Effect of three-dimensional printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Maolin ,  YANG Liu , HE Rui , HAO Peng , SUN Jiawei

Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China;

Corresponding author：

YANG Liu, Email: jointsurgery@163.com

Keywords：

Three-dimensional printing technique; guide plate; total knee athroplasty; lower limb alignment; femoral rotational alignment; patellar tracking

DOI：

10.7507/1002-1892.201907045

Video：

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Objective To investigate the effect of three-dimensional (3D) printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty (TKA).Methods Between January 2018 and October 2018, 60 patients (60 knees) with advanced knee osteoarthritis who received TKA and met the selection criteria were selected as the study subjects. Patients were randomly divided into two groups according to the random number table method, with 30 patients in each group. The TKA was done with the help of 3D printing guide plate in the guide group and following traditional procedure in the control group. There was no significant difference in gender, age, disease duration, side, and preoperative hip-knee-ankle angle (HKA), posterior condylar angle (PCA), patella transverse axis-femoral transepicondylar axis angle (PFA), Hospital for Special Surgery (HSS) score, and American Knee Society (AKS) score (P>0.05).Results All incisions healed by first intention and no complications related to the operation occurred. All patients were followed up 10-12 months, with an average of 11 months. HSS score and AKS score of the two groups at 6 months after operation were significantly higher than those before operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Postoperative X-ray films showed that the prosthesis was in good position, and no prosthesis loosening or sinking occurred during follow-up. HKA, PCA, and PFA significantly improved in the two groups at 10 months after operation compared with those before operation (P<0.05). There was no significant difference in HKA at 10 months between the two groups (t=1.031, P=0.307). PCA and PFA in the guide group were smaller than those in the control group (P<0.05).Conclusion Application of 3D printing guide plate in TKA can not only correct the deformity of the knee joint and alleviate the pain symptoms, but also achieve the goal of the accurate femoral rotation alignment and good patellar tracking.

Citation： SUN Maolin, YANG Liu, HE Rui, HAO Peng, SUN Jiawei. Effect of three-dimensional printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 335-340. doi: 10.7507/1002-1892.201907045 Copy

1.	Everhart JS, Abouljoud MM, Kirven JC, et al. Full-thickness cartilage defects are important independent predictive factors for progression to total knee arthroplasty in older adults with minimal to moderate osteoarthritis: data from the osteoarthritis initiative. J Bone Joint Surg (Am), 2019, 101(1): 56-63.
2.	Kobayashi S, Niki Y, Harato K, et al. Rheumatoid arthritis patients achieve better satisfaction but lower functional activities as compared to osteoarthritis patients after total knee arthroplasty. J Arthroplasty, 2019, 34(3): 478-482.
3.	Gui Q, Zhang X, Liu L, et al. Cost-utility analysis of total knee arthroplasty for osteoarthritis in a regional medical center in China. Health Econ Rev, 2019, 9(1): 15.
4.	Lim JB, Chou AC, Chong HC, et al. Are patients more satisfied and have better functional outcome after bilateral total knee arthroplasty as compared to total hip arthroplasty and unilateral total knee arthroplasty surgery? A two-year follow-up study. Acta Orthop Belg, 2015, 81(4): 682-689.
5.	Leichtenberg CS, Vliet Vieland TPM, Kroon HM, et al. Self-reported knee instability associated with pain, activity limitations, and poorer quality of life before and 1 year after total knee arthroplasty in patients with knee osteoarthritis. J Orthop Res, 2018, 36(10): 2671-2678.
6.	Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res, 2010, 468(1): 57-63.
7.	Khan M, Osman K, Green G, et al. The epidemiology of failure in total knee arthroplasty: avoiding your next revision. Bone Joint J, 2016, 98-B(1 Suppl A): 105-112.
8.	Evangelopoulos DS, Ahmad SS, Krismer AM, et al. Periprosthetic infection: major cause of early failure of primary and revision total knee arthroplasty. J Knee Surg, 2018, 32(10). doi: 10.1055/s-0038-1672203.
9.	Camus T, Long WJ. Total knee arthroplasty in young patients: factors predictive of aseptic failure in the 2nd-4th decade. J Orthop, 2018, 15(1): 28-31.
10.	许志庆, 王武炼, 庄至坤, 等. 3D 打印技术辅助人工全膝关节置换术治疗合并关节外畸形的膝骨关节炎. 中国修复重建外科杂志, 2017, 31(8): 913-917.
11.	刘德健, 李彦林, 蔡国锋, 等. 3D 打印截骨导板辅助人工全膝关节置换术早期疗效分析. 中国修复重建外科杂志, 2018, 32(7): 899-905.
12.	Aunan E, Østergaard D, Meland A, et al. A simple method for accurate rotational positioning of the femoral component in total knee arthroplasty. Acta Orthop, 2017, 88(6): 657-663.
13.	Franceschini V, Nodzo SR, Gonzalez Della Valle A. Femoral component rotation in total knee arthroplasty: A comparison between transepicondylar axis and posterior condylar line referencing. J Arthroplasty, 2016, 31(12): 2917-2921.
14.	Yu B, Fu M, Zhang Z, et al. The plane of the distal femur anterior cortex is a useful index for femoral component rotation in total knee arthroplasty. J Orthop, 2017, 14(1): 59-61.
15.	Gao YH, Li SQ, Yang C, et al. Favorable femoral component rotation achieved in severe varus deformity by using the gap-balancing technique. Knee, 2016, 23(5): 867-870.
16.	Berger RA, Crossett LS, Jacobs JJ, et al. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res, 1998, (356): 144-153.
17.	Kenawey M, Liodakis E, Krettek C, et al. Effect of the lower limb rotational alignment on tibiofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1851-1859.
18.	Kumar K, Sharma D. A study of anatomy of distal femur pertaining to total knee replacement: an analysis, conclusions and recommendations. Musculoskelet Surg, 2018, 102(1): 29-34.
19.	Heegaard JH, Leyvraz PF, Hovey CB. A computer model to simulate patellar biomechanics following total knee replacement: the effects of femoral component alignment. Clin Biomech (Bristol, Avon), 2001, 16(5): 415-423.
20.	Alcelik IA, Blomfield MI, Diana G, et al. A comparison of short-term outcomes of minimally invasive computer-assisted vs minimally invasive conventional instrumentation for primary total knee arthroplasty: A systematic review and meta-analysis. J Arthroplasty, 2016, 31(2): 410-418.
21.	Hsu RW, Himeno S, Coventry MB, et al. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res, 1990, (255): 215-227.

1. Everhart JS, Abouljoud MM, Kirven JC, et al. Full-thickness cartilage defects are important independent predictive factors for progression to total knee arthroplasty in older adults with minimal to moderate osteoarthritis: data from the osteoarthritis initiative. J Bone Joint Surg (Am), 2019, 101(1): 56-63.
2. Kobayashi S, Niki Y, Harato K, et al. Rheumatoid arthritis patients achieve better satisfaction but lower functional activities as compared to osteoarthritis patients after total knee arthroplasty. J Arthroplasty, 2019, 34(3): 478-482.
3. Gui Q, Zhang X, Liu L, et al. Cost-utility analysis of total knee arthroplasty for osteoarthritis in a regional medical center in China. Health Econ Rev, 2019, 9(1): 15.
4. Lim JB, Chou AC, Chong HC, et al. Are patients more satisfied and have better functional outcome after bilateral total knee arthroplasty as compared to total hip arthroplasty and unilateral total knee arthroplasty surgery? A two-year follow-up study. Acta Orthop Belg, 2015, 81(4): 682-689.
5. Leichtenberg CS, Vliet Vieland TPM, Kroon HM, et al. Self-reported knee instability associated with pain, activity limitations, and poorer quality of life before and 1 year after total knee arthroplasty in patients with knee osteoarthritis. J Orthop Res, 2018, 36(10): 2671-2678.
6. Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res, 2010, 468(1): 57-63.
7. Khan M, Osman K, Green G, et al. The epidemiology of failure in total knee arthroplasty: avoiding your next revision. Bone Joint J, 2016, 98-B(1 Suppl A): 105-112.
8. Evangelopoulos DS, Ahmad SS, Krismer AM, et al. Periprosthetic infection: major cause of early failure of primary and revision total knee arthroplasty. J Knee Surg, 2018, 32(10). doi: 10.1055/s-0038-1672203.
9. Camus T, Long WJ. Total knee arthroplasty in young patients: factors predictive of aseptic failure in the 2nd-4th decade. J Orthop, 2018, 15(1): 28-31.
10. 许志庆, 王武炼, 庄至坤, 等. 3D 打印技术辅助人工全膝关节置换术治疗合并关节外畸形的膝骨关节炎. 中国修复重建外科杂志, 2017, 31(8): 913-917.
11. 刘德健, 李彦林, 蔡国锋, 等. 3D 打印截骨导板辅助人工全膝关节置换术早期疗效分析. 中国修复重建外科杂志, 2018, 32(7): 899-905.
12. Aunan E, Østergaard D, Meland A, et al. A simple method for accurate rotational positioning of the femoral component in total knee arthroplasty. Acta Orthop, 2017, 88(6): 657-663.
13. Franceschini V, Nodzo SR, Gonzalez Della Valle A. Femoral component rotation in total knee arthroplasty: A comparison between transepicondylar axis and posterior condylar line referencing. J Arthroplasty, 2016, 31(12): 2917-2921.
14. Yu B, Fu M, Zhang Z, et al. The plane of the distal femur anterior cortex is a useful index for femoral component rotation in total knee arthroplasty. J Orthop, 2017, 14(1): 59-61.
15. Gao YH, Li SQ, Yang C, et al. Favorable femoral component rotation achieved in severe varus deformity by using the gap-balancing technique. Knee, 2016, 23(5): 867-870.
16. Berger RA, Crossett LS, Jacobs JJ, et al. Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res, 1998, (356): 144-153.
17. Kenawey M, Liodakis E, Krettek C, et al. Effect of the lower limb rotational alignment on tibiofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1851-1859.
18. Kumar K, Sharma D. A study of anatomy of distal femur pertaining to total knee replacement: an analysis, conclusions and recommendations. Musculoskelet Surg, 2018, 102(1): 29-34.
19. Heegaard JH, Leyvraz PF, Hovey CB. A computer model to simulate patellar biomechanics following total knee replacement: the effects of femoral component alignment. Clin Biomech (Bristol, Avon), 2001, 16(5): 415-423.
20. Alcelik IA, Blomfield MI, Diana G, et al. A comparison of short-term outcomes of minimally invasive computer-assisted vs minimally invasive conventional instrumentation for primary total knee arthroplasty: A systematic review and meta-analysis. J Arthroplasty, 2016, 31(2): 410-418.
21. Hsu RW, Himeno S, Coventry MB, et al. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res, 1990, (255): 215-227.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of three-dimensional printing guide plate on improving femoral rotational alignment and patellar tracking in total knee arthroplasty

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