Establishing a Customized Guide Plate for Osteotomy in Total Knee Arthroplasty Using Lower-extremity X-ray and Knee Computed Tomography Images

Background: The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty (TKA). This study investigated a customized guide plate for osteotomy placement in TKAs with the aid of the statistical shape model technique using weight-bearing lower-extremity X-rays and computed tomography (CT) images of the knee. Methods: From October 2014 to June 2015, 42 patients who underwent a TKA in Guizhou Provincial People's Hospital were divided into a guide plate group (GPG, 21 cases) and a traditional surgery group (TSG, 21 cases) using a random number table method. In the GPG group, a guide plate was designed and printed using preoperative three-dimensional measurements to plan and digitally simulate the operation. TSG cases were treated with the conventional method. Outcomes were obtained from the postoperative image examination and short-term follow-up. Results: Operative time was 49.0 +/- 10.5 min for GPG, and 62.0 +/- 9.7 min in TSG. The coronal femoral angle, coronal tibial angle, posterior tibial slope, and the angle between the posterior condylar osteotomy surface and the surgical transepicondylar axis were 89.2 +/- 1.7 degrees, 89.0 +/- 1.1 degrees, 6.6 +/- 1.4 degrees, and 0.9 +/- 0.3 degrees in GPG, and 86.7 +/- 2.9 degrees, 87.6 +/- 2.1 degrees, 8.9 +/- 2.8 degrees, and 1.7 +/- 0.8 degrees in TSG, respectively. The Hospital for Special Surgery scores 3 months after surgery were 83.7 +/- 18.4 in GPG and 71.5 +/- 15.2 in TSG. Statistically significant differences were found between GPG and TSG in all measurements. Conclusions: A customized guide plate to create an accurate osteotomy in TKAs may be created using lower-extremity X-ray and knee CT images. This allows for shorter operative times and better postoperative alignment than the traditional surgery. Application of the digital guide plate may also result in better short-term outcomes.