Comparison of Postoperative Coronal Leg Alignment in Customized Individually Made and Conventional Total Knee Arthroplasty

Neutral coronal leg alignment is known to be important for postoperative outcome in total knee arthroplasty (TKA). Customized individually made implants (CIM) instrumented with patient-specific cutting guides are an innovation aiming to increase the precision and reliability of implant positioning and reconstruction of leg alignment. We aimed to compare reconstruction of the hip-knee-ankle angle (HKA) of the novel CIM system iTotal (TM) CR G2 (ConforMIS Inc.) to a matched cohort of the off-the-shelf (OTS) knee replacement system Vanguard (TM) CR (Zimmer Biomet). Retrospective analysis of postoperative coronal full-leg weight-bearing radiographs of 562 TKA (283 CIM TKA, 279 OTS TKA) was conducted. Via a medical planning software, HKA and rotation of the leg were measured in postoperative radiographs. HKA was then adjusted for rotational error, and 180 degrees +/- 3 degrees varus/valgus was defined as the target zone HKA. Corrected postoperative HKA in the CIM group was 179.0 degrees +/- 2.8 degrees and 179.2 degrees +/- 3.1 degrees in the OTS group (p = 0.34). The rate of outliers, outside of the +/- 3 degrees target zone, was equal in both groups (32.9%). Our analysis showed that TKA using patient-specific cutting guides and implants and OTS TKA implanted with conventional instrumentation resulted in equally satisfying restoration of the coronal leg alignment with less scattering in the CIM group.

Automated summary

This study compared the reconstruction of the hip-knee-ankle angle in total knee arthroplasty using patient-specific cutting guides and implants to off-the-shelf knee replacement system, and found that the former resulted in equally satisfying restoration of the coronal leg alignment with less scattering.