Patient-specific instrumentation in total knee arthroplasty. Should we adopt it?

Abstract

Total knee arthroplasty (TKA) is a surgical procedure of paramount relevance that restores a substantial degree of function in arthritic knees. Increased consideration has been given to the influence of limb alignment on longevity after TKA, as errors in component placement can be associated with inferior function and compromised long-term performance. Consequently, numerous studies comparing patient-specific instrumentation (PSI) to standard instruments (SI) have been published. Patient-specific approaches use preoperative imaging to create specific materials for each patient's anatomy and were designed to achieve a higher rate of success in TKA, causing the entire procedure to be more efficient and cost-effective. However, it is not clear to what degree these studies support the potential advantages of PSI. Thus, the present study aimed to review the current evidence comparing PSI to SI, concerning alignment, cost-effectiveness, and postoperative functional evaluation.

An Approach to Developing Customized Total Knee Replacement Implants

“…However, Rodrigues and Gutierres [ 5 ] reviewed comparison studies between patient-specific instrumentation (PSI) and standard instruments in TKR, and they noted that PSI had not consistently been shown to be cost-effective or to offer any clinical benefit with regard to functional scores. More studies and longer follow-up period are needed to make definitive conclusions about the PSI efficacy and the potential applicability of PSI to special situations.…”

“…There are 336 papers available through a PUBMED search (revised September 25, 2017) using the query “Total knee replacement/arthroplasty” and “patient specific instrumentation.” However, there are 68 papers available through a PUBMED search (revised September 25, 2017) using the query “Total knee replacement/arthroplasty” and “customized.” Among these 68 papers, 28 papers are relevant to the knee replacement and patient-specific instrumentation (PSI) or implant designs. There were recent review papers on PSI by Rodrigues and Gutierres [ 5 ] and Alcelik et al [ 6 ]; therefore, this paper will focus on customized TKR implants and musculoskeletal (MSK) modelling of knee joint. Relevant papers searched from ScienceDirect (Elsevier) were also reviewed for the development of customized TKR.…”

Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial

“…Over recent years, several orthopaedic manufacturers have introduced patient-specific instrumentation (PSI) and single-use instrumentation (SUI) for TKA. PSI is a bespoke surgical approach which aims to provide increased implant accuracy and surgical efficiency over conventional techniques 7 8. PSI for TKA is designed using MRI or CT scans of the patient’s preoperative knee 7–9.…”

“…PSI is a bespoke surgical approach which aims to provide increased implant accuracy and surgical efficiency over conventional techniques 7 8. PSI for TKA is designed using MRI or CT scans of the patient’s preoperative knee 7–9. Using the 3D image of the knee, a plan of the intended procedure can be created by the surgeon, which includes recommended implant size and alignment 7 10.…”

“…Using the 3D image of the knee, a plan of the intended procedure can be created by the surgeon, which includes recommended implant size and alignment 7 10. From the agreed plan, bespoke cutting blocks are created to guide the saw intraoperatively for accurate placement of the implant 8. Given the detailed preoperative plan, PSI reduces the number of TKA instruments and intraoperative surgical steps.…”