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Safe and Accurate Utilization of Patient Specific Instrumentation in Total Knee Arthroplasty

March 01, 2013

Contributors: Mark Aaron Yaffe, MD; Raju S. Ghate, MD; S David Stulberg, MD; Anay R. Patel, MD; Anay R. Patel, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

Patient specific Instrumentation (PSI) is an emerging total knee arthroplasty (TKA) technology that utilizes advanced imaging modalities to create 3-D models of a patient's unique anatomy. This model is then used in conjunction with computer software to preoperatively determine boney resection, implant sizing, and implant placement. Intraoperatively, the PSI technology efficiently and accurately reproduces the preoperative plan. We believe that the proper use of the PSI requires proper exposure, proper guide placement, and accurate boney resection. All three of these objectives can be achieved by honoring traditional methods and using traditional tools, such as extramedullary guides, calipers, and styluses. In this video, we describe our preferred technique for using PSI in TKA. The technique emphasizes the methods for confirming proper guide placement and verifying proper boney resection. We also present our initial data, which indicates that PSI appears to be fulfilling its potential as a method to perform accurate and efficient TKA in an instrument-conserving manner. Our data indicates that PSI accurately predicts the final femoral component size in more than 90% of cases. On average, all our boney resections have been within 1 mm of the planned surgical resection. We achieved coronal alignment within 3 degrees of a neutral mechanical axis in 86% percent of our patients. The anterior femoral cut was flush in 97% of patients, and the planning software's assessment of Whiteside's Line was congruent with the surgeon's assessment of Whiteside's Line in 97.8 % of our patients. Patient specific instrumentation is a promising technology in TKA. However, the potential of this new technology depends on precise and conscientious application of proper technique based on fundamental surgical principles.

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