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Outcome Validation of a Simulation Based Patient Specific TKA Planning Tool

5 pagesPublished: September 26, 2020

Abstract

Dynamic knee computer simulations are a promising surgical planning option in TKA, allowing the impact of plan alterations on joint dynamics to be analysed prior to surgery. Previously, the dynamic results of our simulation have been shown to correlate with outcome; here we show validation of its use in pre-operative planning.
A database of TKA Patients undergoing surgery from 1-Jan-2014 operated on by 9 surgeons, who received a pre-operative and post-operative CT were assessed. A musculoskeletal computational model with similar boundary conditions to the Oxford Knee Rig was used to simulate post-TKA knee dynamics using Adams MSC software (Newport, CA). In addition, a set of pre-operative simulations were generated covering positional variations. The Dynamic Knee Score (DKS), a predictive algorithm machine learned from KOOS scored postoperative cases to predict outcome in preoperative planning was applied to all simulations.
Patients were split into groups depending on whether the ‘post-operative achieved position’ was the ‘best’ of the preoperative modelled options in terms of simulated DKS score or not. These results were compared with 12 month postoperative KOOS scores. Cases where the best plan was followed had better outcome results. A relationship was shown with the KOOS Pain subscore, with the portion of patients below a KOOS Pain score of 70 dropping to 11% from 16% (p=0.030) when the best plan was followed.
This study shows significant relationships between selection of patient specific kinematically optimal surgical plan and outcome. Such tools will play an important role in future patient specific decision making.

Keyphrases: PROMS, simulation, Total knee arthroplasty, Validation

In: Ferdinando Rodriguez Y Baena and Fabio Tatti (editors). CAOS 2020. The 20th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 4, pages 259--263

Links:
BibTeX entry
@inproceedings{CAOS2020:Outcome_Validation_of_Simulation,
  author    = {Joshua Twiggs and Justin Roe and Brett Fritsch and David Parker and Brad Miles},
  title     = {Outcome Validation of a Simulation Based Patient Specific TKA Planning Tool},
  booktitle = {CAOS 2020. The 20th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Ferdinando Rodriguez Y Baena and Fabio Tatti},
  series    = {EPiC Series in Health Sciences},
  volume    = {4},
  pages     = {259--263},
  year      = {2020},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {https://easychair.org/publications/paper/RqMC},
  doi       = {10.29007/3mvp}}
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