Advantages of patient-specific cutting guides with disposable instrumentation in total knee arthroplasty: a case control study

Abstract

Background Total knee arthroplasty (TKA) is most frequently planned using conventional two-dimensional weight-bearing lower limb radiographs and is performed with conventional femoral and tibial cutting guides. Questions have been raised about the accuracy of conventional TKA instrumentation and planning for an anatomically standard or complex joint. Use of computed tomography (CT)-based three-dimensional (3D) templating and patient-specific cutting guides printed in 3D has shown improved postoperative lower limb alignment parameters. This case-control study compared costs and operative times of using CT-based, patient-specific, single-use instruments versus conventional metal instruments for TKA. Methods In this case-control, retrospective chart review, all TKAs were performed by one senior surgeon, using the F.I.R.S.T. posterior-stabilised knee prosthesis (Symbios, CH), with a similar protocol and identical operating room setup. Group A included 51 TKAs performed with patient-specific cutting guides and conventional metal instruments. Group B included 49 TKAs performed with patient-specific cutting guides and patient-specific, single-use instrumentation. Operation duration, number of instrumentation trays and sterilisation costs were evaluated. Results The groups were similar for age, body mass index, hip-knee-ankle angle and operation duration. The mean number of instrumentation trays was 8.0 ± 0.8 for group A (controls) and 5.1 ± 0.9 for group B (p<0.001). The mean sterilisation costs were 380 ± 47 Swiss Francs (CHF) for group A and 243 ± 55 CHF for group B (p<0.001), for a mean cost reduction of 130.50 CHF per intervention in group B. The time interval between two consecutive surgeries was 24 min for group A and 18 min for group B. There were no adverse events or complications, instrument-related or otherwise. Conclusion Compared to conventional instrumentation, use of patient-specific, single-use instruments for TKA reduced the number of instrumentation trays by more than one-third and saved 36% in sterilisation costs. If fabrication costs of single-use instruments are included by the company, the total cost is significantly diminished. There was no operative time advantage for single-use instrumentation.

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

“…Despite the emergence of patient-specific instrumentation, standard cutting guides, navigation, and accelerometer-based navigation, these new operation approaches are costly [ [19] , [20] , [21] ]. Recently, the robotic-assisted TKA system has been introduced to clinical practice for TKA [ 22 ].…”

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty: A systematic review and meta-analysis

“…Of the included studies three were randomised controlled trials[ 27 , 38 , 44 ], twenty-one were retrospective studies[ 11 , 12 , 28 - 31 , 33 , 34 , 36 , 37 , 40 - 43 , 46 , 49 - 52 , 56 ], seven were prospective studies[ 32 , 35 , 39 , 45 , 47 , 48 , 55 ] and one was a theoretical cohort study[ 54 ]. Publication years ranged from 1998 to 2020.…”

“…This was mainly caused by the presence of randomization bias. Thirteen non-randomised studies were assessed, of which eleven had a moderate risk of bias[ 11 , 31 , 36 , 41 , 42 , 48 , 49 , 51 , 52 , 55 , 56 ]. One single study showed a low risk of bias[ 40 ] and one study showed serious risk of bias[ 34 ].…”

Assistive technologies in knee arthroplasty: fashion or evolution? Rate of publications and national registries prove the Scott Parabola wrong

“…However, the PSI conserves a high interest for other reasons than the surgical accuracy. The PSI is recently used with customized implants [30], or to improve the cost-efficiency ratio in operating room with the concept of singleuse instrumentation [31,32]. Even if clear advantages and superiority of these assistive technologies are not yet proven, these innovations allow to progress slowly.…”