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2D versus 3D templating in total knee arthroplasty.

Max Ettinger1, Leif Claassen1, Peter Paes1

  • 1Department of Orthopedic Surgery, Hannover Medical School, Hanover, Germany.

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Summary
This summary is machine-generated.

Three-dimensional (3D) templating accurately predicts total knee arthroplasty (TKA) implant size. Two-dimensional (2D) templating offers approximate size prediction, enabling template-directed instrumentation with less surgeon experience.

Keywords:
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Area of Science:

  • Orthopedic Surgery
  • Medical Imaging
  • Arthroplasty Design

Background:

  • Preoperative digital templating in total knee arthroplasty (TKA) aids in planning bony resections and anticipating intraoperative strategies.
  • Patient-specific instrumentation (PSI) templating is a novel approach, with limited comparative data against traditional 2D planning.

Purpose of the Study:

  • To compare the accuracy of 3D MRI-based templating with 2D digital templating for TKA implant size prediction.
  • To evaluate the reliability of 2D templating for guiding template-directed instrumentation (TDI).

Main Methods:

  • 94 patients undergoing unilateral primary TKA were analyzed using MRI-based 3D templating and PSI cutting blocks.
  • Three independent observers performed 2D digital templating on standard preoperative X-rays, blinded to intraoperative component sizes.

Main Results:

  • 3D templating achieved 100% accuracy in predicting the correct implant size.
  • 2D templating showed variable accuracy for exact size prediction (43.6%-68%), but high accuracy (93.6%-98.9%) when allowing a ±1 size difference.
  • High inter-observer agreement was observed, indicating reliable results across different users.

Conclusions:

  • 3D templating demonstrates superior accuracy for precise TKA implant size prediction.
  • 2D digital templating is a sufficiently accurate method for approximate size determination (±1 size) and can support template-directed instrumentation.
  • 2D templating may allow surgeons with less experience to confidently plan TKA procedures.