Custom-made 3D printed patient specific guides (PSG) improves component axial alignment in total knee arthroplasty (TKA)

Q4 Medicine
Chetan Sood , Saqib Yasin
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引用次数: 1

Abstract

Background

Usage of Patient Specific Instrumentation (PSI) or Patient Specific Guides (PSG) in TKA has evolved rapidly in the past decade. Restoration of Mechanical axis in TKA is vital to achieve good functional outcome and long term implant survival. We carried out a comparative study to assess the efficacy of PSG in achieving neutral axial alignment and its impact on early functional outcomes compared to Conventional Instrumentation (CI).

Methods

Patients eligible as per study design (n = 100) undergoing TKA were randomized and divided in two equal groups which were matched in baseline demographics and clinical profile. All the patients in the PSG group (n = 50) and conventional instrumentation (CI) group (n = 50) underwent TKA with same implant. Pre-operative CT scans done as per specified protocol to acquire image data for 3D printing PSG. Duration of surgery and post-operative Hip-Knee-Ankle (HKA) angles achieved in the two groups was compared. Post-operative functional outcomes were assessed using WOMAC scores.

Results

There was statistically significant difference in the mean post-operative axial alignment achieved between the two groups (p = 0.041). Outliers (180 ± 3 deg) of HKA angle were more in the CI Group (p = 0.007). There was no difference in functional outcomes between the two groups at one year. Duration of surgery was significantly less in PSG Group (p < 0.001).

Conclusion

3D printed PSG are superior in achieving neutral HKA axis as compared to CI in TKA. Better axial alignment of TKA components does not correlate with better patient reported functional outcomes. PSG use significantly reduces surgical time.

定制3D打印患者专用导向器(PSG)改善全膝关节置换术(TKA)中部件轴向对齐
在过去的十年中,TKA中患者专用仪器(PSI)或患者专用指南(PSG)的使用发展迅速。机械轴的修复对于获得良好的功能结果和种植体的长期存活至关重要。我们进行了一项比较研究,以评估PSG在实现中性轴向对齐方面的功效,以及与传统仪器(CI)相比,PSG对早期功能结局的影响。方法根据研究设计(n = 100),将接受TKA的患者随机分为基线人口统计学和临床资料相匹配的两组。PSG组(n = 50)和常规器械(CI)组(n = 50)均采用相同种植体的TKA。术前按照指定方案进行CT扫描,获取3D打印PSG所需的图像数据。比较两组手术时间和术后髋关节-膝关节-踝关节(HKA)角度。术后功能结局采用WOMAC评分进行评估。结果两组患者术后平均轴位矫正率比较,差异有统计学意义(p = 0.041)。CI组HKA角度异常值(180±3°)较多(p = 0.007)。两组在一年后的功能结果没有差异。PSG组手术时间明显缩短(p <0.001)。结论3d打印PSG在TKA中实现中性HKA轴优于CI。TKA组件更好的轴向排列与更好的患者报告的功能结果无关。PSG的使用显著缩短了手术时间。
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来源期刊
Journal of Arthroscopy and Joint Surgery
Journal of Arthroscopy and Joint Surgery Medicine-Orthopedics and Sports Medicine
CiteScore
0.60
自引率
0.00%
发文量
1
期刊介绍: Journal of Arthroscopy and Joint Surgery (JAJS) is committed to bring forth scientific manuscripts in the form of original research articles, current concept reviews, meta-analyses, case reports and letters to the editor. The focus of the Journal is to present wide-ranging, multi-disciplinary perspectives on the problems of the joints that are amenable with Arthroscopy and Arthroplasty. Though Arthroscopy and Arthroplasty entail surgical procedures, the Journal shall not restrict itself to these purely surgical procedures and will also encompass pharmacological, rehabilitative and physical measures that can prevent or postpone the execution of a surgical procedure. The Journal will also publish scientific research related to tissues other than joints that would ultimately have an effect on the joint function.
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