Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Zhiqing ¹ , WANG Wulian ² , ZHUANG Zhikun ¹ ,  ZHANG Yiyuan ²

1. Department of Joint Surgery, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou Fujian, 362000, P.R.China;
2. Department of Joint Surgery, the Second Hospital of Fuzhou, Teaching Hospital of Xiamen University, Fuzhou Fujian, 350001, P.R.China;

Corresponding author：

ZHANG Yiyuan, Email: 972133982@qq.com

Keywords：

Three-dimensional printing technology; total knee arthroplasty; extra-articular deformity; knee; osteoarthritis

DOI：

10.7507/1002-1892.201701075

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Objective To evaluate the effectiveness of total knee arthroplasty (TKA) using three-dimensional (3D) printing technology for knee osteoarthritis (KOA) accompanied with extra-articular deformity. Methods Between March 2013 and December 2015, 15 patients (18 knees) with extra-articular deformity and KOA underwent TKA. There were 6 males (6 knees) and 9 females (12 knees), aged 55-70 years (mean, 60.2 years). The mean disease duration was 10.8 years (range, 7-15 years). The unilateral knee was involved in 12 cases and bilateral knees in 3 cases. The clinical score was 57.44±1.06 and the functional score was 60.88±1.26 of Knee Society Score (KSS). The range of motion of the knee joint was (72.22±0.18)°. The deviation of mechanical axis of lower limb was (18.89±0.92)° preoperatively. There were 8 cases (10 knees) with extra-articular femoral deformity, 5 cases (5 knees) with extra-articular tibial deformity, and 2 cases (3 knees) with extra-articular femoral and tibial deformities. Bone models and the navigation templates were printed and the operation plans were designed using 3D printing technology. The right knee joint prostheses were chosen. Results The operation time was 65-100 minutes (mean, 75.6 minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was no poor incision healing, infection, or deep venous thrombosis after operation. All patients were followed up 12- 30 months (mean, 22 months). Prostheses were located in the right place, and no sign of loosening or subsidence was observed by X-ray examination. At last follow-up, the deviation of mechanical axis of lower limb was (2.00±0.29)°, showing significant difference when compared with preoperative one (t=13.120, P=0.007). The KSS clinical score was 87.50±0.88 and function score was 81.94±1.41, showing significant differences when compared with preoperative ones (t=27.553, P=0.000; t=35.551, P=0.000). The range of motion of knee was (101.94±1.42)°, showing significant difference when compared with preoperative one (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular deformity, TKA using 3D printing technology has advantages such as individualized treatment, reducing the difficulty of operation, and achieving the satisfactory function.

Citation： XU Zhiqing, WANG Wulian, ZHUANG Zhikun, ZHANG Yiyuan. Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 913-917. doi: 10.7507/1002-1892.201701075 Copy

1.	Fasel JH, Aguiar D, Kiss-Bodolay D, et al. Adapting anatomy teaching to surgical trends: a combination of classical dissection, medical imaging, and 3D-printing technologies. Surg Radiol Anat, 2016, 38(3): 361-367.
2.	Khaled SA, Burley JC, Alexander MR, et al. 3D printing of tablets containing multiple drugs with defined release profiles. Int J Pharm, 2015, 494(2): 643-650.
3.	Ma B, Kunz M, Gammon B, et al. A laboratory comparison of computer navigation and individualized guides for distal radius osteotomy. Int J Comput Assist Radiol Surg, 2014, 4(9): 713-724.
4.	Qiao F, Li D, Jin Z, et al. Application of 3D printed customized external fixator in fracture reduction. Injury, 2015, 46(6): 1150-1155.
5.	宋长辉, 杨永强, 张曼慧, 等. 基于数字化 3D 技术的股骨假体再设计与激光选区熔化制造. 光学精密工程, 2014, 22(8): 2117-2126.
6.	Schubert C, van Langeveld MC, Donoso LA. Innovations in 3D printing: a 3D overview from optics to organs. Br J Ophthalmol, 2014, 98(2): 159-161.
7.	Inzana JA, Olvera D, Fuller SM, et al. 3D printing of composite calcium phosphate and collagen scaffolds for bone regeneration. Biomaterials, 2014, 35(13): 4026-4034.
8.	Tam MD, Laycock SD, Bell D, et al. 3-D printout of a DICOM file to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia. J Radiol Case Rep, 2012, 6(1): 31-37.
9.	Fasel JH, Aguiar D, Kiss-Bodolay D, et al. Adapting anatomy teaching to surgical trends: a combination of classical dissection, medical imaging, and 3D-printing technologies. Surg Radiol Anat, 2016, 38(3): 361-367.
10.	陈国仙, 李国山, 林宗锦, 等. 3-D 打印技术辅助胫骨高位截骨术治疗膝内翻畸形骨关节炎的疗效观察. 中国修复重建外科杂志, 2016, 30(4): 407-410.
11.	孙涛, 高东强. 基于 CT 图像的个性化人骨三维建模方法. 机械设计与制造, 2010, 9: 262-263.
12.	Molli RG, Anderson KC, Buehler KC, et al. Computer-assisted navigation software advancements improve the accuracy of total knee arthroplasty. J Arthroplasty, 2011, 26 (3): 432-438.
13.	Marczak D, Synder M, Sibinski M, et al. One-stage total knee arthroplasty with pre-existing fracture deformity: post-fracture total knee arthroplasty. J Arthroplasty, 2014, 29(11): 2104-2108.
14.	Jung KA, Lee SC, Ahn NK, et al. Delayed Femoral Fracture Through a Tracker Pin Site After Navigated Total Knee Arthroplasty. J Arthroplasty, 2011, 26(3): 505. e9-505. e11.
15.	Wirtz DC, Birnbaum K, Siebert CH, et al. Bilateral total hip replacement in pseudoachondroplasia. Acta Orthop Belg, 2000, 66(4): 405-408.
16.	Segal O, Lammens J. Ilizarov treatment for extreme bilateral genu recurvatum in a pseudoachondroplasia patient: a case report. Acta Orthop Belg, 2010, 76(1): 124-128.
17.	Lonner JH, Siliski JM, Lotke PA. Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity. J Bone Joint Surg (Am), 2000, 82(3): 342-348.
18.	Koenig JH, Maheshwari AV, Ranawat AS, et al. Extra-articular deformity is always correctable intra-articularly: in the affirmative. Orthopedics, 2009, 32(9): 676-678.
19.	Wang JW, Wang CJ. Total knee arthroplasty for arthritis of the knee with extra-articular deformity. J Bone Joint Surg (Am), 2002, 84(10): 1769-1774.
20.	Deschamps G, Khiami F, Catonne Y, et al. Total knee arthroplasty for osteoarthritis secondary to extra-articular malunions. Orthop Traumatol Surg Res, 2010, 96(8): 849-855.

1. Fasel JH, Aguiar D, Kiss-Bodolay D, et al. Adapting anatomy teaching to surgical trends: a combination of classical dissection, medical imaging, and 3D-printing technologies. Surg Radiol Anat, 2016, 38(3): 361-367.
2. Khaled SA, Burley JC, Alexander MR, et al. 3D printing of tablets containing multiple drugs with defined release profiles. Int J Pharm, 2015, 494(2): 643-650.
3. Ma B, Kunz M, Gammon B, et al. A laboratory comparison of computer navigation and individualized guides for distal radius osteotomy. Int J Comput Assist Radiol Surg, 2014, 4(9): 713-724.
4. Qiao F, Li D, Jin Z, et al. Application of 3D printed customized external fixator in fracture reduction. Injury, 2015, 46(6): 1150-1155.
5. 宋长辉, 杨永强, 张曼慧, 等. 基于数字化 3D 技术的股骨假体再设计与激光选区熔化制造. 光学精密工程, 2014, 22(8): 2117-2126.
6. Schubert C, van Langeveld MC, Donoso LA. Innovations in 3D printing: a 3D overview from optics to organs. Br J Ophthalmol, 2014, 98(2): 159-161.
7. Inzana JA, Olvera D, Fuller SM, et al. 3D printing of composite calcium phosphate and collagen scaffolds for bone regeneration. Biomaterials, 2014, 35(13): 4026-4034.
8. Tam MD, Laycock SD, Bell D, et al. 3-D printout of a DICOM file to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia. J Radiol Case Rep, 2012, 6(1): 31-37.
9. Fasel JH, Aguiar D, Kiss-Bodolay D, et al. Adapting anatomy teaching to surgical trends: a combination of classical dissection, medical imaging, and 3D-printing technologies. Surg Radiol Anat, 2016, 38(3): 361-367.
10. 陈国仙, 李国山, 林宗锦, 等. 3-D 打印技术辅助胫骨高位截骨术治疗膝内翻畸形骨关节炎的疗效观察. 中国修复重建外科杂志, 2016, 30(4): 407-410.
11. 孙涛, 高东强. 基于 CT 图像的个性化人骨三维建模方法. 机械设计与制造, 2010, 9: 262-263.
12. Molli RG, Anderson KC, Buehler KC, et al. Computer-assisted navigation software advancements improve the accuracy of total knee arthroplasty. J Arthroplasty, 2011, 26 (3): 432-438.
13. Marczak D, Synder M, Sibinski M, et al. One-stage total knee arthroplasty with pre-existing fracture deformity: post-fracture total knee arthroplasty. J Arthroplasty, 2014, 29(11): 2104-2108.
14. Jung KA, Lee SC, Ahn NK, et al. Delayed Femoral Fracture Through a Tracker Pin Site After Navigated Total Knee Arthroplasty. J Arthroplasty, 2011, 26(3): 505. e9-505. e11.
15. Wirtz DC, Birnbaum K, Siebert CH, et al. Bilateral total hip replacement in pseudoachondroplasia. Acta Orthop Belg, 2000, 66(4): 405-408.
16. Segal O, Lammens J. Ilizarov treatment for extreme bilateral genu recurvatum in a pseudoachondroplasia patient: a case report. Acta Orthop Belg, 2010, 76(1): 124-128.
17. Lonner JH, Siliski JM, Lotke PA. Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity. J Bone Joint Surg (Am), 2000, 82(3): 342-348.
18. Koenig JH, Maheshwari AV, Ranawat AS, et al. Extra-articular deformity is always correctable intra-articularly: in the affirmative. Orthopedics, 2009, 32(9): 676-678.
19. Wang JW, Wang CJ. Total knee arthroplasty for arthritis of the knee with extra-articular deformity. J Bone Joint Surg (Am), 2002, 84(10): 1769-1774.
20. Deschamps G, Khiami F, Catonne Y, et al. Total knee arthroplasty for osteoarthritis secondary to extra-articular malunions. Orthop Traumatol Surg Res, 2010, 96(8): 849-855.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity

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