Guiding Device for the Patellar Cut in Total Knee Arthroplasty: Design and Validation

Bioengineering. 2018;5(2):38 DOI 10.3390/bioengineering5020038

 

Journal Homepage

Journal Title: Bioengineering

ISSN: 2306-5354 (Online)

Publisher: MDPI AG

LCC Subject Category: Technology | Science: Biology (General)

Country of publisher: Switzerland

Language of fulltext: English

Full-text formats available: PDF, HTML, XML

 

AUTHORS

Erica L. Rex (Biomedical Engineering and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 1N4, Canada)
Cinzia Gaudelli (Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada)
Emmanuel M. Illical (Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA)
John Person (Box 13 Engineering, Calgary, AB T3L 2P5, Canada)
Karen C. T. Arlt (Biomedical Engineering and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 1N4, Canada)
Barry Wylant (Q Industrial Design Corporation, Calgary, AB T2T 0E7, Canada)
Carolyn Anglin (Biomedical Engineering and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB T2N 1N4, Canada)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 6 weeks

 

Abstract | Full Text

An incorrect cut of the patella (kneecap) during total knee arthroplasty, affects the thickness in different quadrants of the patella, leading to pain and poor function. Because of the disadvantages of existing devices, many surgeons choose to perform the cut freehand. Given this mistrust of existing devices, a quick, but accurate, method is needed that guides the cut, without constraining the surgeon. A novel device is described that allows the surgeon to mark a line at the desired cutting plane parallel to the front (anterior) surface using a cautery tool, remove the device, and then align the saw guide, reamer, or freehand saw with the marked line to cut the patella. The device was tested on 36 artificial patellae, custom-molded from two shapes considered easier and harder to resect accurately, and eight paired cadaveric specimens, each in comparison to the conventional saw guide technique. The mediolateral angle, superoinferior angle, difference from intended thickness, and time were comparable or better for the new device. Addressing the remaining outliers should be possible through additional design changes. Use of this guidance device has the potential to improve patellar resection accuracy, as well as provide training to residents and a double-check and feedback tool for expert surgeons.