Sathikumar Aravind Sai, Jacob George, Varghese Jacob, Mathew Vivek
Department of Orthopaedics, Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital, Lakeshore Hospital and Research Centre Ltd., Kochi, Kerala, India.
Department of Endocrinology, VPS Lakeshore Hospital, Lakeshore Hospital and Research Centre Ltd., Kochi, Kerala, India.
J Orthop Case Rep. 2023 Aug;13(8):84-88. doi: 10.13107/jocr.2023.v13.i08.3826.
Patients with Paget's disease develop abnormal bony anatomy which can result in significantly altered lower limb alignment predisposing them to early secondary osteoarthritis. Due to the severe extra-articular deformity, total knee arthroplasty (TKA) in these patients is challenging. Conventional knee arthroplasty using intramedullary guides is not an option and can lead to erroneous limb alignment postoperatively. Patient-specific instrumentation (PSI) is a simple solution in such complex primary knee arthroplasty.
A 70-year-old male patient presented with a severe left femur deformity and left knee pain. He was diagnosed to have monostotic Paget's disease of the left femur with tricompartmental osteoarthritis of the left knee. After reduction in pathological bone turnover, the patient was planned for a total knee replacement. As a standard intramedullary femoral jig was not applicable due to the femoral deformity, a computed topography-based 3D-printed patient-specific instrument was used. This custom jig was used to define and perform the distal femur cut at 90 degrees to the mechanical axis of the femur in the coronal and sagittal plane. Postoperatively, the patient did well and achieved good function and pain relief.
The use of a 3D-printed PSI for complex primary knee arthroplasty is an excellent option with no additional operative time than a conventional knee arthroplasty. Although a robotic or computer-navigated TKA would be an excellent option in this case, we restored the limb alignment using a cost-effective patient-specific femoral jig. This could be a viable option in centers without navigation or robotic arthroplasty.
佩吉特病患者会出现异常的骨骼解剖结构，这可能导致下肢力线显著改变，使他们易患早期继发性骨关节炎。由于严重的关节外畸形，这些患者的全膝关节置换术（TKA）具有挑战性。使用髓内导向器的传统膝关节置换术不可行，且可能导致术后肢体力线错误。在这种复杂的初次膝关节置换术中，患者特异性器械（PSI）是一个简单的解决方案。
一名70岁男性患者，有严重的左股骨畸形和左膝疼痛。他被诊断为左股骨单骨型佩吉特病伴左膝三关节骨关节炎。在病理性骨转换降低后，计划为该患者进行全膝关节置换。由于股骨畸形，标准的髓内股骨夹具不适用，因此使用了基于计算机断层扫描的3D打印患者特异性器械。这个定制夹具用于在冠状面和矢状面与股骨机械轴成90度角处确定并进行股骨远端截骨。术后，患者情况良好，功能恢复良好，疼痛缓解。
在复杂的初次膝关节置换术中使用3D打印的PSI是一个很好的选择，与传统膝关节置换术相比，不增加额外的手术时间。尽管在这种情况下，机器人辅助或计算机导航的TKA会是一个很好的选择，但我们使用了具有成本效益的患者特异性股骨夹具恢复了肢体力线。在没有导航或机器人辅助关节置换术的中心，这可能是一个可行的选择。
