Technical note
The use of a reconstructed three-dimensional solid model from CT to aid the surgical management of a total knee arthroplasty: a case study

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Abstract

The use of a rapid prototyping method was utilised to produce a pre-operative solid model of the proximal tibia in a patient with a massive defect of the medial tibial plateau. The solid model was reconstructed from aligned sequential CT images of the knee. This was then used to determine the level of bone resection of the proximal tibia for the optimum placement of the tibial component of a total knee replacement. This technique gives the surgeon both the three-dimensional anatomical information needed to ascertain whether there is adequate bony support after cutting for the prosthesis, as well as a solid model on which to carry out the proposed surgery, before undertaking the procedure on the patient.

Introduction

Reconstructing the knee with the aid of a prosthesis in patients with gross degenerative changes and large bone loss presents many challenges to the orthopaedic surgeon, therefore any aid in the pre-operative planning would enhance the outcome of this form of surgery. Plane radiographs give little insight into the bone geometry in all three dimensions, especially the geometry of the cortex at the potential plane of resection.

The use of three-dimensional (3D) reconstructed images from CT for the assessment and planning of complex hip pathologies has been investigated and is reported in the literature [1], [2], [3], [4], [5] and has been shown to be helpful in the planning of surgery. More recently, the production of physical models of the bone-deficient or dysplastic acetabulum using data generated from CT scans has been used in the computer-aided design and manufacture of implants [6]. The successful production of custom-made femoral components in total hip replacements has been also been reported [7], [8], [9] as well as the use of 3D models in complex cranio-facial surgery. However, their use in the reconstruction of complex bone shapes around the knee has not been reported.

Section snippets

Materials and methods

The patient was a 60 year old lady with a long history of rheumatoid arthritis which first presented at the age of 15 with deformity of the fingers. She had a Benjiman’s double osteotomy of the left knee at 27 because of the potential of subluxation, and a synovectomy of the right knee at 35. The left knee progressively became more varus and unstable and she presented at the age of 59, wheelchair bound with a grossly unstable and deformed left knee (Fig. 1). She was considered for total knee

Post-operative management and follow up

Clinically the post-operative period was uneventful, however, post-operative check radiograph the following day did reveal a vertical fracture of the shaft of the tibia which was thought to have occurred at some point during the peri-operative period and was felt to be most probably due to the marked rheumatoid arthritis and disuse as no traumatic event had been noted.

This did alter the normal post-operative regime of early mobilisation and was treated with 6 weeks in a full leg length splint

Discussion

The technique described above provides detailed information of the bone morphology in the region of the intended surgery and facilitated prediction of the level of transection of the deformed tibia at a level best suited to supporting the prosthesis. In addition, it provided a model on which the planned surgery could be carried out, before ever reaching the patient. This degree of pre-operative information is extremely useful, and should there have been insufficient bone at the proposed level

References (11)

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