Although achieving precise implant alignment is crucial for producing good outcomes in total knee arthroplasty, the contribution of the bone-cutting process to overall variability has not been measured previously. Eight orthopaedic surgeons with varying amounts of total knee arthroplasty experience performed 85 resections on 19 cadaver femora and tibiae, and the planes of the resulting cut surfaces were compared with the guide planes. Varus-valgus alignment variability ranged from 0.4 degrees to 0.8 degrees SD for expert and trainee surgeons. Sagittal variability was approximately 1.3 degrees SD for both surgeon groups. Slotted cutting guides reduced the variability and eliminated the bias in the sagittal plane for experienced surgeons but did not improve significantly frontal plane alignment variability. Guide movement contributed 10% to 40% of the total cutting error, depending on cut and guide type.
Copyright 2002, Elsevier Science (USA).