Digital Orthopedic Technology In Total Knee Arthroplasty: Clinical Application And Related Basic Research

The mainly purpose of digital orthopedic used in total knee arthroplasty (TKA) isimprovement of the accuracy of TKA surgery which include improving the accuracyof the prosthesis position, recovery postoperative limb alignment, reducing surgicaltrauma, and then improving knee function and increasing survival time of prosthesis.Long-term clinical follow-up results showed that postoperative limb alignment wasthe key factor for functional recovery and long-term survival of the prosthesis. Butrestoring limb alignment depends on the correct position of the prosthesis and goodsoft tissue balance. For a surgeon, in order to get a successful surgery, the first step isto complete an accurate cutting of femoral and tibial bone. If the bone is not cuttedaccurately, it means that the prosthesis will be positioned inaccurately and soft tissuebalance, restoring limb alignment and getting long-term survival of the prosthesiswill be also out of the question. The first part of the study was designed to analyzethree tibial axis reference lines including the anterior tibial cortex (ATC) line, thefibular line (FL), and the anatomical axis of tibia (AAT) line, to determine which linemost closely parallels the mechanical axis (MA) of the tibia in the sagittal plane usingthree-dimensional reconstruction of CT scans.The clinical relevance of the study isthat through finding a reliable landmark on the leg, a surgeon may minimize posteriortibial slope measurement errors thereby and improving the technique for assuringproper alignment of total knee arthroplasty. The second part of the study was toevaluate the efficacy of computed-navigated total knee arthroplasty for the treatmentof osteoarthritis associated with severe valgus or femoral deformity.The third part wasabout how to design personalized femoral osteotomy guide in order to improve thedistal femoral osteotomy and rotational osteotomy accuracy. The results showed that FL was more closely parallel to the MA of tibia in the sagittal plane. TKA withcomputer navigation was a viable treatment option in treatment of knee osteoarthritis(OA) patients with severe valgus knee or deformity of the femur.It was feasible todesign patient-specific instruments using three-dimensional reconstruction of CT,computer-aided design technology, reverse engineering, and rapid prototypingthrough a combination of digital technology and total knee arthroplasy principles.