Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan.
Wayne State University School of Medicine, Detroit, Michigan.
J Knee Surg. 2023 Jul;36(8):837-842. doi: 10.1055/s-0042-1743496. Epub 2022 Mar 3.
Templating prior to total hip arthroplasty is a widely adopted practice that aims to improve operative efficiency and reduce clinical outliers. Predicting implant size before total knee arthroplasty (TKA), although less common, could increase operating room efficiency by reducing necessary equipment needed for the procedure. This study compared templating accuracy in TKA using two-dimensional (2D) digital radiographs to a novel imaging technology that generates a three-dimensional (3D) model from these 2D radiographs. Two hundred and two robotic-assisted primary TKA surgical cases using Persona Knee System (Zimmer Biomet, Warsaw, IN) were retrospectively analyzed. For all cases, 3D templating was completed preoperatively using a novel radiographic image acquisition protocol. Using the same radiographs, the knee was templated using a 2D digital templating program. All surgeons were blinded to the final implant sizes, and all templating was done independently. The accuracy of predictions within ± 1 from the final implant size was determined for the femoral and tibial components. The accuracy (within 1 size) of tibial size predictions was comparable between attending surgeons and residents (87 vs. 82%, = 0.08), but attending surgeons more accurately predicted the femoral size (77 vs. 60%, < 0.05). The 2D to 3D imaging technology more accurately predicted both tibial and femoral sizes compared with the attending surgeons (99.5 vs. 87%, < 0.05; 84% vs. 77%, < 0.05). However, the imaging technology, attending surgeons, and residents were all more likely to overestimate femur size ( < 0.05). Moreover, the 3D imaging technology predicted the exact tibial component size in 93.1% of cases, which was significantly greater compared with residents (40%, < 0.01) and attending surgeons (53%, < 0.01). The 2D to 3D imaging technology more accurately predicted tibial and femoral component sizes compared with 2D digital templating done by surgeons. All templating predictions were more accurate for the tibial implant size than for the femoral size. The increased accuracy of implant size predictions from this 3D templating technology has the potential to improve intraoperative efficiency and minimize costs and surgical time.
在全髋关节置换术前进行模板设计是一种广泛采用的做法，旨在提高手术效率并减少临床异常值。虽然在全膝关节置换术（TKA）前预测植入物大小的情况较少，但通过减少手术所需的必要设备，可提高手术室效率。本研究比较了使用二维（2D）数字射线照相术进行 TKA 模板设计的准确性，以及一种从这些 2D 射线照相术中生成三维（3D）模型的新型成像技术。回顾性分析了 202 例使用 Persona Knee System（Zimmer Biomet，印第安纳州华沙）进行的机器人辅助初次 TKA 手术病例。对于所有病例，均使用新型射线照相图像采集方案在术前完成 3D 模板设计。使用相同的射线照相，使用 2D 数字模板程序对膝关节进行模板设计。所有外科医生均对最终植入物大小、以及所有模板设计均为独立进行不知情。确定股骨和胫骨部件的最终植入物大小的预测值在 ±1 以内的准确性。在胫骨大小预测方面，主治医生和住院医师的准确性（在 1 个尺寸内）相当（87%比 82%， = 0.08），但主治医生更准确地预测了股骨尺寸（77%比 60%， < 0.05）。与主治医生相比，2D 至 3D 成像技术更准确地预测了胫骨和股骨尺寸（99.5 比 87%， < 0.05；84%比 77%， < 0.05）。然而，成像技术、主治医生和住院医师都更有可能高估股骨尺寸（ < 0.05）。此外，3D 成像技术在 93.1%的病例中准确预测了胫骨组件的尺寸，明显高于住院医师（40%， < 0.01）和主治医生（53%， < 0.01）。与外科医生进行的 2D 数字模板设计相比，2D 至 3D 成像技术更准确地预测了胫骨和股骨组件的尺寸。与股骨植入物尺寸相比，所有模板设计对胫骨植入物尺寸的预测更准确。这种 3D 模板技术对植入物尺寸预测的准确性提高，有可能提高手术室内效率并最小化成本和手术时间。
