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Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

An Erratum to this article was published on 18 February 2012

Abstract

Background

Coronal alignment may impact clinical outcome and survivorship in TKA. Patient-specific instrumentation has been developed to restore mechanical or kinematic axis and potentially reduce component malpositioning. Although it is clear these instruments add cost, it is unclear whether they improve alignment.

Questions/purposes

We determined whether the mean coronal alignment after TKA performed with conventional versus patient-specific instrumentation better restored the mechanical and kinematic axes and whether there were more outliers with one of the two methods.

Methods

We retrospectively evaluated 150 primary TKAs performed for osteoarthritis: Group 1 (n = 50) conventional instrumentation; Group 2 (n = 50) patient-specific instrumentation restoring the mechanical axis; Group 3 (n = 50) patient-specific instrumentation restoring the kinematic axis, and measured femorotibial angle, hip-knee-ankle angle, and the zone of the mechanical axis from scout CT images taken 0 to 6 weeks postoperatively.

Results

The mean femorotibial angle differed between the groups: Group 1 had the greatest varus mean alignment and most varus outliers. The mean hip-knee angle was similar between Groups 1 and 2, with Group 3 having greater valgus mean alignment and the most valgus outliers. For the zone of the mechanical axis, Groups 1 and 2 had similar percentages of outliers (40% versus 32%), whereas Group 3 had a greater number of outliers (64%) that were valgus.

Conclusions

TKAs with patient-specific instrumentation restoring the mechanical axis had a similar number of outliers as conventional instrumentation with both groups having more varus outliers than TKAs with patient-specific instrumentation restoring kinematic axis, which had more valgus outliers. Therefore, additional studies are needed to determine whether patient-specific instrumentation improves clinical function or patient satisfaction and whether their routine use can be justified in primary TKA.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Brandon Williams for help with the radiographic images for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO, 63110, USA

    Ryan M. Nunley MD, Bradley S. Ellison MD, Jinjun Zhu MD, PhD, Erin L. Ruh MS & Robert L. Barrack MD

  2. VA Medical Center, John Cochran Division, St Louis, MO, USA

    Ryan M. Nunley MD

  3. Methodist Hospital of Sacramento, Sacramento, CA, USA

    Stephen M. Howell MD

Authors
  1. Ryan M. Nunley MD
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  2. Bradley S. Ellison MD
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  3. Jinjun Zhu MD, PhD
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  4. Erin L. Ruh MS
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  5. Stephen M. Howell MD
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  6. Robert L. Barrack MD
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Corresponding author

Correspondence to Ryan M. Nunley MD.

Additional information

One of the authors (RMN) is a paid consultant for Smith & Nephew Orthopaedics, Wright Medical Technology Inc, Salient Surgical, and CardioMEMS. One of the authors (RLB) has received royalties from Smith & Nephew Orthopaedics and is a paid consultant for Stryker. One of the authors (SMH) receives royalties from Biomet and is a paid consultant for Biomet and Stryker.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Washington University, St Louis, MO, USA.

An erratum to this article can be found at http://dx.doi.org/10.1007/s11999-012-2243-5.

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Nunley, R.M., Ellison, B.S., Zhu, J. et al. Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?. Clin Orthop Relat Res 470, 895–902 (2012). https://doi.org/10.1007/s11999-011-2222-2

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  • DOI: https://doi.org/10.1007/s11999-011-2222-2

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