title: Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA.
abstract: BACKGROUND
  Coronal malalignment occurs frequently in TKA and may affect implant durability and knee function. Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA.
  
  
  OBJECTIVE
  We compared the effectiveness of patient-specific positioning guides to manual instrumentation with intramedullary femoral and extramedullary tibial guides in restoring the mechanical axis of the extremity and achieving neutral coronal alignment of the femoral and tibial components.
  
  
  METHODS
  We retrospectively reviewed 569 TKAs performed with patient-specific positioning guides and 155 with manual instrumentation by two surgeons using postoperative long-leg radiographs. For all patients, we assessed the zone in which the overall mechanical axis passed through the knee, and for one surgeon's cases (105 patient-specific positioning guide, 55 manual instrumentation), we also measured the hip-knee-ankle angle and the individual component angles with respect to their mechanical axes.
  
  
  RESULTS
  The overall mechanical axis passed through the central third of the knee more often with patient-specific positioning guides (88%) than with manual instrumentation (78%). The overall mean hip-knee-ankle angle for patient-specific positioning guides (180.6°) was similar to manual instrumentation (181.1°), but there were fewer ± 3° hip-knee-ankle angle outliers with patient-specific positioning guides (9%) than with manual instrumentation (22%). The overall mean tibial (89.9° versus 90.4°) and femoral (90.7° versus 91.3°) component angles were closer to neutral with patient-specific positioning guides than with manual instrumentation, but the rate of ± 2° outliers was similar for both the tibia (10% versus 7%) and femur (22% versus 18%).
  
  
  CONCLUSIONS
  Patient-specific positioning guides can assist in achieving a neutral mechanical axis with reduction in outliers.
authors.affiliation: Department of Orthopaedics, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Vincent Y
authors.initials: VY
authors.lastname: Ng
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: DeClaire
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
authors.forename: Bethany C
authors.initials: BC
authors.lastname: Gulick
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017760:Bone Malalignment / Q000517:prevention & control*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation* / Q000379:methods; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D056888:Patient Positioning / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome