Bone Preservation in a Novel Patient Specific Total Knee Replacement.
DOI:
https://doi.org/10.15438/rr.6.1.133Keywords:
Total knee arthroplasty, bone resection, bone preservation, patient-specific implantAbstract
Background: The volume of total knee arthroplasty procedures is growing rapidly and, correspondingly, it is expected that the volume of revision procedures will grow rapidly as well. Revision surgery is most successful when adequate bone remains on both the tibia and femur to allow for the least invasive revision.
We hypothesized that total knee arthroplasty with a patient-specific implant would result in significant bone preservation as compared to standard total knee arthroplasty with “off-the-shelf” implants.
Methods: We evaluated 100 total knee arthroplasties which utilized patient-specific implants, versus 37 standard posterior stabilized and 32 standard posterior cruciate retaining total knee arthroplasties. Bone resection was quantified utilizing intra-operative measurements of actual resected bone. Additionally we performed a virtual, CAD-based analysis of resections via CT imaging on 15 knees.
Findings: We found that patients had significantly less bone resected in all zones measured, on both the femur and tibia, when patient-specific implants with patient-specific jigs were used. When assessed volumetrically with CAD imaging, standard implants resected 12-49% more bone than did patient-specific implants, depending on the size of the implant utilized.
Interpretations: Utilizing patient-specific implants in total knee arthroplasty results in significant bone sparing as compared to standard total knee arthroplasty. This has the potential for less invasive revision surgery in the future, possibly obviating the need for dedicated revision implants or augments and other bone substituting devices.
References
S. Kurtz, K. Ong, E. Lau, F. Mowat, M. Halpern, Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030, J. Bone Joint Surg. Am. 89 (2007) 780-785.
M.A. Mont, T.M. Seyler, P.S. Ragland, R. Starr, J. Erhart, A. Bhave, Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty, J Arthroplasty 22 (2007) 100-108
D.L. Bartel, V.L. Bicknell, T.M. Wright, The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement, J. Bone Joint Surg. Am. 68 (1986) 1041-1051
R.A. Bojarski, R. Ketelholn, B.S. Parsley, J.E. Slamin, Optimizing knee femoral component strength and bone preservation with finite element analysis, 58th Annual Meeting of the Orthopedic Research Society (2012) Poster No. 1042
W.A. Hodge, Intraoperative assessment of bone cuts to guide surgical technique during total knee arthroplasty, J. Bone Joint Surg. Am. 89 (2007) 137-43
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 William B. Kurtz, John E. Slamin, Scott W. Doody

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.