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. 2020 Jun 30:2020:6485178.
doi: 10.1155/2020/6485178. eCollection 2020.

Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

Maolin Sun  1 , Ying Zhang  1 , Yang Peng  1 , Dejie Fu  1 , Huaquan Fan  1 , Rui He  1
Affiliations

Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

Maolin Sun et al. Biomed Res Int. .

Abstract

Background: With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA.

Methods: Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip-knee-ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS).

Results: The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P < 0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P < 0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference.

Conclusion: 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

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Conflict of interest statement

The authors declare that there are no competing interests regarding the publication of the paper.

Figures

Figure 1
Figure 1
The flow diagram of participants according to the inclusion and exclusion criteria. TKA: total knee arthroplasty.
Figure 2
Figure 2
The method to distinguish the insufficient or excessive extorsion of femoral component was measured by CT. Red lines showed the patella transverse line (PTL) and the surgical transepicondylar axis (sTEA), respectively, the green and blue lines represented posterior condyle lines (PCL) under different external rotation states. If it was PCL1 (green line) in the internal rotation position of sTEA (green curved arrow), the patient was assigned to group C; if it was PCL2 (blue line) in the external rotation position of sTEA (blue curved arrow), the patient was assigned to group B.
Figure 3
Figure 3
The design and morphology of the guide. (a, b) Determining the surgical transepicondylar axis (sTEA) and the intramedullary positioning. (c–e) The design of the guide. (f–i) The morphology of the guide.
Figure 4
Figure 4
Surgical technique in group A. (a) Placing the personalized guide. (b) Fixing the guide with Kirschner wire. (c) Drilling into the distal femur. (d) Palpating the epicondyles as the first check for accuracy. (e) Completing the distal femoral cuts. (f) Observing the relationship between the epicondylar axis and sTEA as the second check for accuracy.
Figure 5
Figure 5
Gait analysis equipment and the position of reflective markers. (a) Gait analysis equipment. (b–d) The position of reflective markers.
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