Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

Abstract

PurposeThe purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on of-the-shelf (OTS) TKA. Methods Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and ive refused participation, leaving 140 patients for analysis. Patients completed pre-and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical indings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical indings as means, standard deviations (SD) and ranges, or numbers and percentages. Results At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisied or very satisied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. Conclusions At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisied or very satisied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with suicient statistical power are needed to corroborate these indings and generalise them to unselected TKA patients. Level of evidence IV, retrospective cohort study.

Satisfaction after total knee arthroplasty: a prospective matched‐pair analysis of patients with customised individually made and off‐the‐shelf implants

“…After promising first results [ 44 ], a large improvement in the KSS was recently shown, with a mean KSS of 94 points after 1 year [ 45 ]. Another study reported a high satisfaction rate of 94% after a mean follow-up of 2.8 years [ 46 ]. KOOS and FJS-12 results in this study were similar or slightly lower than our results after 2 years.…”

High Expectations Among Patients Who Have Undergone TKA Do Not Correlate With Satisfaction

“…Regarding the different implants, patients with customized, individually made TKA implants had higher expectations, without any effect on patient satisfaction. The impact of customized, individually made TKA implants on patient satisfaction is still controversial, and recent studies have shown conflicting results [11,34,58].…”

Five or more gender‐ and size‐diverse customizations of distal femur prostheses are needed to improve fit for Chinese knees

“…While reconstructive knee surgeries like total knee arthroplasty (TKA) improve quality of life [10], post‐operative pain is a significant problem with dissatisfaction rates up to 30% [10, 13, 16]. Primary causes include soft tissue impingement due to mis‐fitting femoral prostheses [9]. In China, most available femoral components are based on Caucasian knees, found to be unsuitable for Asian patients [8, 24].…”