The Journal of Bone and Joint Surgery (American). 2009;91:69-76.
doi:10.2106/JBJS.H.01448
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Unicompartmental Knee Arthroplasty with Use of Novel Patient-Specific Resurfacing Implants and Personalized Jigs

Wolfgang Fitz, MD1

1 Orthopedic and Arthritis Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, 850 Boylston Street, Chestnut Hill, MA 02467. E-mail address: wfitz{at}partners.org

Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. The author or a member of his immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (ConforMIS and DePuy Orthopaedics). Also, a commercial entity (DePuy Orthopaedics) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

This paper describes the surgical technique with a patient-specific resurfacing unicompartmental knee arthroplasty. The patient-specific implant is currently designed on the basis of data from preoperative computed tomography. The implant is provided with a set of patient-specific, disposable cutting jigs. Biomechanical and anatomic axes are factored into jigs from a scan obtained through the hip, knee, and ankle, effectively achieving pre-navigation of the cut planes without the need for a navigation system. The surgical technique is reduced to five simple, reproducible steps. After removing the articular cartilage, the knee is balanced to determine the correct amount of tibial resection; this is followed by femoral preparation, verification of balancing and tibial preparation, and trial and cementing of the implant. The introduction of personalized three-dimensional image-derived resurfacing implants, as well as personalized single-use instrumentation, has the potential to change the common surgical practice of unicompartmental knee arthroplasty. Patient-specific resurfacing implants enable a femoral bone-preserving approach and enhance cortical bone support on the tibia, overcoming critical design limitations of commercial off-the-shelf implants. Patient-specific resurfacing implants can restore normal anatomy, the position of the joint line, and normal joint function, with the potential to result in more normal knee kinematics.


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