Improved Accuracy of Alignment With Patient-specific Positioning Guides Compared With Manual Instrumentation in TKA

TLDR

Coronal malalignment frequently occurs in total knee arthroplasty and can compromise implant durability and knee function. The study aimed to compare the effectiveness of patient‑specific positioning guides versus manual instrumentation in restoring the mechanical axis and achieving neutral coronal alignment in TKA. Researchers retrospectively reviewed postoperative long‑leg radiographs of 569 patient‑specific guide TKAs and 155 manual instrumentation TKAs, measuring the mechanical axis zone and component angles. Patient‑specific guides produced a higher proportion of central‑third mechanical axis alignment (88% vs 78%) and fewer ±3° hip‑knee‑ankle outliers (9% vs 22%), while component angles were closer to neutral but outlier rates were similar.

Abstract

Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA.We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components.We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes.The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3° hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9° versus 90.4°) and femoral (90.7° versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the rate of ± 2° outliers was similar for both the tibia (10% versus 7%) and femur (22% versus 18%).Patient-specific positioning guides can assist in achieving a neutral mechanical axis with reduction in outliers.