Computed tomography (CT) can be utilized to design patient specific instruments (PSI) for total knee arthroplasty (TKA). The PSI preoperative plans predict bone resection, anterior-posterior implant position, implant rotation and implant size. The purpose of this study was to compare preoperatively predicted implant sizes (tibia and femur) to the actual implanted sizes. Data were compiled from two surgeons, one in the United Kingdom (Surgeon 1, cruciate retaining) and one in the United States (Surgeon 2, posterior stabilizing). Both used the same primary TKA implant systems (Sigma® and Attune®; DePuySynthes®, Warsaw, Indiana). This is the largest comparison of CT-based PSI size accuracy between two implant systems. An international cohort of 396 CT-based PSI-TKA preoperative plans (TruMatch®)were compared to postoperative implant records. Data were retrospectively analyzed for Sigma®(n=351) and Attune® (n=45), both as separate cohorts and as a combined cohort (Sigma® + Attune®). Three analyses were performed: Tibia and femur plan accuracy, major size changes (femoral size change or tibial size change resulting in a femoral size change) and minor size changes (tibial size change not impacting femoral size). Inter-rater reliability analyses using ICC (intra-class correlation) and the Kappa statistic were performed to determine reliability and agreement among the groups. Combined TKA implant data (Sigma® + Attune®) for surgeons 1 and 2 were compared for accuracy between users utilizing different implant designs, cruciate retaining (CR) versus posterior stabilized (PS).Introduction
Methods
