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Comparison of custom to standard TKA instrumentation with computed tomography
Purpose There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We us...
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| Published in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2014-08, Vol.22 (8), p.1833-1842 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
| container_volume | 22 |
| creator | Ng, Vincent Y. Arnott, Lindsay Li, Jia Hopkins, Ronald Lewis, Jamie Sutphen, Sean Nicholson, Lisa Reader, Douglas McShane, Michael A. |
| description | Purpose
There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We used postoperative computed tomography (CT) to evaluate preoperative three-dimensional templating and CI to facilitate accurate and efficient implantation of TKA femoral and tibial components.
Methods
We prospectively evaluated a single-surgeon cohort of 78 TKA patients (51 custom, 27 standard) with postoperative CT scans using 3D reconstruction and contour-matching technology to preoperative imaging. Component alignment was measured in coronal, sagittal and axial planes.
Results
Preoperative templating for custom instrumentation was 87 and 79 % accurate for femoral and tibial component size. All custom components were within 1 size except for the tibial component in one patient (2 sizes). Tourniquet time was 5 min longer for custom (30 min) than standard (25 min). In no case was custom instrumentation aborted in favour of standard instrumentation nor was original alignment of custom instrumentation required to be adjusted intraoperatively. There were more outliers greater than 2° from intended alignment with standard instrumentation than custom for both components in all three planes. Custom instrumentation was more accurate in component position for tibial coronal alignment (custom: 1.5° ± 1.2°; standard: 3° ± 1.9°;
p
= 0.0001) and both tibial (custom: 1.4° ± 1.1°; standard: 16.9° ± 6.8°;
p
|
| doi_str_mv | 10.1007/s00167-013-2632-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1554951744</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1546217629</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-d551172ff3b2b831f84b8de6e2026cb4f9a2262e2557ddfb3b1605477bd0341f3</originalsourceid><addsrcrecordid>eNqNkctKxDAUhoMoOl4ewI0U3LipJie3dimDN1Tc6DqkTTJWps2YpMi8vRlmFBEEVzmQ7_8Phw-hY4LPCcbyImJMhCwxoSUICqXcQhPCKC0lZXIbTXDNoATMxR7aj_EN4zyyehftAa1lzUk1QY9T3y906KIfCu-KdozJ90XyRUx6MDqY4vn-suiGmMLY2yHp1GXyo0uvRZuTY7Im072fBb14XR6iHafn0R5t3gP0cn31PL0tH55u7qaXD2XLJE-l4ZwQCc7RBpqKElexpjJWWMAg2oa5WgMIsMC5NMY1tCECcyZlYzBlxNEDdLbuXQT_PtqYVN_F1s7nerB-jIpwzvJ9krF_oEwAkQLqjJ7-Qt_8GIZ8yIriteBQV5kia6oNPsZgnVqErtdhqQhWKy1qrUVlLWqlRcmcOdk0j01vzXfiy0MGYA3E_DXMbPix-s_WT1cUlsc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1545965298</pqid></control><display><type>article</type><title>Comparison of custom to standard TKA instrumentation with computed tomography</title><source>Wiley</source><source>Springer Nature</source><source>SPORTDiscus</source><creator>Ng, Vincent Y. ; Arnott, Lindsay ; Li, Jia ; Hopkins, Ronald ; Lewis, Jamie ; Sutphen, Sean ; Nicholson, Lisa ; Reader, Douglas ; McShane, Michael A.</creator><creatorcontrib>Ng, Vincent Y. ; Arnott, Lindsay ; Li, Jia ; Hopkins, Ronald ; Lewis, Jamie ; Sutphen, Sean ; Nicholson, Lisa ; Reader, Douglas ; McShane, Michael A.</creatorcontrib><description>Purpose
There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We used postoperative computed tomography (CT) to evaluate preoperative three-dimensional templating and CI to facilitate accurate and efficient implantation of TKA femoral and tibial components.
Methods
We prospectively evaluated a single-surgeon cohort of 78 TKA patients (51 custom, 27 standard) with postoperative CT scans using 3D reconstruction and contour-matching technology to preoperative imaging. Component alignment was measured in coronal, sagittal and axial planes.
Results
Preoperative templating for custom instrumentation was 87 and 79 % accurate for femoral and tibial component size. All custom components were within 1 size except for the tibial component in one patient (2 sizes). Tourniquet time was 5 min longer for custom (30 min) than standard (25 min). In no case was custom instrumentation aborted in favour of standard instrumentation nor was original alignment of custom instrumentation required to be adjusted intraoperatively. There were more outliers greater than 2° from intended alignment with standard instrumentation than custom for both components in all three planes. Custom instrumentation was more accurate in component position for tibial coronal alignment (custom: 1.5° ± 1.2°; standard: 3° ± 1.9°;
p
= 0.0001) and both tibial (custom: 1.4° ± 1.1°; standard: 16.9° ± 6.8°;
p
< 0.0001) and femoral (custom: 1.2° ± 0.9°; standard: 3.1° ± 2.1°;
p
< 0.0001) rotational alignment, and was similar to standard instrumentation in other measurements.
Conclusions
When evaluated with CT, custom instrumentation performs similar or better to standard instrumentation in component alignment and accurately templates component size. Tourniquet time was mildly increased for custom compared to standard.
Level of evidence
Level I, prospective diagnostic.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-013-2632-7</identifier><identifier>PMID: 23979518</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Arthritis ; Arthroplasty, Replacement, Knee - instrumentation ; Female ; Femur - diagnostic imaging ; Femur - surgery ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Joint replacement surgery ; Knee ; Knee Joint - diagnostic imaging ; Knee Joint - surgery ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Middle Aged ; Orthopedics ; Osteoarthritis, Knee - diagnostic imaging ; Osteoarthritis, Knee - surgery ; Patients ; Surgeons ; Surgery, Computer-Assisted ; Tibia - diagnostic imaging ; Tibia - surgery ; Tomography ; Tomography, X-Ray Computed</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014-08, Vol.22 (8), p.1833-1842</ispartof><rights>Springer-Verlag Berlin Heidelberg 2013</rights><rights>Springer-Verlag Berlin Heidelberg 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-d551172ff3b2b831f84b8de6e2026cb4f9a2262e2557ddfb3b1605477bd0341f3</citedby><cites>FETCH-LOGICAL-c475t-d551172ff3b2b831f84b8de6e2026cb4f9a2262e2557ddfb3b1605477bd0341f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23979518$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ng, Vincent Y.</creatorcontrib><creatorcontrib>Arnott, Lindsay</creatorcontrib><creatorcontrib>Li, Jia</creatorcontrib><creatorcontrib>Hopkins, Ronald</creatorcontrib><creatorcontrib>Lewis, Jamie</creatorcontrib><creatorcontrib>Sutphen, Sean</creatorcontrib><creatorcontrib>Nicholson, Lisa</creatorcontrib><creatorcontrib>Reader, Douglas</creatorcontrib><creatorcontrib>McShane, Michael A.</creatorcontrib><title>Comparison of custom to standard TKA instrumentation with computed tomography</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We used postoperative computed tomography (CT) to evaluate preoperative three-dimensional templating and CI to facilitate accurate and efficient implantation of TKA femoral and tibial components.
Methods
We prospectively evaluated a single-surgeon cohort of 78 TKA patients (51 custom, 27 standard) with postoperative CT scans using 3D reconstruction and contour-matching technology to preoperative imaging. Component alignment was measured in coronal, sagittal and axial planes.
Results
Preoperative templating for custom instrumentation was 87 and 79 % accurate for femoral and tibial component size. All custom components were within 1 size except for the tibial component in one patient (2 sizes). Tourniquet time was 5 min longer for custom (30 min) than standard (25 min). In no case was custom instrumentation aborted in favour of standard instrumentation nor was original alignment of custom instrumentation required to be adjusted intraoperatively. There were more outliers greater than 2° from intended alignment with standard instrumentation than custom for both components in all three planes. Custom instrumentation was more accurate in component position for tibial coronal alignment (custom: 1.5° ± 1.2°; standard: 3° ± 1.9°;
p
= 0.0001) and both tibial (custom: 1.4° ± 1.1°; standard: 16.9° ± 6.8°;
p
< 0.0001) and femoral (custom: 1.2° ± 0.9°; standard: 3.1° ± 2.1°;
p
< 0.0001) rotational alignment, and was similar to standard instrumentation in other measurements.
Conclusions
When evaluated with CT, custom instrumentation performs similar or better to standard instrumentation in component alignment and accurately templates component size. Tourniquet time was mildly increased for custom compared to standard.
Level of evidence
Level I, prospective diagnostic.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arthritis</subject><subject>Arthroplasty, Replacement, Knee - instrumentation</subject><subject>Female</subject><subject>Femur - diagnostic imaging</subject><subject>Femur - surgery</subject><subject>Humans</subject><subject>Image Processing, Computer-Assisted</subject><subject>Imaging, Three-Dimensional</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Knee Joint - diagnostic imaging</subject><subject>Knee Joint - surgery</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteoarthritis, Knee - diagnostic imaging</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Patients</subject><subject>Surgeons</subject><subject>Surgery, Computer-Assisted</subject><subject>Tibia - diagnostic imaging</subject><subject>Tibia - surgery</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqNkctKxDAUhoMoOl4ewI0U3LipJie3dimDN1Tc6DqkTTJWps2YpMi8vRlmFBEEVzmQ7_8Phw-hY4LPCcbyImJMhCwxoSUICqXcQhPCKC0lZXIbTXDNoATMxR7aj_EN4zyyehftAa1lzUk1QY9T3y906KIfCu-KdozJ90XyRUx6MDqY4vn-suiGmMLY2yHp1GXyo0uvRZuTY7Im072fBb14XR6iHafn0R5t3gP0cn31PL0tH55u7qaXD2XLJE-l4ZwQCc7RBpqKElexpjJWWMAg2oa5WgMIsMC5NMY1tCECcyZlYzBlxNEDdLbuXQT_PtqYVN_F1s7nerB-jIpwzvJ9krF_oEwAkQLqjJ7-Qt_8GIZ8yIriteBQV5kia6oNPsZgnVqErtdhqQhWKy1qrUVlLWqlRcmcOdk0j01vzXfiy0MGYA3E_DXMbPix-s_WT1cUlsc</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Ng, Vincent Y.</creator><creator>Arnott, Lindsay</creator><creator>Li, Jia</creator><creator>Hopkins, Ronald</creator><creator>Lewis, Jamie</creator><creator>Sutphen, Sean</creator><creator>Nicholson, Lisa</creator><creator>Reader, Douglas</creator><creator>McShane, Michael A.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Comparison of custom to standard TKA instrumentation with computed tomography</title><author>Ng, Vincent Y. ; Arnott, Lindsay ; Li, Jia ; Hopkins, Ronald ; Lewis, Jamie ; Sutphen, Sean ; Nicholson, Lisa ; Reader, Douglas ; McShane, Michael A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-d551172ff3b2b831f84b8de6e2026cb4f9a2262e2557ddfb3b1605477bd0341f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arthritis</topic><topic>Arthroplasty, Replacement, Knee - instrumentation</topic><topic>Female</topic><topic>Femur - diagnostic imaging</topic><topic>Femur - surgery</topic><topic>Humans</topic><topic>Image Processing, Computer-Assisted</topic><topic>Imaging, Three-Dimensional</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Knee Joint - diagnostic imaging</topic><topic>Knee Joint - surgery</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Osteoarthritis, Knee - diagnostic imaging</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Patients</topic><topic>Surgeons</topic><topic>Surgery, Computer-Assisted</topic><topic>Tibia - diagnostic imaging</topic><topic>Tibia - surgery</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ng, Vincent Y.</creatorcontrib><creatorcontrib>Arnott, Lindsay</creatorcontrib><creatorcontrib>Li, Jia</creatorcontrib><creatorcontrib>Hopkins, Ronald</creatorcontrib><creatorcontrib>Lewis, Jamie</creatorcontrib><creatorcontrib>Sutphen, Sean</creatorcontrib><creatorcontrib>Nicholson, Lisa</creatorcontrib><creatorcontrib>Reader, Douglas</creatorcontrib><creatorcontrib>McShane, Michael A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database (ProQuest)</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ng, Vincent Y.</au><au>Arnott, Lindsay</au><au>Li, Jia</au><au>Hopkins, Ronald</au><au>Lewis, Jamie</au><au>Sutphen, Sean</au><au>Nicholson, Lisa</au><au>Reader, Douglas</au><au>McShane, Michael A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of custom to standard TKA instrumentation with computed tomography</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>22</volume><issue>8</issue><spage>1833</spage><epage>1842</epage><pages>1833-1842</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
There is conflicting evidence whether custom instrumentation for total knee arthroplasty (TKA) improves component position compared to standard instrumentation. Studies have relied on long-limb radiographs limited to two-dimensional (2D) analysis and subjected to rotational inaccuracy. We used postoperative computed tomography (CT) to evaluate preoperative three-dimensional templating and CI to facilitate accurate and efficient implantation of TKA femoral and tibial components.
Methods
We prospectively evaluated a single-surgeon cohort of 78 TKA patients (51 custom, 27 standard) with postoperative CT scans using 3D reconstruction and contour-matching technology to preoperative imaging. Component alignment was measured in coronal, sagittal and axial planes.
Results
Preoperative templating for custom instrumentation was 87 and 79 % accurate for femoral and tibial component size. All custom components were within 1 size except for the tibial component in one patient (2 sizes). Tourniquet time was 5 min longer for custom (30 min) than standard (25 min). In no case was custom instrumentation aborted in favour of standard instrumentation nor was original alignment of custom instrumentation required to be adjusted intraoperatively. There were more outliers greater than 2° from intended alignment with standard instrumentation than custom for both components in all three planes. Custom instrumentation was more accurate in component position for tibial coronal alignment (custom: 1.5° ± 1.2°; standard: 3° ± 1.9°;
p
= 0.0001) and both tibial (custom: 1.4° ± 1.1°; standard: 16.9° ± 6.8°;
p
< 0.0001) and femoral (custom: 1.2° ± 0.9°; standard: 3.1° ± 2.1°;
p
< 0.0001) rotational alignment, and was similar to standard instrumentation in other measurements.
Conclusions
When evaluated with CT, custom instrumentation performs similar or better to standard instrumentation in component alignment and accurately templates component size. Tourniquet time was mildly increased for custom compared to standard.
Level of evidence
Level I, prospective diagnostic.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>23979518</pmid><doi>10.1007/s00167-013-2632-7</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014-08, Vol.22 (8), p.1833-1842 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1554951744 |
| source | Wiley; Springer Nature; SPORTDiscus |
| subjects | Aged Aged, 80 and over Arthritis Arthroplasty, Replacement, Knee - instrumentation Female Femur - diagnostic imaging Femur - surgery Humans Image Processing, Computer-Assisted Imaging, Three-Dimensional Joint replacement surgery Knee Knee Joint - diagnostic imaging Knee Joint - surgery Male Medical imaging Medicine Medicine & Public Health Middle Aged Orthopedics Osteoarthritis, Knee - diagnostic imaging Osteoarthritis, Knee - surgery Patients Surgeons Surgery, Computer-Assisted Tibia - diagnostic imaging Tibia - surgery Tomography Tomography, X-Ray Computed |
| title | Comparison of custom to standard TKA instrumentation with computed tomography |
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