3D PRINTING TECHNIQUE FOR PATIENT-SPECIFIC INSTRUMENTATION IN TOTAL KNEE ARTHROPLASTY

Cover Page


Cite item

Full Text

Abstract

The aim of the study was to evaluate clinical and radiological outcomes of knee arthroplasty using patient specific guides produced using physical prototypes and 3D printing that are applied for positioning of resection blocks.

 Materials and methods. The authors analyzed the treatment outcomes of 4 patients during the period from 2015 to 2016 who underwent total knee arthroplasty for posttraumatic gonarthrosis of III-IV stage with the use of patient specific guides for resection blocks positioning. The mean age of patients was 59±12 years. Initially, all patients reported marked limitation of movement in the knee joint. The average flexion prior to surgery was 53.3±35.1°. According to FLFS roentgenography all patients had a varus deformity of the lower limb with an average value of 15.0±12.3°.

Results. In all cases the axis of the lower limb was normalized postoperatively. The average KOOS score for “pain” was 85.2±14.0, for “daily physical activity” — 74.5±14.8, for “symptoms and stiffness” — 69.0±11.0, for “quality of life” — 62.5±12.5 points. Average knee ROM after arthroplasty: flexion 113.3±5.787° and full extension. Such outcomes can be considered as excellent considering preoperative marked knee movement limitations in all patients.

Conclusion. Preoperative planning using the technology of producing patient specific guides and prototyping on physical tibia and femur models allowed to restore normal axis of the lower limb. The authors observed a significant improvement in joint function and a pain syndrome reduction in all patients. In authors’ opinion patient specific precision guides can be used in the following cases: inflammatory process or deformation of the femur in patient’s history; when the use of intramedullary guides is difficult and does not allow positioning of the prosthesis components with sufficient accuracy or is associated with an increased risk of a purulent-inflammatory process; ipsilateral hip joint prosthesis when it is desirable to avoid opening the medullary canal; substantial bone defects or massive osteophytes of the posterior portion of femoral condyles that impede correct rotation of the femoral component; severe movement limitations in the knee joint, when it is technically impossible to perform TKA using computer navigation and the use of a standard set of instruments poses significant technical difficulties.

About the authors

N. N. Karyakin

ФГБОУ ВО «Нижегородская государственная медицинская академия» Минздрава России

Email: fake@neicon.ru

Nikolay N. Karyakin — Dr. Sci. (Med.), Acting Rector

10/1, pl. Minina i Pozharskogo, Nizhny Novgorod, 603950

Россия

E. E. Malyshev

ФГБУ «Приволжский федеральный медицинский исследовательский центр» Минздрава России;
ФГБОУ ВО «Нижегородская государственная медицинская академия» Минздрава России

Author for correspondence.
Email: eugenemal@yandex.ru

Evgeny E. Malyshev — Cand. Sci. (Med.), Associate Professor, Department of Traumatology, Orthopedics and Field Surgery 

18/1, ul. Verkhne-Volzhskaya Naberezhnaya, Nizhny Novgorod, 603155

Россия

R. O. Gorbatov

ФГБУ «Приволжский федеральный медицинский исследовательский центр» Минздрава России

Email: fake@neicon.ru

Roman O. Gorbatov — Head of Laboratory of Additive Technologies 

10/1, pl. Minina i Pozharskogo, Nizhny Novgorod, 603950

Россия

G K. Rotich

Nizhny Novgorod State Medical Academy;
St. Lukes Orthopaedics and Trauma Hospital Nandi Road

Email: fake@neicon.ru

Geoffrey Kipsang Rotich — Medical Practitioner, St. Luke’s orthopaedic and Trauma Hospital Nandi Road, Kenya; resident doctor, Nizhny Novgorod State Medical Academy

P.O Box 3705-30100, Eldoret

Кения

References

  1. Корнилов Н.Н., Куляба Т.А. Артропластика коленного сустава. СПб., 2012. 228 с. Kornilov N.N., Kulyaba T.A. Artroplastika kolennogo sustava [Knee arthroplasty]. St. Petersburg; 2012. 228 p. (in Russian).
  2. Малышев Е.Е., Павлов Д.В., Блинов С.В. Динамический контроль угловых деформаций в коленном суставе. Травматология и ортопедия России. 2013;(3):136-142. Malyshev E.E., Pavlov D.V., Blinov S.V. [Dynamic control of angular deformations in the knee joint]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2013;(3):136-142. (in Russian).
  3. Soo Hoo N.F., Lieberman J.R., Ko C.Y., Zingmond D.S. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88(3):480-485. doi: 10.2106/00004623-200603000-00003.
  4. W u L. D., Xiong Y., Yan S. G., Yang Q. S. Total knee replacement for posttraumatic degenerative arthritis of the knee. Chin J Traumatol. 2005;8(4):195-199. doi: 10.1007/978-1-4612-4310-6_24.
  5. Haidukewych G.J., Springer B.D., Jacofsky D.J., Berry D.J. Total knee arthroplasty for salvage of failed internal fixation or nonunion of the distal femur. J Arthroplasty. 2005;20(3):344-349.
  6. Lunebourg A., Parratte S., Ollivier M., Garcia-Parra K., Argenson J. Lower function, quality of life, and survival rate after total knee arthroplasty for posttraumatic arthritis than for primary arthritis. Acta Orthop. 2015;86(2): 189-194. doi: 10.3109/17453674.2014.979723.
  7. Papagelopoulos P.J, Karachalios T., Themistocleous G.S., Papadopoulos E.C., Savvidou O.D., Rand J.A. Total knee arthroplasty in patients with pre-existing fracture deformity. Orthopedics. 2007;30(5):373-378. doi: 10.1016/j.arth.2014.07.007.
  8. П риходько В.С., Тарбушкин А.А., Прохорова М.Ю., Шилин А.П., Усманов Д.Н., Морозов Д.С. Риски при эндопротезировании крупных суставов у пациентов с ожирением. Ожирение и метаболизм. 2015;12(4):52-56. Prikhodko V.S., Tarbushkin A.A., Prokhorova M.Yu., Shilin A.P., Usmanov D.N., Morozov D.S. [Risks in arthroplasty of large joints in patients with obesity]. Ozhirenie i metabolism [Obesity and Metabolism]. 2015;12(4):52-56. (in Russian).
  9. Sassoon A., Nam D., Nunley R. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res. 2015;473(1): 151-158. doi: 10.1007/s11999-014-3804-6.
  10. Burnett R.S., Barrack R.L. Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review. Clin Orthop Relat Res. 2013;471(1): 264-276. doi: 10.1007/s11999-012-2528-8.
  11. Confalonieri N., Manzotti A., Pullen C., Ragone V. Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. Acta Orthop Belg. 2005;71(6):703-709.
  12. Mattei L., Pellegrino P., Calo M. Patient specific instrumentation in total knee arthroplasty: a state of the art. Ann Transl Med. 2016;4(7):126. doi: 10.21037/atm.2016.03.33.
  13. Pang C.H., Chan W.L., Yen C.H. Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding systems: a prospective study. J Orthop Surg [Hong Kong]. 2009;17(2):170-173. doi: 10.1177/230949900901700209.
  14. Y affe M., Luo M., Goyal N. Clinical, functional, and radiographic outcomes following total knee arthroplasty with patient-specific instrumentation, computer-assisted surgery, and manual instrumentation: a short-term followup study. Int J Comput Assist Radiol Surg. 2014;9(5): 837-844. doi: 10.1007/s11548-013-0968-6.
  15. Nunley R.M., Ellison B.S., Ruh E.L. Are patient-specific cutting blocks cost-effective for total knee arthroplasty? Clin Orthop Relat Res. 2012;470(3):889-894. doi: 10.1007/s11999-011-2221-3.
  16. Boonen B., Schotanus M.G., Kort N.P. Preliminary experience with the patient-specific templating total knee arthroplasty. Acta Orthop. 2012;83(4):387-393. doi: 10.3109/17453674.2012.711700.
  17. Conteduca F., Massai F., Iorio R. Blood loss in computerassisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop. 2009;33(6):1609-1613. doi: 10.1007/s00264-008-0651-7.
  18. Tibesku C.O. Total knee arthroplasty with the use of patient specific instruments: The Visionaire system. Orthopade. 2016;45(4):286-293. doi: 10.1007/978-3-642-29728-1_3.
  19. Zambianchi F., Colombelli A., Digennaro V. Assessment of patient-specific instrumentation precision through bone resection measurements. Knee Surg Sports Traumatol Arthrosc. 2015. [Epub ahead of print]. URL: https://www.ncbi.nlm.nih.gov/pubmed/26704807. doi: 10.1007/s00167-015-3949-1.
  20. Scholes C., Sahni V., Lustig S. Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation. Knee Surg Sports Traumatol Arthrosc. 2014;22(3):660-665. doi: 10.1007/s00167-013-2670-1.
  21. Thienpont E., Grosu I., Paternostre F. The use of patientspecific instruments does not reduce blood loss during minimally invasive total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2055-2060. doi: 10.1007/s00167-014-2952-2.
  22. Voleti P.B., Hamula M.J., Baldwin K.D. Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty. J Arthroplasty. 2014;29(9): 1709-1712. doi: 10.1016/j.arth.2014.01.039.
  23. Hamilton W.G., Parks N.L., Saxena A. Patientspecific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty. 2013;28(8):96-100. doi: 10.1016/j.arth.2013.04.049.
  24. Мурылев В., Музыченков А., Жучков А., Рукин Я., Рубин Г., Лычагин А. Тотальное эндопротезировние коленного сустава при посттравматических деформациях нижних конечностей. Врач. 2015;(11):4-7. Murylev V., Muzychenkov A., Zhuchkov A., Rukin YA., Rubin G., Lychagin A. [Total knee arthroplasty in posttraumatic deformities of the lower extremities]. Vrach [The Doctor]. 2015;(11):4-7. (in Russian).
  25. П етухов А.И., Корнилов Н.Н., Куляба Т.А., Тихилов Р.М., Селин А.В., Кроитору И.И., Игнатенко В.Л., Сараев А.В., Муранчик Ю.И. Современные взгляды на применение компьютерных навигационных систем при первичном тотальном эндопротезировании коленного сустава (обзор литературы). Травматология и ортопедия России. 2010;(1):115-123. Petukhov A.I., Kornilov N.N., Kulyaba T.A., Tikhilov R.M., Selin A.V., Kroitoru I.I., Ignatenko V.L., Saraev A.V., Muranchik Y.I. [Сontemporary view on computer navigation using at primary knee total replacement (review)]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2010;(1):115-123. (in Russian).
  26. Гиркало М.В., Гаврилов М.А., Бахтеева Н.Х., Воскресенский О.Ю., Коршунова Г.А., Козлов В.В. Эндопротезирование коленного сустава при комбинированной контрактуре. Саратовский научно-исследовательский журнал. 2009;5(3):410-414. G irkalo M.V., Gavrilov M.A., Bakhteyeva N.Kh., Voskresenskiy O.Yu., Korshunova G.A., Kozlov V.V. [Endoprosthetics of the knee joint with combined contracture]. Saratovskiy nauchno-issledovatelskiy zhurnal [Saratov Research Journal]. 2009;5(3):410-414. (in Russian).

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies