Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial

Boonen, Bert; Schotanus, Martijn G.M.; Kerens, B.; Weegen, Walter van der; Drumpt, Rogier A.M. van; Kort, Nanne P.

doi:10.1007/s00167-013-2620-y

Cited by 112 publications

(159 citation statements)

References 14 publications

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“…Although there was no statistically significant difference between cohorts, our findings, with 48.98 % of outliers in HKA angle and 42.9 % of malalignments in ZMA in the PSI group are puzzling. Similarly to Boonen et al [31], we have no firm explanation as to why the alignment in our series in the PSI group was not superior to the conventional method, and why literature data are so discrepant. Nevertheless, against such a backdrop, we believe our article is a compelling contribution to the discussion on the utility of PSI systems.…”

Section: Discussioncontrasting

confidence: 79%

“…In their study, designed to compare MRI-based Signature™ PSI with standard instrumentation, better results were obtained with PSI for all of the above angles. Less optimistic results were observed in a multicentre, randomised control trial performed by Boonen et al [31], who found a statistically significant difference in outliers for the LFC angle, with a higher percentage of outliers in the MRIbased Signature™ PSI group than in the conventional group (65 % vs. 49 %, respectively). Stronach et al [23] reported inadequate fit of MRI-based Signature™ PSI.…”

Section: Discussionmentioning

confidence: 88%

“…2 Determination of the zone of mechanical axis (ZMA), i.e. the zone of the tibial base plate (divided into three equal regions) that intersect with the mechanical axis of the limb [24]; intersection with zones II-V was considered an outlier et al [31], who found no statistically significant differences between MRI-based Signature PSI and traditional instrumentation in terms of obtaining a neutral mechanical axis and individual component alignment in the frontal plane. Nunley et al [8] compared coronal alignment measurements after TKA performed using traditional instrumentation and two different types of custom-made guides: Signature™ MRIbased PSI, and OtisMed™ MRI-based PSI (manufactured to restore kinematic alignment).…”

Section: Discussionmentioning

confidence: 99%

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Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Kotela

2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare radiological results of total knee arthroplasties (TKAs) performed with patient-specific computed tomography (CT)-based instrumentation and conventional technique. The main study hypothesis was that CT-based patient-specific instrumentation (PSI) increases the accuracy of TKA. Methods A prospective, randomized controlled trial was carried out between January and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients operated on with the aid of the Signature™ CT-based implant positioning system. The control group consisted of 60 patients operated on using conventional instrumentation. The radiographic evaluation of implant positioning and overall coronal alignment was performed 12 months after the surgery by using standing anteroposterior radiographs of the entire lower limb and standard lateral radiographs. Results Of the 112 patients initially enrolled for the study, 95 were included in the subsequent analyses. There were no statistically significant differences between groups in respect to coronal and sagittal component positioning and overall coronal alignment, except for frontal tibial component positioning. For this parameter, better results were obtained in the control group, with borderline statistical significance. Conclusions Our study did not reveal superiority of the CTbased PSI system over conventional instrumentation. Further high-quality investigations of patient-specific systems are absolutely indispensable to assess their utility for TKA. In our opinion, the surgeon applying PSI technology is required to have advanced knowledge and considerable experience with the conventional method.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study

Kotela

2014

International Orthopaedics (SICOT)

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“…This perioperative guiding technique eliminates the use of intra-and extra medullar rods to make bony resections. Previous published results on PSG suggest this to be a good alternative to conventional instrumentation with comparable results, improved radiological outcome and reduced operation time and blood loss [7,[13][14][15][16][17][18][19][20][21][22][23] . This prospective study on PSG between different manufacturers and conventional technique for the implantation of TKA was designed to address the following research questions: Is there a significant difference in outliers in alignment in the frontal and lateral plane between PSG and conventional TKA, secondly between the four individual different PSG systems and thirdly between cut-and pin PSG?…”

Section: Introductionmentioning

confidence: 84%

“…All patients gave informed consent to participate in this prospective study and were operated by a senior knee orthopaedic surgeon (NK) with extensive experience with PSG [15,16] . Patients were not blinded to the type of alignment method used.…”

Section: Methodsmentioning

confidence: 99%

Patient specific guides for total knee arthroplasty are ready for primetime

Schotanus

Boonen

Kort

2016

WJO

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AIM:To present the radiological results of total knee arthroplasty (TKA) with use of patient specific matched guides (PSG) from different manufacturer in patients suffering from severe osteoarthritis of the knee joint. METHODS:This study describes the results of 57 knees operated with 4 different PSG systems and a group operated with conventional instrumentation (n = 60) by a single surgeon. The PSG systems were compared with each other and subdivided into cut-and pin PSG. The biomechanical axis [hip-knee- RESULTS:The inter class correlation coefficient (ICC) revealed that radiographic measurements between both assessors were reliable (ICC > 0.8). Fisher exact test was used to test differences of proportions. The percentage of outliers of the HKA-axis was comparable between both the PSG and conventional groups (12.28% vs 18.33%, P < 0.424) and the cut-and pin PSG groups (14.3% vs 10.3%, P < 1.00). The percentage of outliers of the FFC (0% vs 18.33%, P < 0.000), LFC (15.78% vs 58.33%, P < 0.000) and LTC (15.78% vs 41.67%, P < 0.033) were significant different in favour of the PSG Core tip: Total knee arthroplasty (TKA) is one of the most successful and commonly performed surgical procedure for the treatment of severe knee osteoarthritis with excellent 15-20 years survivorships. This article provides an analysis on patient specific matched guides (PSG) between different manufacturers and the conventional technique and between pin-and cutting guides for TKA. In addition, we compared our results with previous studies (level 1 evidence), which are generally unambiguous, and show no radiological difference. However, in this trial, we do see difference in favour of the PSG technique.Schotanus MGM, Boonen B, Kort NP. Patient specific guides for total knee arthroplasty are ready for primetime. World J Orthop 2016; 7(1): 6168 Available from:

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