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. 2018 Dec;33(4):258-263.
doi: 10.1097/BTO.0000000000000253. Epub 2017 Dec 25.

Hospital-based Patient-specific Templates for Total Knee Arthroplasty: A Proof of Concept Clinical Study

Mahmoud A Hafez  1 , Hosamuddin Hamza  1 , Ahmed Nabeel  1
Affiliations

Hospital-based Patient-specific Templates for Total Knee Arthroplasty: A Proof of Concept Clinical Study

Mahmoud A Hafez et al. Tech Orthop. 2018 Dec.

Abstract

Introduction: All available patient-specific instruments or patient-specific templates (PSTs) are controlled by implant companies. Most of these companies outsource some of the steps of the PST such as imaging, preoperative planning, manufacturing of PST, and packing/sterilization. This is a proof of concept clinical study on the hospital-based PST system for total knee arthroplasty (TKA).

Methods: A total number of 257 TKA procedures were performed on the basis of a new concept of hospital-based PSTs. All 5 steps of the PST [ie, imaging (computed tomographic scanning), planning, PST production, packing/sterilization, and surgery] were performed by the hospital. All cases included in this work are documented in the Egyptian Community Arthroplasty Register.

Results: All cases had their surgeries performed without resorting to conventional intramedullary guides. Computed tomography-based imaging was easy and affordable. Planning was controlled by the surgeon. Polyamide nylon was the best available material and it was autoclavable. Desktop 3-dimensional printers were able to produce PSTs made of nylon, but it was difficult and time consuming. Industrial printers were superior in quality to desktop printers but more expensive. The whole process could be performed in as short a duration as 3 working days.

Conclusions: Hospital-based PST was feasible and it was facilitated by the introduction of desktop 3-dimensional printers. This technique was less expensive and more time saving than commercially available PSTs as well as the conventional TKA.

Keywords: 3D printers; CAOS; custom-made cutting guides; hospital-based; patient-specific templates; total knee arthroplasty.

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Figures

FIGURE 1
FIGURE 1
A scanogram and 3-dimensional views of the computed tomographic scan.
FIGURE 2
FIGURE 2
Planning for patient-specific template.
FIGURE 3
FIGURE 3
(A) Industrial and (B) desktop 3D printers used for the production of PST.
FIGURE 4
FIGURE 4
Trial implant, PST, supporting instruments for TKA.
FIGURE 5
FIGURE 5
Work cycle of hospital-based PST. CT indicates computed tomography; PST, patient-specific template; TKA, total knee arthroplasty; 3D, 3-dimensional.
FIGURE 6
FIGURE 6
Conventional instrumentation in >10 trays as compared to PST and few pieces of supporting instruments used for bilateral total knee arthroplasty.
FIGURE 7
FIGURE 7
Intraoperative images of the femora and tibial PST used for TKA.
See this image and copyright information in PMC

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