Improved tibial component rotation in TKA using patient-specific instrumentation

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• 作者：Thomas J. Heyse ; Carsten O. Tibesku
• 关键词：Patient ; matched cutting jigs ; Tibial component rotation ; TKA ; PSI ; MRI
• 刊名：Archives of Orthopaedic and Trauma Surgery
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：135
• 期：5
• 页码：697-701
• 全文大小：603 KB
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• 作者单位：Thomas J. Heyse (1)
  Carsten O. Tibesku (2)
  
  1. Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
  2. Sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-3916

文摘

Introduction Patient-specific instrumentation (PSI) was introduced in an attempt to reduce positional outliers of components in total knee arthroplasty (TKA). It was hypothesized that PSI could help with the positioning of tibial components in optimal rotational alignment. Methods A magnetic resonance imaging (MRI) analysis of 58 patients following TKA was conducted. Of these, 30 operations were performed using PSI and 28 using conventional instrumentation. The rotation of the tibial components was determined in MRI using three different reference lines: a tangent to the dorsal tibial condyles, the tibial epicondylar line, and the tibial tubercle. Deviations >9° were considered outliers. Also internal rotation >1° was considered an outlier. Data were analyzed statistically for positional outliers using the Chi-squared test. Results There was excellent inter- and intraobserver reliability with low standard deviations for the determination of tibial component rotation using the tangent to the dorsal condyles and the tibial epicondylar line as reference. Using the dorsal tangent as reference, there were eight components in excessive external rotation (28.6?%) and one component being in relative internal rotation (5.4°) in the conventional group, while there were two components in excessive external rotation in the PSI group (6.7?%). Using the tibial epicondyles as reference, there were seven components in excessive external rotation (21.4?%) and one component being in relative internal rotation (4.4°) in the conventional group; while there were two components in excessive external rotation in the PSI group (6.7?%). These differences were statistically significant (p?<?0.05). Measurements based on the tibial tubercle showed poor reproducibility in terms of intra- and interobserver reliability and was of little use in the context of the research question. Discussion and conclusion In this setup, PSI was effective in significantly reducing outliers of optimal rotational tibial component alignment during TKA. Anatomy of the proximal tibia does not deliver clear landmarks that are prominent and consistent. This makes both, MRI analysis as well as cutting jig production and intraoperative placement a challenge.