Download PDF
J Knee Surg 2021; 34(10): 1085-1091
DOI: 10.1055/s-0040-1701453
Original Article

Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stabilized TKA

Prakrit Kumar
1   University of Birmingham Medical School, Birmingham, United Kingdom
,
Jacob Elfrink
2   University of Missouri Department of Orthopaedic Surgery, Columbia, Missouri
,
James P. Daniels
2   University of Missouri Department of Orthopaedic Surgery, Columbia, Missouri
,
Ajay Aggarwal
2   University of Missouri Department of Orthopaedic Surgery, Columbia, Missouri
,
James A. Keeney
2   University of Missouri Department of Orthopaedic Surgery, Columbia, Missouri
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Customized individually manufactured total knee arthroplasty (CIM-TKA) was developed to improve kinematic total knee arthroplasty (TKA) performance. Component placement accuracy may influence the success of CIM-TKA designs. We performed this study to compare radiographic component alignment and revision rates of a cruciate retaining (CR) CIM-TKA and a contemporary posterior stabilized TKA (PS-TKA). After obtaining Institutional Review Board approval, we identified 94 CR CIM-TKAs (76 patients) and 91 PS-TKAs (82 patients) performed between July 1, 2013 and December 31, 2014 with a minimum 2-year follow-up (mean 41.1 months, range 24–59 months). We performed a retrospective electronic medical record review to identify patient demographic characteristics and revision procedures performed. Postoperative plain radiographs were reviewed to assess component alignment including cruciate ligament imbalance, femoral overhang, and femoral notching. Demographic characteristics, component malalignment, and revision surgery rates were assessed using a student's t-test or two-tailed Fisher's exact test, with a p-value < 0.05 designating significance. Technical errors were more commonly identified with CR CIM-TKA (29.8 vs. 9.9%, p < 0.001), including higher rates of tibiofemoral instability (13.8 vs. 1.1%, p < 0.01), femoral notching (12.8 vs. 3.3%, p = 0.03), and patellofemoral malalignment (20.2 vs. 7.7%, p = 0.02). CR CIM-TKA had more frequent coronal plane malposition (26.6 vs. 9.9%, p < 0.01) or sagittal plane reconstruction > 3 degrees outside of an optimized range (20.2 vs. 9.9%, p = 0.06). Aseptic revisions occurred more frequently with the CR CIM-TKA design (9.6 vs. 3.3%, p = 0.13). Demographic characteristics were not significantly different between the treatment groups. CR CIM-TKA may improve kinematic performance for patients undergoing knee replacement surgery. However, our study observations suggest that careful attention to surgical technique is important for optimizing implant survivorship with the CR CIM-TKA design. Additional study is needed to determine whether higher revision rates identified during this study are related to patient selection, surgical technique, or implant design.

Keywords

total knee arthroplasty - patient-specific instrumentation - body mass index


Publication History

Received: 21 August 2019

Accepted: 13 December 2019

Article published online:
04 February 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Murray CJ, Atkinson C, Bhalla K. et al; U.S. Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310 (06) 591-608
    CrossrefPubMedGoogle Scholar
  • 2 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452) 35-43
    CrossrefPubMedGoogle Scholar
  • 3 Kim TK, Chang CB, Kang YG, Kim SJ, Seong SC. Causes and predictors of patient's dissatisfaction after uncomplicated total knee arthroplasty. J Arthroplasty 2009; 24 (02) 263-271
    CrossrefPubMedGoogle Scholar
  • 4 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
    CrossrefPubMedGoogle Scholar
  • 5 Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern?. Bone Joint J 2014; 96-B (11, suppl A): 96-100
    CrossrefPubMedGoogle Scholar
  • 6 Parvizi J, Nunley RM, Berend KR. et al. High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 2014; 472 (01) 133-137
    CrossrefPubMedGoogle Scholar
  • 7 Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
    CrossrefPubMedGoogle Scholar
  • 8 Maradit Kremers H, Larson DR, Crowson CS. et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
    CrossrefPubMedGoogle Scholar
  • 9 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 10 Park A, Duncan ST, Nunley RM, Keeney JA, Barrack RL, Nam D. Relationship of the posterior femoral axis of the “kinematically aligned” total knee arthroplasty to the posterior condylar, transepicondylar, and anteroposterior femoral axes. Knee 2014; 21 (06) 1120-1123
    CrossrefPubMedGoogle Scholar
  • 11 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
    CrossrefPubMedGoogle Scholar
  • 12 Bellemans J. Neutral mechanical alignment: a requirement for successful TKA: opposes. Orthopedics 2011; 34 (09) e507-e509
    CrossrefPubMedGoogle Scholar
  • 13 Howell SM, Hodapp EE, Vernace JV, Hull ML, Meade TD. Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2281-2287
    CrossrefPubMedGoogle Scholar
  • 14 Blakeney W, Clément J, Desmeules F, Hagemeister N, Rivière C, Vendittoli PA. Kinematic alignment in total knee arthroplasty better reproduces normal gait than mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1410-1417
    CrossrefPubMedGoogle Scholar
  • 15 Courtney PM, Lee GC. Early outcomes of kinematic alignment in primary total knee athroplasty: a meta-analysis of the literature. J Arthroplasty 2017; 32 (06) 2028-2032.e1
    CrossrefPubMedGoogle Scholar
  • 16 Why iTotal?. Clinical rationale for a patient-specific cruciate-retaining knee replacement system. Accessed May 20, 2019 at: https://www.conformis.com/uploads/2017/09/Why-iTotal-Brochure.pdf
    PubMedGoogle Scholar
  • 17 Zeller IM, Sharma A, Kurtz WB, Anderle MR, Komistek RD. Customized versus patient-sized cruciate-retaining total knee arthroplasty: an in vivo kinematics study using mobile fluoroscopy. J Arthroplasty 2017; 32 (04) 1344-1350
    CrossrefPubMedGoogle Scholar
  • 18 Beckmann J, Steinert AF, Huber B. et al. Customised bi-compartmental knee arthroplasty shows encouraging 3-year results: findings of a prospective, multicentre study. Knee Surg Sports Traumatol Arthrosc 2020; 8 (06) 1742-1749
    CrossrefPubMedGoogle Scholar
  • 19 Abane L, Zaoui A, Anract P, Lefevre N, Herman S, Hamadouche M. Can a single-use and patient-specific instrumentation be reliably used in primary total knee arthroplasty? A multicenter controlled study. J Arthroplasty 2018; 33 (07) 2111-2118
    CrossrefPubMedGoogle Scholar
  • 20 Moopanar TR, Amaranath JE, Sorial RM. Component position alignment with patient-specific jigs in total knee arthroplasty. ANZ J Surg 2014; 84 (09) 628-632
    CrossrefPubMedGoogle Scholar
  • 21 Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (03) 895-902
    CrossrefPubMedGoogle Scholar
  • 22 Sassoon A, Nam D, Nunley R, Barrack R. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res 2015; 473 (01) 151-158
    CrossrefPubMedGoogle Scholar
  • 23 Stronach BM, Pelt CE, Erickson JA, Peters CL. Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment. J Arthroplasty 2014; 29 (09) 1705-1708
    CrossrefPubMedGoogle Scholar
  • 24 Stolarczyk A, Nagraba L, Mitek T, Stolarczyk M, Deszczyński JM, Jakucinski M. Does patient-specific instrumentation improve femoral and tibial component alignment in total knee arthroplasty? A prospective randomized study. Adv Exp Med Biol 2018; 1096: 11-17
    CrossrefPubMedGoogle Scholar
  • 25 Stronach BM, Pelt CE, Erickson J, Peters CL. Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res 2013; 471 (01) 169-174
    CrossrefPubMedGoogle Scholar
  • 26 Ostermeier S, Schlomach C, Hurschler C, Windhagen H, Stukenborg-Colsman C. Dynamic in vitro measurement of posterior cruciate ligament load and tibiofemoral stress after TKA in dependence on tibiofemoral slope. Clin Biomech (Bristol, Avon) 2006; 21 (05) 525-532
    CrossrefPubMedGoogle Scholar
  • 27 Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. Comparison of kinematics in cruciate retaining and posterior stabilized for fixed and rotating platform mobile-bearing total knee arthroplasty with respect to different posterior tibial slope. BioMed Res Int 2018; 2018: 5139074
    PubMedGoogle Scholar
  • 28 Kang KT, Kwon SK, Kwon OR, Lee JS, Koh YG. Comparison of the biomechanical effect of posterior condylar offset and kinematics between posterior cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee 2019; 26 (01) 250-257
    CrossrefPubMedGoogle Scholar
  • 29 Chambers AW, Wood AR, Kosmopoulos V, Sanchez HB, Wagner RA. Effect of posterior tibial slope on flexion and anterior-posterior tibial translation in posterior cruciate-retaining total knee arthroplasty. J Arthroplasty 2016; 31 (01) 103-106
    CrossrefPubMedGoogle Scholar
  • 30 Levengood GA, Dupee J. Accuracy of coronal plane mechanical alignment in a customized, individually made total knee replacement with patient-specific instrumentation. J Knee Surg 2018; 31 (08) 792-796
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Schwarzkopf R, Brodsky M, Garcia GA, Gomoll AH. Surgical and functional outcomes in patients undergoing total knee replacement with patient-specific implants compared with “off-the-shelf” implants. Orthop J Sports Med 2015; 3 (07) 2325967115590379
    CrossrefPubMedGoogle Scholar
  • 32 Culler SD, Martin GM, Swearingen A. Comparison of adverse events rates and hospital cost between customized individually made implants and standard off-the-shelf implants for total knee arthroplasty. Arthroplast Today 2017; 3 (04) 257-263
    CrossrefPubMedGoogle Scholar
  • 33 Woolson ST, Harris AH, Wagner DW, Giori NJ. Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 2014; 96 (05) 366-372
    CrossrefPubMedGoogle Scholar