No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA

Fu, Huichao; Wang, Jiaxing; Zhou, Shenyuan; Cheng, Tao; Zhang, Wen; Wang, Qi; Zhang, Xianlong

doi:10.1007/s00167-014-3115-1

Cited by 36 publications

(36 citation statements)

References 45 publications

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“…The other outliers of radiographic outcomes (HKA, FTA, FCA, LFC, LTC, femoral flexion angle and rotational angle) showed no differences between the two groups. These findings results are similar to those of previous studies [33][34][35] . Thus, there is still no evidence for routine use of PSI in TKA 36 .…”

Section: Discussionsupporting

confidence: 93%

No Evidence of Superiority in Reducing Outliers of Component Alignment for Patient‐specific Instrumentation for Total Knee Arthroplasty: a Systematic Review

Zhang¹,

Chen²,

Li³

et al. 2015

Orthopaedic Surgery

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Patient-specific instrumentation (PSI) technology has been developed to improve alignment when implanting total knee arthroplasty (TKA) and is a new focus in the orthopaedic community. Current controversial data concerning PSI are discussed. A systematic review to compare PSI with conventional instrumentation and assess the radiographic outcomes was performed. Electronic databases (including PubMed, Medline, Embase, the Cochrane Library and the Science Citation Index database) and conference proceedings from 1950 to 2014 in the English language were searched. Data, including relevant patient characteristics, sample size, radiographic method, PSI system manufacturer and outliers of implant positioning and alignment on radiography were independently extracted from all eligible studies by two of the authors. A total of 2739 TKAs were included (1410 performed with PSI and 1329 with conventional instrumentation). There were more TCA outliers (malalignment >3°) and tibial slope outliers (malalignment >3°) in the PSI group than in the conventional group. The other radiographic outcomes assessed, including coronal, sagittal or rotational alignment outliers did not differ between the two groups. With regard to radiographic outcomes, our findings indicate that PSI technology is not superior in reducing outliers of component alignment.

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Section: Discussionsupporting

confidence: 93%

No Evidence of Superiority in Reducing Outliers of Component Alignment for Patient‐specific Instrumentation for Total Knee Arthroplasty: a Systematic Review

Zhang¹,

Chen²,

Li³

et al. 2015

Orthopaedic Surgery

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“…Patient-specific instrumentation has not yet been clearly demonstrated as effective in increasing the accuracy or precision of femoral component rotation: several studies have investigated the effect of PSI on rotational alignment and, with a few exceptions 8,27 , did not find statistical difference with respect to the outliers of femoral component rotation 14,15 and the accuracy in postoperative alignment of femoral rotation [12][13][14]20 . Two recent meta-analyses enrolled only 9 studies that reported femoral rotation as an outcome, and reached conflicting results: Thienpont et al concluded that no differences with regard to the rotational alignment are to be expected in the axial plane with the use of PSI, 28 whereas Huijbregts et al calculated the femoral rotation to be 0.45 more accurate with PSI 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a new technology that could reduce the proportion of incorrectly aligned implants appears appealing. However, there is controversy in the available published literature on the ability of PSI to affect the implant positioning, with some studies showing increased accuracy of femoral rotation with the use of PSI [8][9][10][11] and others revealing no differences from conventional alignment techniques [12][13][14][15][16][17][18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

“…Significantly shorter operative times were consistently observed when comparing PSI with computer-assisted surgery 33 . However, conflicting results were obtained in recent meta-analyses 12,15 and dedicated clinical trials when comparing PSI and conventional instrumentation, with only some authors reporting reduction in operative times using PSI 1,12 . Our study was not adequately powered to detect any significant differences in tourniquet time and total surgical time.…”

mentioning

confidence: 99%

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Patient‐specific Instrumentation Affects Rotational Alignment of the Femoral Component in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Cucchi

Menon

Aliprandi³

et al. 2019

Orthopaedic Surgery

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Objective To evaluate whether patient‐specific instrumentation (PSI) improve the accuracy of femoral component rotational alignment with respect to conventionally‐implanted total knee arthroplasty (TKA). Methods Twenty‐four patients were randomized to receive a TKA implanted with PSI or conventional instrumentation. Implant orientation was compared on Computed Tomography (CT). Surgical time, recuts, and component size variations from planning were recorded. Preoperative and postoperative Oxford knee score and visual analogue scale were compared to assess clinical outcomes. Results Femoral components implanted with patient‐specific instrumentation were aligned with greater external rotation than those implanted with conventional instrumentation ( P = 0.022). No significant differences were found in surgical times, number of recuts, and clinical outcomes. Surgeon modifications from the planned size were necessary in 58% of PSI cases. Conclusion Femoral components implanted with PSI had greater external rotation than with conventional instrumentation. Surgeons must carefully evaluate component sizes when using PSI, both in planning and during surgery.

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“…No outlier was even reported in robotic-assisted surgery (0 %) when compared with conventional surgery (24 %) [14]. In contrast, PSI did not show significant improvement in mechanical alignment when compared with conventional surgery [5,7].However, can we expect any difference in clinical outcome between conventional surgery, CAS or PSI taking the mechanical alignment into consideration? Most of the studies did not show any clinical difference in outcome after conventional surgery, CAS or PSI.…”

mentioning

confidence: 96%

Alignment in total knee arthroplasty

Becker

Tandoğan

Violante

2016

Knee Surg Sports Traumatol Arthrosc

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the outlier in mechanical alignment. No outlier was even reported in robotic-assisted surgery (0 %) when compared with conventional surgery (24 %) [14]. In contrast, PSI did not show significant improvement in mechanical alignment when compared with conventional surgery [5,7].However, can we expect any difference in clinical outcome between conventional surgery, CAS or PSI taking the mechanical alignment into consideration? Most of the studies did not show any clinical difference in outcome after conventional surgery, CAS or PSI. Why do we not find any clinical difference despite the fact that we are able to reduce the outlier significantly? No association between prosthetic alignment after total knee replacement and dissatisfaction or change in Oxford Knee Score was reported [8]. That goes in line with a recent review on coronal plane alignment and implant survivorship. The authors did not see a strong correlation between the mechanical alignment and implant survivorship [17]. A multivariate analysis of the clinical outcome showed also no impact of leg alignment on clinical outcome [12].There remains the question what does alignment within a range of three degrees mean in total knee arthroplasty?Despite improvement in accuracy of mechanical alignment, a meta-analysis of the literature failed to show significant difference in clinical outcome [4,8]. The 15-year implant survival rate was not improved in knees with a mechanically alignment within ±3° [13]. The goal of being within the range of ±3° seems to be of little value predicting implant survival. Better function and early successful rehabilitation has been shown in very few studies within the first year when coronal femoral alignment was within 2° [10].Alignment in the coronal plane is one issue, but we need to take the component alignment in the sagittal and transverse plane into consideration as well. The current issue will present results about the impact of tibial rotation on The alignment in total knee arthroplasty (TKA) has been discussed of being an important factor to prevent early implant failure for many years [11].A varus/valgus alignment within a range of three degree has been recommended because of the best clinical outcome is expected. Incorrect alignment may lead to early aseptic loosening, patellofemoral maltracking, abnormal wear, instability and finally inferior clinical outcome.Numerous novel technologies were introduced over the last decades such as computer-assisted surgery (CAS), patient-specific instrumentation (PSI) and robotic-assisted surgery in order to improve component alignment and clinical outcome in TKA. Many studies used the mechanical alignment within ±3° as a quality parameter in order to evaluate the novel technologies. A meta-analysis of level-1 studies compared the coronal alignment after computerassisted surgery and conventional surgery. The authors showed incorrect alignment of >3° in 12.1 % of patients in the CAS group and of 28.7 % in the conventional group [6]. In conclusion, CAS was able to reduce significantly

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No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA

Abstract: Therapeutic study (systematic review and meta-analysis), Level I.

Cited by 36 publications

References 45 publications

No Evidence of Superiority in Reducing Outliers of Component Alignment for Patient‐specific Instrumentation for Total Knee Arthroplasty: a Systematic Review

No Evidence of Superiority in Reducing Outliers of Component Alignment for Patient‐specific Instrumentation for Total Knee Arthroplasty: a Systematic Review

Patient‐specific Instrumentation Affects Rotational Alignment of the Femoral Component in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Alignment in total knee arthroplasty

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