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Computer-assisted total knee replacement

A CONTROLLED CADAVER STUDY USING A MULTI-PARAMETER QUANTITATIVE CT ASSESSMENT OF ALIGNMENT (THE PERTH CT PROTOCOL)

Royal Perth Hospital, Selby St, Perth 6000, Western Australia.

S. Lloyd, CT, Superintendent; R. G. Scott, MBBS, Research Radiology Registrar; and W. Breidahl, FRANZCR, Consultant Radiologist

Perth Radiological Clinic, Rokeby Road, Perth 6008, Western Australia.

J. M. Sikorski, MD, Consultant Orthopaedic Surgeon

Hollywood Specialist Centre, Suite 8, 95 Monash Avenue, Perth 6009, Western Australia.

Correspondence should be sent to Mr S. K. Chauhan.

A controlled study, comparing computer- and conventional jig-assisted total knee replacement in six cadavers is presented. In order to provide a quantitative assessment of the alignment of the replacements, a CT-based technique which measures seven parameters of alignment has been devised and used. In this a multi-slice CT machine scanned in 2.5 mm slices from the acetabular roof to the dome of the talus with the subject’s legs held in a standard position. The mechanical and anatomical axes were identified, from three-dimensional landmarks, in both anteroposterior and lateral planes. The coronal and sagittal alignment of the prosthesis was then measured against the axes. The rotation of the femoral component was measured relative to the transepicondylar axis. The rotation of the tibial component was measured with reference to the posterior tibial condyles and the tibial tuberosity. Coupled femorotibial rotational alignment was assessed by superimposition of the femoral and tibial axial images. The radiation dose was 2.7 mSV.

The computer-assisted total knee replacements showed better alignment in rotation and flexion of the femoral component, the posterior slope of the tibial component and in the matching of the femoral and tibial components in rotation. Differences were statistically significant and of a magnitude that support extension of computer assistance to the clinical situation.

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