Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

J. R. T. Pietrzak; F. E. Rowan; B. Kayani; M. J. Donaldson; S. S. Huq; F. S. Haddad

doi:10.1055/s-0038-1666829

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2019; 32(07): 642-648
DOI: 10.1055/s-0038-1666829

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

Authors

J. R. T. Pietrzak

¹Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, United Kingdom
F. E. Rowan

¹Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, United Kingdom
B. Kayani

¹Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, United Kingdom
M. J. Donaldson

¹Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, United Kingdom
S. S. Huq

¹Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, United Kingdom
F. S. Haddad

¹Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, United Kingdom

Abstract

Patient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (χ ²: 17.965; odds ratio [OR]: 24.957, 3.250–191.661; p < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively (χ ^2: 36.436; OR: 33.480, 7.400–151.481; p < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652–0.890; p < 0.001) for the femur and 0.833 (0.717–0.911; p < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.

Keywords

templating - total knee arthroplasty - robotic surgery - implant sizes

Full Text

References

References
1 Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ. Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late. Bone Joint J 2018; 100-B (02) 161-169
2 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
3 Bourne RB. Measuring tools for functional outcomes in total knee arthroplasty. Clin Orthop Relat Res 2008; 466 (11) 2634-2638
4 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
5 Siston RA, Goodman SB, Delp SL, Giori NJ. Coronal plane stability before and after total knee arthroplasty. Clin Orthop Relat Res 2007; 463 (463) 43-49
6 Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 2002; 84-A (Suppl. 02) 90-98
7 Manaster BJ. Total knee arthroplasty: postoperative radiologic findings. Am J Roentgenol 1995; 165 (04) 899-904
8 Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017; 99-B (05) 640-646
9 Trickett RW, Hodgson P, Forster MC, Robertson A. The reliability and accuracy of digital templating in total knee replacement. J Bone Joint Surg Br 2009; 91 (07) 903-906
10 Miller BS, Steadman JR, Briggs KK, Rodrigo JJ, Rodkey WG. Patient satisfaction and outcome after microfracture of the degenerative knee. J Knee Surg 2004; 17 (01) 13-17
11 Laskin RS. Intramedullary instrumentation: safer and more accurate than extramedullary instrumentation. Orthopedics 2001; 24 (08) 739
12 van der Linden-van der Zwaag HMJ, Wolterbeek R, Nelissen RGHH. Computer assisted orthopedic surgery; its influence on prosthesis size in total knee replacement. Knee 2008; 15 (04) 281-285
13 Hsu AR, Kim JD, Bhatia S, Levine BR. Effect of training level on accuracy of digital templating in primary total hip and knee arthroplasty. Orthopedics 2012; 35 (02) e179-e183
14 Peek AC, Bloch B, Auld J. How useful is templating for total knee replacement component sizing?. Knee 2012; 19 (04) 266-269
15 Biau DJ, Porcher R. A method for monitoring a process from an out of control to an in control state: application to the learning curve. Stat Med 2010; 29 (18) 1900-1909
16 Ooka NHM, Campos ALS, da Fonseca VM. , et al. Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays. Int Orthop 2018; 42 (06) 1275-1282
17 Urabe K, Mahoney OM, Mabuchi K, Itoman M. Morphologic differences of the distal femur between Caucasian and Japanese women. J Orthop Surg (Hong Kong) 2008; 16 (03) 312-315
18 Hussain F, Abdul Kadir MR, Zulkifly AH. , et al. Anthropometric measurements of the human distal femur: a study of the adult Malay population. BioMed Res Int 2013; 2013: 175056
19 Vaidya SV, Ranawat CS, Aroojis A, Laud NS. Anthropometric measurements to design total knee prostheses for the Indian population. J Arthroplasty 2000; 15 (01) 79-85
20 Puthumanapully PK, Harris SJ, Leong A, Cobb JP, Amis AA, Jeffers J. A morphometric study of normal and varus knees. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 2891-2899
21 Iorio R, Siegel J, Specht LM, Tilzey JF, Hartman A, Healy WL. A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty: is digital templating accurate and safe?. J Arthroplasty 2009; 24 (02) 175-179
22 Gandhi RR, Manzotti A, Confalonieri N, Cerveri P. Comparison of CT-based patient-specific templating and digital radiography templating in total knee arthroplasty. J Arthrosc Jt Surg 2016; 3 (01) 17-21
23 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22 (04) 233-236
24 Abbott T, White SM, Pandit JJ. Factors affecting the profitability of surgical procedures under ‘Payment by Results’. Anaesthesia 2011; 66 (04) 283-292
25 Ricketts D, Hartley J, Patterson M, Harries W, Hitchin D. An orthopaedic theatre timings survey. Ann R Coll Surg Engl 1994; 76 (03) 200-204
26 Farrelly JS, Clemons C, Witkins S. , et al. Surgical tray optimization as a simple means to decrease perioperative costs. J Surg Res 2017; 220: 320-326
27 Stockert EW, Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg 2014; 219 (04) 646-655
28 Dennis DA. Evaluation of painful total knee arthroplasty. J Arthroplasty 2004; 19 (04) (Suppl. 01) 35-40
29 Gonzalez MH, Mekhail AO. The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg 2004; 12 (06) 436-446
30 Babazadeh S, Dowsey MM, Swan JD, Stoney JD, Choong PFM. Joint line position correlates with function after primary total knee replacement: a randomised controlled trial comparing conventional and computer-assisted surgery. J Bone Joint Surg Br 2011; 93 (09) 1223-1231
31 Koninckx A, Deltour A, Thienpont E. Femoral sizing in total knee arthroplasty is rotation dependant. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 2941-2946
32 Lesh ML, Schneider DJ, Deol G, Davis B, Jacobs CR, Pellegrini Jr VD. The consequences of anterior femoral notching in total knee arthroplasty. A biomechanical study. J Bone Joint Surg Am 2000; 82-A (08) 1096-1101
33 Kelly MA. Patellofemoral complications following total knee arthroplasty. Instr Course Lect 2001; 50: 403-407
34 Pearle AD, van der List JP, Lee L, Coon TM, Borus TA, Roche MW. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up. Knee 2017; 24 (02) 419-428
35 Lee GC, Cushner FD, Scuderi GR, Insall JN. Optimizing patellofemoral tracking during total knee arthroplasty. J Knee Surg 2004; 17 (03) 144-149
36 Bellemans J, Banks S, Victor J, Vandenneucker H, Moemans A. Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg Br 2002; 84 (01) 50-53
37 Altintas F, Sener N, Ugutmen E. Fracture of the tibial tray after total knee arthroplasty. J Arthroplasty 1999; 14 (01) 112-114
38 Bonnin MP, Schmidt A, Basiglini L, Bossard N, Dantony E. Mediolateral oversizing influences pain, function, and flexion after TKA. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2314-2324
39 Mahoney OM, Kinsey T. Overhang of the femoral component in total knee arthroplasty: risk factors and clinical consequences. J Bone Joint Surg Am 2010; 92 (05) 1115-1121
40 Fehring TK, Fehring KA, Anderson LA, Otero JE, Springer BD. Catastrophic varus collapse of the tibia in obese total knee arthroplasty. J Arthroplasty 2017; 32 (05) 1625-1629
41 The B, Diercks RL, van Ooijen PM, van Horn JR. Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees. Acta Orthop 2005; 76 (01) 78-84