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Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial

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Abstract

Purpose

Patient-specific instrumentation (PSI) was usually applied in total knee arthroplasty (TKA) to acquire a favourable alignment. We hypothesized that using PSI had a potential risk of notching in the anterior femoral cortex, because the femoral component may be placed in an overextension position due to the distal femoral sagittal anteversion. The aim of this study was to figure out the relationship between the notch and the distal femoral sagittal anteversion in PSI-assisted TKA.

Methods

One hundred thirty-one patients who were to undergo total knee arthroplasty (TKA) were randomly divided into conventional instrumentation (CI) group and PSI group. The computed tomography (CT) data of lower extremities was collected and imported to the Mimics software to reconstruct the three-dimensional (3D) bone image of the femur. The angle between distal femoral anatomic axis (DFAA) and femoral mechanical axis (FMA) on sagittal plane was defined as distal femoral sagittal anteverted angle (DFSAA) and measured. The number of notch intra-operative and post-operative was recorded. Then, we calculated the incidence of the notch and analyzed its relationship with DFSAA.

Results

The average DFSAA of 262 femurs is 2.5° ± 1.5° (range, 0.0°–5.7°). When DFSAA ≥ 3°, the incidence of notch was 7.10% in CI group and 33.30% in PSI group, respectively, which shows significant statistical difference in the two groups (P = 0.016 < 0.05). When DFSAA < 3°, the incidence of notch was 6.50% in CI group and 5.30% in PSI group, respectively, which shows no significant statistical difference in the two groups (P = 0.667 > 0.05).

Conclusion

DFSAA could be taken as an indicator to predict the notch when performing TKA assisted with PSI. Especially when the DFSAA ≥ 3°, the risk of notch could be markedly increased.

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Acknowledgments

We appreciated the assistance of measurement and software application from Professor Mingjun Fu in Naton Institute of Medical Technology, Beijing.

Funding

The current study was supported by Clinical Research Fund (no. 2016YLC21), the second affiliated hospital to army medical university of Chinese People’s Liberation Army, and the National Natural Science Foundation of China (grant no. 81501606).

Author information

Authors and Affiliations

Authors

Contributions

Dr. Wang conceived and designed the study. Dr. Ke, Dr. Ran, and Miss He measured the DFSAA. Dr. Wang performed the surgery, Dr. Xu, Dr. Song, and Dr. Lv were assistants. Miss Zhou and Miss He completed the follow-up work. Dr. Ke wrote the paper. Dr. Wang edited the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Min Wang.

Ethics declarations

All the patients received and accepted informed consent to participate in this study, which was approved by the medical ethics committee of our hospital (2018-YD084-01).

Conflict of interest

The authors declare that they have no conflicts of interest

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Level of evidence III, clinically case-controlled study

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Ke, S., Ran, T., He, Y. et al. Does patient-specific instrumentation increase the risk of notching in the anterior femoral cortex in total knee arthroplasty? A comparative prospective trial. International Orthopaedics (SICOT) 44, 2603–2611 (2020). https://doi.org/10.1007/s00264-020-04779-4

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  • DOI: https://doi.org/10.1007/s00264-020-04779-4

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