1. Retrospektive Studie zur Planungsgenauigkeit bei Implantation einer Persona-Knietotalendoprothese
- Author
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Gutsche, Alexander Ernst Joseph
- Subjects
planning accuracy ,total knee arthroplasty ,Knietotalendoprothese ,Einflussfaktoren ,Planungsgenauigkeit ,factors of influence - Abstract
Hintergrund und Ziele: Die präoperative Planung ist von wesentlicher Bedeutung, um optimale Ergebnisse im Hinblick auf die Implantatgröße und -ausrichtung zu erreichen. Ziel dieser Arbeit ist die Genauigkeit der digitalen Planung und Implantation einer Persona®- Knietotalendoprothese am Kepler Universitätsklinikum Linz herauszufinden. Außerdem sollen mögliche Einflussfaktoren (Erfahrungsniveau des Operateurs, Body-Mass-Index, Geschlecht und Alter) untersucht werden. Methodik: In dieser retrospektiven Studie wurden alle Patienten, denen im Zeitraum vom 01.01.2018 bis zum 31.12.2018 eine Persona®-Knietotalendoprothese implantiert wurde, untersucht. Zur Analyse wurden Arztbriefe, Anästhesieprotokolle, Operationsprotokolle und Röntgenaufnahmen aus den Krankenhausakten sowie die Planungssoftware mediCAD® Classic V6.0 verwendet. Die statistische Signifikanzprüfung erfolgte mittels T-Test, Mann-Whitney-U- Test und Kruskal-Wallis-Test. Ergebnisse: Das Auswertungskollektiv umfasste insgesamt 331 Patienten. Es wurden 109 (32,9%) männliche und 222 (67,1%) weibliche Patienten untersucht. Das Durchschnittsalter zum Operationszeitpunkt betrug 70,0 Jahre (Minimum 37 Jahre; Maximum 91 Jahre; SD 9,4 Jahre). Im Hinblick auf die Planungsgenauigkeit der Komponentengröße haben sich Unterschiede zwischen Femur- und Tibiakomponente herausgestellt. Während die Tibiakomponente sehr genau geplant wurde (93,4%), gab es bei der Femurkomponente weniger Übereinstimmungen (55,7%). Die Ausrichtungsgenauigkeit wurde anhand des mechanischen medialen proximalen Tibiawinkels (mMPTW) und des mechanisch lateralen distalen Femurwinkels (mLDFW) gemessen. Es zeigten sich vergleichbare Resultate (mMPTW: 89,5%; mLDFW: 81,3%). Die Planungs- und Implantationsgenauigkeit ist in Bezug auf die Ausrichtung ausreichend genau. Bei den Einflussfaktoren zeigte sich, dass das Erfahrungsniveau einen Einfluss auf die Ausrichtungsgenauigkeit hat. Ärzte mit größerer Erfahrung erreichen genauere Winkel. Ebenso zeigte sich beim Body-Mass-Index (BMI) eine negative Korrelation zwischen Ausrichtungsgenauigkeit und erhöhtem BMI. Außerdem konnten Unterschiede zwischen den Geschlechtern im Hinblick auf die Genauigkeit festgestellt werden. Das Alter war jedoch kein relevanter Einflussfaktor. Schlussfolgerung: Die Planung ist ein essentieller Bestandteil bei der Implantation einer Knietotalendoprothese. Das Ziel ist es, eine möglichst hohe Genauigkeit zu erreichen, um postoperative Komplikationen zu minimieren und ein optimales Ressourcenmanagment zu erreichen. Zur Verbesserung künftiger Planungen und Operationen könnten zum Beispiel Demographie-basierte Modelle und roboterassistierte Navigation eingesetzt werden. Background: Preoperative planning is substantial in order to reach optimal results in terms of size of implant and alignment. The aim of this study is to find out the accuracy in planning and implantation of the Persona® total knee arthroplasty at the “Kepler Universitätsklinikum” Linz. Moreover, other potential factors of influence (physicians’ experience, body mass index, gender, age) should be investigated. Methods: This retrospective study contains all patients, who received a Persona® total knee arthroplasty from 01.01.2018 to 31.12.2018. For the analysis physicians’ documentations, intra- operative records, X-rays, as well as reports of the anesthetists and the planning-tool medCAD® Classic V6.0 were used. The statistical analysis is based on the T-Test, Mann-Whitney-U-Test and the Kruskal-Wallis-Test. Results: The collective comprised 331 patients. 109 (32,9%) were male and 222 (67,1%) were female. The mean age was 70,0 years (minimum 37 years; maximum 91 years, SD 9,4 years). Concerning the planning accuracy of the component size, there were to be found differences between the femoral and tibial component. While the tibial component size was very accurate (93,4%), the accuracy of the femoral component size was significantly lower (55,7%). The component alignment is determined by the mechanical medial proximal tibial angle (mMPTW) and the mechanical lateral distal femoral angle (mLDFW). There were comparable results concerning those angles (mMPTW: 89,5%; mLDFW: 81,3%). All in all, the planning accuracy of the alignment is given. With regard to the factors of influence, it has become obvious that the physicians’ experience has an effect on the accuracy of alignment. Physicians with higher experience are more accurate. In addition to that, the body mass index had a significant impact on the alignment: The higher the BMI, the lower the accuracy. Moreover, a difference between male and female patients was detected. The age seems to be no factor of influence. Conclusion: Preoperative planning is an essential part in the process of implanting total knee arthroplasties. It is the intention to reach a maximum of accuracy in order to minimize post- operative complications and to allocate capabilities optimally. Beside the implementation of models containing demographical data, the use of robotic-assisted navigation can be a way to improve the accuracy. Background: Preoperative planning is substantial in order to reach optimal results in terms of size of implant and alignment. The aim of this study is to find out the accuracy in planning and implantation of the Persona® total knee arthroplasty at the “Kepler Universitätsklinikum” Linz. Moreover, other potential factors of influence (physicians experience, body mass index, gender, age) should be investigated. Methods: This retrospective study contains all patients, who received a Persona® total knee arthroplasty from 01.01.2018 to 31.12.2018. For the analysis physicians documentations, intra- operative records, X-rays, as well as reports of the anesthetists and the planning-tool medCAD® Classic V6.0 were used. The statistical analysis is based on the T-Test, Mann-Whitney-U-Test and the Kruskal-Wallis-Test. Results: The collective comprised 331 patients. 109 (32,9%) were male and 222 (67,1%) were female. The mean age was 70,0 years (minimum 37 years; maximum 91 years, SD 9,4 years). Concerning the planning accuracy of the component size, there were to be found differences between the femoral and tibial component. While the tibial component size was very accurate (93,4%), the accuracy of the femoral component size was significantly lower (55,7%). The component alignment is determined by the mechanical medial proximal tibial angle (mMPTW) and the mechanical lateral distal femoral angle (mLDFW). There were comparable results concerning those angles (mMPTW: 89,5%; mLDFW: 81,3%). All in all, the planning accuracy of the alignment is given. With regard to the factors of influence, it has become obvious that the physicians experience has an effect on the accuracy of alignment. Physicians with higher experience are more accurate. In addition to that, the body mass index had a significant impact on the alignment: The higher the BMI, the lower the accuracy. Moreover, a difference between male and female patients was detected. The age seems to be no factor of influence. Conclusion: Preoperative planning is an essential part in the process of implanting total knee arthroplasties. It is the intention to reach a maximum of accuracy in order to minimize post- operative complications and to allocate capabilities optimally. Beside the implementation of models containing demographical data, the use of robotic-assisted navigation can be a way to improve the accuracy. eingereicht von Alexander Gutsche Masterarbeit Universität Linz 2021
- Published
- 2021