Introduction

Three anatomic landmarks are typically used to estimate proper femoral component rotation in total knee arthroplasty: the transepicondylar axis (TEA), Whiteside's line, and the posterior condylar axis (PCA). Previous studies have shown that the presence of tibia vara may be accompanied by a hyperplastic posteromedial femoral condyle, which affects the relationship between the PCA and the TEA. The purpose of this study was to determine the relationship of tibia vara with the PCA.

Introduction

Current techniques in total knee arthroplasty aim to restore the coronal mechanical axis to neutral. Preoperative planning has historically been based on long-leg standing films (LLSF) which allow surgeons to plan bony resection and soft tissue releases. However, LSSF can be prone to error if malrotated. Recently, patient-specific guides (PSG) utilizing supine magnetic resonance imaging (sMRI) have become an accepted technique for preoperative planning. In this study we sought to compare the degree of coronal deformity using LLSF and sMRI.

Introduction

Total knee arthroplasty is effective for the management of osteoarthritis of the knee. Conventional techniques utilizing manual instrumentation (MI) make use of intramedullary femoral guides and either extramedullary or intramedullary tibial guides. While MI techniques can achieve excellent results in the majority of patients, those with ipsilateral hardware, post-traumatic deformity or abnormal anatomy may be technically more challenging, resulting in poorer outcomes. Computer-assisted navigation (CAN) is an alternative that utilizes fixed trackers and anatomic registration points, foregoing the need for intramedullary guides. This technique has been shown to yield excellent results including superior alignment outcomes compared to MI with fewer outliers. However, studies report a high learning curve, increased expenses and increased operative times. As a result, few surgeons are trained and comfortable utilizing CAN. Patient-specific instrumentation is an alternative innovation for total knee arthroplasty. Custom guide blocks are fabricated based on a patient's unique anatomy, allowing for the benefits of CAN but without the increased operative times or the high learning curve. In this study we sought to evaluate the accuracy of PSI techniques in patients with previous ipsilateral hardware of the femur.

Introduction:

Total knee arthroplasty (TKA) is an effective operation for the management of osteoarthritis of the knee. Conventional technique utilizing manual instrumentation (MI) allows for reproducible and accurate execution of the procedure. The most common techniques make use of intramedullary femoral guides and either extrameduallary or intrameduallary tibial guides. While these methods can achieve excellent results in the majority of patients, those with ipsilateral hardware, post-traumatic deformity or abnormal anatomy may preclude the accurate use of these techniques.

Patient-specific instrumentation (PSI) is an alternative innovation for total knee arthroplasty. Utilizing magnetic resonance imaging (MRI) or computed tomography (CT), custom guide blocks are fabricated based on a patient's unique anatomy. This allows for the benefits of computer assisted navigation (CAN) but without the increased operative times or the high learning curve associated with it. Furthermore it allows the use of familiar cutting blocks and guides to check the accuracy of the PSI guide blocks. In this study we sought to evaluate the accuracy of PSI techniques in patients with previous ipsilateral hardware, which would make the use of MI technically challenging and possibly subject to inaccuracy.

Introduction:

Patient specific instrumentation (PSI) is an innovative technology in total knee arthroplasty. With the use of a preoperative MRI or CT scan, custom guide blocks are individually manufactured for each patient. Contrary to other TKA technologies such as computer-assisted surgery, PSI utilizes measured resection technique rather than a primarily ligament balancing technique. This has the potential to negatively affect the operating surgeon's ability to achieve optimal soft tissue balancing, which is especially critical in patients with severe lower extremity malalignment. Despite early research suggesting that PSI is accurate, has a low learning curve, and can reduce OR time, it remains unclear whether a surgeon using PSI can achieve optimal soft tissue balancing using a measured resection technique. The purpose of this study is to evaluate the efficacy of PSI in patients with severe preoperative limb alignment deformities.

Introduction

Patient specific instrumentation (PSI) is an innovative technology in total knee arthroplasty (TKA). With the use of a preoperative MRI or CT scan, custom guide blocks are individually manufactured for each patient. Contrary to other TKA technologies such as computer-assisted surgery, PSI utilises measured resection technique rather than a primarily ligament balancing technique. This has the potential to negatively affect the operating surgeon's ability to achieve optimal soft tissue balancing, which is especially critical in patients with severe lower extremity malalignment. Despite early research suggesting that PSI is accurate, has a low learning curve, and can reduce operating room time, it remains unclear whether a surgeon using PSI can achieve optimal soft tissue balancing using a measured resection technique. The purpose of this study is to evaluate the efficacy of PSI in patients with severe preoperative limb alignment deformities.

Introduction

Proper femoral component rotation is a crucial factor in successful total knee arthroplasty (TKA). Femoral component rotation using anatomic landmarks has traditionally been established by referencing the transepicondylar axis (TEA), Whiteside's Line (WSL), or the posterior condylar axis (PCA). TEA is thought to best approximate the flexion-axis of the knee, however WSL or PCA are commonly used as surrogates of the TEA in the operating room due to their accessibility. The relationship of these anatomic landmarks has been previously investigated in anatomic and computed tomography based studies. The relatively few knees evaluated have limited the power of these studies. Patient Specific Instrumentation (PSI) utilizing magnetic resonance imaging (MRI) is an emerging technology in total knee replacement. The purpose of this study was to use magnetic resonance imaging based planning software to assess the relationship of WSL and PCA to the TEA and to determine if the relationships were influenced by the magnitude of the pre-operative coronal deformity.