国际暨第六届全国口腔颌面外科学术会议论文集[C]. 2002.

[24] 卢秉恒,赵万华,洪军,等.增材制造及RP&M集成制造系统研究[A]. 第七届中国国际机床展览会(CIMT 2001)论文集[C]. 2001.

[25] 陈增海,张凤山,朱振宇. 实用骨科彩色图谱[M].上海:第二军医大学出版社, 2003.

[26] Nishihara S, Sugano N, Ikai M, et al. Accuracy evaluation of a shape-based navigation system for total knee arthroplasty. J Knee Surg. 2003;16(8): 98-105.

[27] Churchill DL, Incavo SJ, Johnson CC, et al. The transeipcondylar axis appropriates the optimal flexion axis of the knee. Clin Orthop. 1998;356(1):111-118.

[28] Olcott CW, Scott RD. Femoral component rotation during total knee arthroplasty. Clin Orthop. 1999;367(8): 39-42.

[29] Olcott CW, Scott RD. Determining proper femoral component rotational alignment during total knee arthroplasty. J Knee Surg. 2000;13(4): 166-168.

[30] Hood RW, Vanni M, Insall JN. The correction of knee alignment in 225 consecutive total condylar knee replacements. Clin Orthop. 1994;229(7): 32-43.

[31] Venkatesan M, Mahadevan D, Ashford RU. Computer- assisted navigation in knee arthroplasty: a critical appraisal. J Knee Surg. 2013;26(5): 357-361.

[32] Heyse TJ, Tibesku CO. Improved femoral component rotation in TKA using patient-specific instrumentation. Knee. 2014; 21(1): 268-271.

[33] Victor J, Dujardin J, Vandenneucker H, et al. Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res. 2014;472(1):263-271.

[34] Roh YW, Kim TW, Lee S, et al. Is TKA using patient-specific instruments comparable to conventional TKA? A randomized controlled study of one system. Clin Orthop Relat Res. 2013; 471(12): 3988-3995.

[35] Howell SM, Papadopoulos S, Kuznik KT, et al. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc. 2013;21(10): 2271-2280.

[36] Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1): 57-63.

[37] Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty. 2009; 24 (6): 39-43.

[38] Green GV, Berend KR, Berend ME, et al. The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: the posteromedial hot spot. J Arthroplasty. 2002; 17(8): 1033-1039.

[39] Nunley RM, Ellison BS, Zhu J, et al. Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res. 2012;470(3): 895-902.

[40] Bali K, Walker P, Bruce W. Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplasty. 2012;27(6): 1149-1154.

[41] Noble JW, Moore CA, Liu N. The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty. 2012; 27(1): 153-155.