A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement

Thienpont, Emmanuel; Schwab, Pierre‐Emmanuel; Fennema, Peter

doi:10.1302/0301-620x.96b8.33747

Cited by 113 publications

(100 citation statements)

References 40 publications

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“…We collected all the published articles on the topic of interest that met our inclusion and quality criteria. The results of our meta-analysis reflect on the state-ofthe-art related to the accuracy of total knee arthroplasty when performed with patient-specific cutting blocks.Our conclusions cannot be called into question by the arguments of Shuo et al, especially since our findings are consistent with the latest review and meta-analysis on this topic [5]. …”

supporting

confidence: 82%

Response to Jie et al.: How to explain the evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty?

Cavaignac¹,

Pailhé²,

Laumond³

et al. 2015

International Orthopaedics (SICOT)

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Dear Editor, We read with great interest the letter to the Editor entitled "How to explain the evaluation of the accuracy of patientspecific cutting blocks for total knee arthroplasty?" by Jie et al. [1] that was published in the December 2014 issue of International Orthopaedics. This letter was a comment on our recently published article entitled "Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty: a meta-analysis" [2].We were very surprised to come across this letter to the Editor whilst we were doing additional research on the topic of patientspecific cutting blocks, a subject that we feel strongly about. As the authors of the original article in question, we would like to have been informed of these remarks so as to exercise our right to respond immediately in the same issue of the journal. In addition, there was no indication in the title that comments were being made specifically on our article, as is typically done.1. MEDLINE is the name of the database and PubMed is the interface used to access this database (http://www.ncbi. nlm.nih.gov/pubmed). We looked for all the articles on the topic in question on PubMed. We should have specified PubMed (MEDLINE) in the original article, but we felt this was obvious. 2. The meta-analysis was carried out according to the PRISMA statement criteria [3], which is the goldstandard in this field. We followed each of the steps recommended in the PRISMA statement while adopting rigorous methodology for each step. A manual search of each article's bibliography was done to supplement the list of included articles. In our results, one entire section lists each type of study included with the full referencing information needed to find this article [2]. Forest plots show the results for each study and each variable. We could not elaborate on this item because of the required word count limits for published articles. 3. Publication bias was measured using the tool provided in the Cochrane Handbook for systematic reviews of interventions [4], which is also a gold-standard for literature reviews. We can provide the relevant funnel plots if needed.Contrary to the claims by Shuo et al., our methodology is appropriate for the research question and is similar to other published meta-analyses. We collected all the published articles on the topic of interest that met our inclusion and quality criteria. The results of our meta-analysis reflect on the state-ofthe-art related to the accuracy of total knee arthroplasty when performed with patient-specific cutting blocks.Our conclusions cannot be called into question by the arguments of Shuo et al., especially since our findings are consistent with the latest review and meta-analysis on this topic [5].

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supporting

confidence: 82%

Response to Jie et al.: How to explain the evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty?

Cavaignac¹,

Pailhé²,

Laumond³

et al. 2015

International Orthopaedics (SICOT)

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“…Using an extramedullary guide or a short intramedullary guide may avoid this problem. Computer-assisted navigation or patient-specific instrument enable calculation of the mechanical axis pre-or intra-operatively, 12,[14][15][16] but is complex and costly.…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Rattanaprichavej

Laoruengthana

2016

J Orthop Surg (Hong Kong)

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This study reports 3 patients who underwent total knee arthroplasty combined with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia.Key words : arthroplasty, replacement, knee; fractures, ununited introduction It is difficult to obtain optimal mechanical alignment through total knee arthroplasty (TKA) in patients with knee deformity, because the deformity (canal sclerosis, crooked canal, or retained hardware) may prevent the use of an intramedullary guide. Distortion of an anatomic landmark secondary to a previous trauma or treatment can make TKA more challenging and the outcome less satisfactory.1,2 The deformity can be corrected using an intra-or extra-articular Total knee arthroplasty with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia: a report of three cases Piti Rattanaprichavej, Artit Laoruengthana Naresuan University, Thailand Address correspondence and reprint requests to: Piti Rattanaprichavej, Naresuan University, Thailand. Email: pt-rp@hotmail.com Surgery 2016;24(1):116-20 correction technique with a conventional instrument, computer-assisted navigation system, or patientspecific instrument. This study reports 3 patients who underwent TKA combined with extra-or intraarticular correction technique for arthritic knees with extra-articular deformity of the femur or tibia. Journal of Orthopaedic case reportsA single surgeon performed all 3 TKAs under spinal anaesthesia with a femoral nerve block through the median parapatellar approach using conventional instruments and a fixed bearing, posterior-stabilised prosthesis. Preoperative planning was performed to determine the corrective osteotomy, cutting line so as not to endanger the collateral ligament attachment, amount of bone lost, and need for expanding stems or augments. Intra-operatively, prosthesis orientation, lower-limb alignment, and soft-tissue balance were checked using fluoroscopy. Postoperatively, standing radiograph of the knee was obtained at 1, 3, 6, and 12 months. Knee Society knee and function scores were assessed. The mean follow-up duration was 35 Vol. 24 No. 1, April 2016 TKA with extra-or intra-articular correction technique for deformity of the femur or tibia 117 (range, 29-39) months.

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“…This was due to the tightness of the cord ligaments making placement of the sagittal saw cut in the planned position difficult; importantly, PSI tended to result in the medialisation of the tibial implant, which reduces the risk of bearing dislocation compared with a more laterally placed implant that could lead to the bearing impinging on the medial tibial implant wall [19]. The benefits of PSI have been questioned in the literature, but these conclusions have predominantly been based upon the assessment of experienced surgeons undertaking a common procedure, specifically TKR [1]. This has potentially undervalued the benefits of PSI with infrequently performed procedures, especially when undertaken by inexperienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Proposed benefits of this technology to arthroplasty surgeons include: increased accuracy of implant placement, reduced costs and faster operating times [1].…”

Section: Introductionmentioning

confidence: 99%

Patient-specific instrumentation improves alignment of lateral unicompartmental knee replacements by novice surgeons

Newman

Harris

et al. 2017

International Orthopaedics (SICOT)

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Purpose Patient-specific instrumentation (PSI) has the potential to offer numerous benefits-not least of all, improved resection accuracy; but its potential has not been realised in clinical studies. An explanation may be the focus of such studies on the total knee replacement (TKR-a common procedure, with which surgeons are generally very familiar. Consequently, we sought to investigate the potential role of PSI in guiding novice surgeons to perform the more technically demanding and less familiar lateral unicondylar knee replacement (LUKR). Methods Twelve orthopaedic trainees naive to LUKR were instructed to perform the procedure according to a preoperative plan. These were carried out on synthetic sawbones and were completed once with conventional instrumentation alone and once with the adjunct of PSI, allowing a comparison of the plan adherence achieved by the two sets of instrumentation. Results There was a tendency for PSI to demonstrate improved plan adherence, though a statistically significant improvement was only seen in compound rotational error of the femoral implant (p = 0.004). PSI was, however, able to produce narrower standard deviations in the mean translational displacement of the femoral implant and also the mean rotational displacement of both implants, suggesting a higher degree of precision.Conclusions Our study provides some evidence that PSI can improve the ability of novice surgeons to replicate a preoperative plan, but our results suggest the need for largerscale clinical studies to establish the role of PSI in this procedure.

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A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement

Cited by 113 publications

References 40 publications

Response to Jie et al.: How to explain the evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty?

Response to Jie et al.: How to explain the evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty?

Total Knee Arthroplasty with Extra- or Intra-Articular Correction Technique for Arthritic Knees with Extra-Articular Deformity of the Femur or Tibia: A Report of Three Cases

Patient-specific instrumentation improves alignment of lateral unicompartmental knee replacements by novice surgeons

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