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  • 1
    Online Resource
    Online Resource
    Total Knee Arthroplasty in the Valgus Knee: Can New Operative Technologies Affect Surgical Technique and Outcomes?
    Surgical Technology Online ; 2021
    In:  Surgical Technology Online Vol. 39 ( 2021-06-01)
    Details
    In: Surgical Technology Online, Surgical Technology Online, Vol. 39 ( 2021-06-01)
    Abstract: Introduction: Valgus knee deformities can sometimes be challenging to address during total knee arthroplasties (TKAs). While appropriate surgical technique is often debated, the role of new operative technologies in addressing these complex cases has not been clearly established. The purpose of this study was to analyze the usefulness of computed tomography scan (CT)-based three-dimensional (3D) modeling operative technology in assisting with TKA planning, execution of bone cuts, and alignment. Specifically, we evaluated valgus TKAs performed using this CT-based technology for: (1) intraoperative implant plan, number of releases, and surgeon prediction of component size; (2) survivorship and clinical outcomes at a minimum follow up of one year; and (3) radiographic outcomes. Materials and Methods: A total of 152 patients who had valgus deformities receiving a CT-based TKA performed by a single surgeon were analyzed. Cases were performed using an enhanced preoperative planning and real-time intraoperative feedback and cutting tool. The surgeon predicted and recorded implant sizes preoperatively and all patients received implants with initial and final implant alignment, flexion/extension gaps, and full or partial soft tissue releases recorded. A modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.) scores were collected preoperatively and at approximately six months and one year postoperatively. Preoperative coronal alignment ranged from 1 to 13° valgus. Follow-up radiographs were also evaluated for alignments, loosenings, and/or progressive radiolucencies. Results: A total of 96% of cases were corrected to within 3° of mechanical neutral. For outlier cases, initial deformities ranged from valgus 5 to 13°, with final alignment ranging from 4 to 8° valgus (mean 4° correction). Patients had mean femoral internal rotation of 2° and mean femoral flexion of 4°. The surgeon was within one size on the femur and tibia 94 and 100% of the time, respectively. Only one patient required a lateral soft tissue release and one patient had osteophytes removed, which required a medial soft tissue release. Five patients required manipulations under anesthesia. Aside from these, there were no postoperative medical and/or surgical complications and there was 100% survivorship at final follow up. WOMAC and KOOS, JR. scores improved significantly from a mean of 21 ± 9 and 48 ± 10 points preoperatively to 4 ± 6 (p 〈 0.05) and 82 ± 15 (p 〈 0.05) at final follow up, respectively. None of the cases exhibited progressive radiolucencies by final follow up. Discussion: A limitation of this study was not evaluating dynamic kinematics in these patients to determine if rotation had any effects on kinematics. Future studies will evaluate this concern. Nevertheless, the technology successfully assisted with planning, executing bone cuts, and achieving alignment in TKAs complicated by the deformity. This may allow surgeons to predictably avoid soft tissue releases and accurately know component sizes preoperatively, while consistently achieving desired postoperative alignment. Conclusions: This study demonstrated the utility of CT-based 3D modeling techniques for challenging valgus deformity cases. Use of 3D modeling allowed the TKA components to be positioned according to the patient’s anatomy in the coronal, transverse, and sagittal planes. When making these intraoperative implant adjustments, the surgeon may choose to place components outside the preoperative planning guidelines based on the clinical needs of the patient.
    Type of Medium: Online Resource
    ISSN: 1090-3941
    URL: Journal
    URL: Article
    DOI: 10.52198/STI.Surg.Tech.1090-3941
    DOI: 10.52198/21.STI.39.OS1462
    Language: Unknown
    Publisher: Surgical Technology Online
    Publication Date: 2021
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Clinical Outcomes After Computed Tomography-Based Total Knee Arthroplasty: A Surgeon’s First 1,000 Cases
    Surgical Technology Online ; 2021
    In:  Surgical Technology Online Vol. 40 ( 2021-05-17)
    Details
    In: Surgical Technology Online, Surgical Technology Online, Vol. 40 ( 2021-05-17)
    Abstract: Introduction: Computed tomography scan (CT)-based three-dimensional (3D) modeling operative technologies have been shown to improve upon many perioperative results of manual total knee arthroplasties (TKAs). Although patient satisfaction has been reported for CT-based TKAs, studies evaluating large cohorts are limited. The purpose of this study was to compare the clinical outcomes of a surgeon’s first 1,000 CT-based TKAs with manual TKAs during a minimum follow-up time of approximately six months. Specifically, we analyzed: (1) survivorship; (2) functional outcomes; (3) radiographic outcomes (i.e., alignment, progressive radiolucencies); and (4) complications. Materials and Methods: A total of 1,000 consecutive primary CT-based total knee arthroplasty cases (988 patients) performed by a single surgeon at a single center between July 1, 2016 and July 1, 2021 were compared to a total of 1,000 consecutive manual TKAs (996 patients) completed by the same surgeon between May 18, 2013 and July 1, 2016. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) surveys were collected at approximately six months postoperatively. Subgroup analyses were performed on the physical function and pain scores. Follow-up radiographs were also examined for alignment, progressive radiolucencies, and/or loosenings. Results: There was 100% survivorship at approximately six months follow up. The mean physical function score for the manual cohort and CT-based cohort were 10 ± 4 (range, 0 to 32) and 5 ± 4 (range, 0 to 22), respectively (p 〈 0.05). The mean pain score for the manual cohort and CT-based cohort were 4 ± 4 (range, 0 to 20) and 3 ± 2 (range, 0 to 15), respectively (p 〈 0.05). The mean total WOMAC score for the manual cohort and CT-based cohort were 13 ± 9 (range, 0 to 44) and 8 ± 7 (range, 0 to 33), respectively (p 〈 0.05). None of the manual or CT-based cases exhibited progressive radiolucencies by final follow up. There were no postoperative medical and/or surgical complications at final follow up in the two cohorts. Discussion/Conclusions: The 1,000 CT-based TKA clinical outcomes from this study continue to support great survivorship and radiographic outcomes, minimal complications, as well as improved physical function, pain, and total WOMAC scores. Therefore, those who undergo CT-based 3D modeling total knee arthroplasties should have the advantage of superior patient satisfaction.
    Type of Medium: Online Resource
    ISSN: 1090-3941
    URL: Journal
    URL: Article
    DOI: 10.52198/STI.Surg.Tech.1090-3941
    DOI: 10.52198/22.STI.40.OS1581
    Language: Unknown
    Publisher: Surgical Technology Online
    Publication Date: 2021
    Location Call Number Limitation Availability
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    Online Resource
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