Clinical results of customized three-dimentional printing mold assisted simultaneous bilateral total knee placement

Abstract

Objective To observe advantages of simultaneous bilateral total knee arthroplasty (TKA) with three-dimentional(3D) printing osteotomy-guiding-plate and to analysis the actual significance of 3D printing technology in total knee arthroplasty. Methods From October 2014 to February 2015, the patients with osteoarthritis of knee joint were selected from inpatients of joint surgery department in Shenyang Orthopedic Hospital. The inclusion criteria were as follows: diagnosed as knee osteoarthritis(KOA); the symptoms were severe; classification of OA≥stage three; 60-75 years old without contraindication for surgery. Rheumatoid arthritis, traumatic arthritis, infection and cardiac or cerebrovascular diseases were excluded. Nineteen patients underwent bilateral total artificial knee arthroplasty with the help of personalized customized customized 3D printing mold(the 3D group), the other 20 patients who were selected by random number table underwent conventional total knee arthroplasty (the control group). The 3D group included 15 females and four males; the control group included 16 females and four males. The operation time, intraoperative blood loss, amount of post-operation drainage and occult bleeding volume were evaluated and compared between the 3D group and the control group with the same surgical approach. After the surgery, the two groups used the same rehabilitation program and medication regimen. A standardized follow-up was performed at three and six months postoperatively. The American Knee Society knee score(KSS) was used to evaluate the rehabilitation of knee joint function. Normalized lateral radiographs were taken to assess the angle between the femoral and tibial mechanical axes(MFTA), the angle between the anatomical axis of the femur and the tangent line of the femoral condyle in the coronal position(LDFA), the angle between the tibial anatomical axis and the tibial plateau tangent in the coronal position(MPTA), and the tibial posterior tilt angle in the sagittal plane(STCA). The differences between the two groups were compared by t test. Results There was no significant difference in age and sex between the two groups, and there was no statistical significance(P>0.05). In the comparison of operation time, the 3D group was (170.6±26.5) min, slightly longer than the control group(165.3±24.6)min, but not statistically significant(P>0.05). In the comparison of intraoperative blood loss(t=7.1177), amount of post-operation drainage(t=7.2297) and occult bleeding volume(t=27.3163), the 3D group were less than the control group, there were significant differences(all P 0.05). Conclusion TKA with customized 3D printing osteotomy guides has the advantages of individualization, precision, digitization, and minimal trauma compared with TKA using conventional tools; in particular, the use of customized 3D printing osteotomy guides plays a good supporting role in bilateral simultaneous TKA. Key words: Arthroplasty, replacement, knee; Printing, three dimentional