Accuracy of CT-based patient-specific guides for total knee arthroplasty in patients with post-traumatic osteoarthritis

Abstract

Published clinical trials who studied the accuracy of patient-specific guides (PSG) for total knee arthroplasty exclude patients with articular deformity of the knee joint. We prospectively analysed a series of 30 patients with post-traumatic osteoarthritis of the knee joint with use of PSG. At 1 year post-operative, the achieved biomechanical (HKA) axis and varus/valgus of the femur and tibia components were measured on anterior-posterior (AP) long-standing weight-bearing radiographs. Flexion/extension of the femoral and AP slope of the tibia component was measured on standard lateral radiographs. Percentages >3° deviation of the pre-operative planned HKA axis and individual implant components were considered as outliers. Approved and used implant size, median blood loss (ml) and operation time (min) were obtained from the operation records. Pre- and 1-year post-operative patient-reported outcome measures (PROMs) were performed. Eighty-three per cent of the patients had a HKA axis restored <3° of the pre-operative planned alignment. Varus/valgus outliers were 0.0 and 6.7 % for the femoral and tibial components, respectively. Percentages of outliers of flexion/extension were 36.7 % for the femoral component and 10.0 % for the AP slope of the tibial component. Median blood loss was 300 ml (50-700), while operation time was 67 min (44-144). In 20 % of all cases, the approved implant size was changed into one size smaller. One-year post-operative PROMs improved significantly. We conclude that the accuracy of CT-based PSG is not impaired in patients with post-traumatic osteoarthritis and this modality can restore biomechanical limb alignment.

Keywords: CT-based; Knee alignment; Patient-specific guides; Post-traumatic osteoarthritis; Retained metal hardware; Total knee arthroplasty.