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@PHDTHESIS{Ehreiser:988379,
author = {Ehreiser, Sonja},
othercontributors = {Radermacher, Klaus and Stindel, Eric},
title = {{O}ptimization of patient matching in total knee
arthroplasty through improved implant sizing and detailed
fit assessment},
school = {Rheinisch-Westfälische Technische Hochschule Aachen},
type = {Dissertation},
address = {Aachen},
publisher = {RWTH Aachen University},
reportid = {RWTH-2024-06145},
pages = {1 Online-Ressource : Illustrationen},
year = {2024},
note = {Veröffentlicht auf dem Publikationsserver der RWTH Aachen
University; Dissertation, Rheinisch-Westfälische Technische
Hochschule Aachen, 2024},
abstract = {Total knee arthroplasty is one of the most performed
surgeries worldwide. Indicators of treatment success, such
as revision rates or patient satisfaction, are subject to
multiple influences, with implant design and associated
patient-specific implant fit being a relevant and variable
factor. A considerable discrepancy between implant and bone
shape in terms of size as well as individual morphologic
parameters has been reported for various populations. Such
mismatch can motivate the advising of a customized implant.
However, there is currently no standardized method to
support this decision, or for detailed assessment of knee
implant fit in general. Hence, the aim of this thesis was to
evaluate the potential for standard implant size
optimization and to develop methods for patient-specific
implant fit evaluation, with the goal of optimizing patient
matching in total knee arthroplasty. The possibility of
improved size matching through numerically optimized sizing
was demonstrated for a large database of over 85.000 knees.
With the numerically optimized sizes an increase in
population coverage of $19\%$ to $26\%$ compared to
representative existing implant systems was reached. The
need for further fit analysis beyond size was demonstrated
by an exemplary documentation of size-independent shape
variations using the femoral J-curve as an example, and by
relevant morphological deviations even in the case of an
ideal size fit. Many objective criteria for assessing
implant fit have been defined in the literature, which were
assigned to the categories interface, morphological,
alignment and other. As morphological criteria are defined
for the physiological, non-deformed knee morphology, a
parameter-based deformity correction was developed and
verified. Based on the analysis of existing imaging
procedures, concepts for the evaluation of the identified
criteria were defined. The chosen concept includes an
initial fit assessment based on standardized radiographs
and, if required, an additional detailed fit evaluation
using computed tomography data. The potential for clinical
integration was demonstrated in an exemplary implementation
with a high level of automation. The fit evaluation was
carried out for an exemplary implant and a large knee
database, demonstrating the workflows robustness. With the
implant size optimization and individual fit evaluation,
more patients can be provided with an adequate standard
implant and those requiring a customized implant identified
objectively, thereby maximizing patient matching.},
cin = {419410},
ddc = {620},
cid = {$I:(DE-82)419410_20140620$},
typ = {PUB:(DE-HGF)11},
doi = {10.18154/RWTH-2024-06145},
url = {https://publications.rwth-aachen.de/record/988379},
}
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