Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty

Nam, Denis; Maher, Patrick; Rebolledo, Brian J.; Nawabi, Danyal H.; McLawhorn, Alexander S.; Pearle, Andrew D.

doi:10.1016/j.knee.2012.12.009

Cited by 41 publications

(33 citation statements)

References 16 publications

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“…They compared 105 TKAs performed with MRI-based Signature™ PSI to 55 TKAs performed with manual instrumentation and obtained 9 % vs. 22 % of outliers in respect to HKA angle, respectively. Nam et al [13] performed a nonrandomised, retrospective study to compare the alignment accuracy of MRI-based Signature™ PSI to an imageless computerassisted-surgery (CAS) system. They found that 70.7 % of patients operated on with PSI had an alignment within 3°of neutral mechanical axis vs. 92.7 % in the CAS group (p<0.02).…”

Section: Discussionmentioning

confidence: 99%

“…In all cases, the same type of uncemented cruciate-retaining prostheses were implanted (Vanguard™ Complete Knee System; Biomet Inc. Warsaw, IN, USA), without resurfacing the patella. The process by which Signature™ instrumentation is produced and used has been described precisely in previous studies [3,13,14,[21][22][23]. Briefly, each patient in group 1 obtained a preoperative CT scan of the knee joint, along with …”

Section: Methodsmentioning

confidence: 99%

“…The second set of measurements was carried out two weeks after the first. To evaluate observer reliability, the interclass correlation coefficient (ICC) was calculated and grated using previously described semiquantitative criteria: excellent 0.9 ≤ (p≤1.0), good 0.7≤ (p≤0.89), fair 0.5≤ (p≤0.69), low 0.25≤ (p≤0.49) and poor 0.0≤ (p≤0.24) [13] . The ICC is proven to be excellent for all measured angles.…”

Section: Exclusion Criteriamentioning

confidence: 99%

“…One particular modern solution for knee arthroplasty involves systems in which intraoperative navigation is based on single-use guides fashioned for the specific patient. The main idea behind patient-specific instrumentation (PSI) is that knee-joint arthroplasty procedures can be individualised, with benefits including precise realignment of the normal mechanical axis of the operated lower limb, minimised resection of the patient's bony tissue, reduced surgical times, simplified instrumentation, reduced peri-and postoperative blood loss, no need of femoral medullary cavity reaming and a reduced rate of thromboembolic complications [3,[13][14][15][16]. A recently published survey showed a considerable interest in PSI among surgeons, confirmed by the massively increasing numbers of PSI-aided procedures performed in Europe and worldwide; PSI use for TKA increased globally by an average of 1.5 times between 2011 and 2012 [17].…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Exclusion Criteriamentioning

confidence: 99%

Section: Introductionmentioning

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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“…26 PSI is inferior to computer navigation in terms of percentage of patients with accurate HKA angle (70.7% vs. 92.7%), tibial component alignment (87.8% vs. 100%), and femoral component alignment (90.2% vs. 100%). 27 PSI is on par with SI. The number of surgical trays, surgical steps, and the intra-operative surgeon-directed changes all affect the operation time.…”

Section: Discussionmentioning

confidence: 99%

Review Article: Patient-Specific versus Standard Instrumentation for Total Knee Arthroplasty

Sharareh

Schwarzkopf

2015

J Orthop Surg (Hong Kong)

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Postoperative limb alignment in total knee replacement. Conventional versus navigated versus robotic techniques

Durán-Serrano

Palomares

Giménez

et al. 2023

Robotics Computer Surgery

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Background Our objective was to compare the coronal mechanical axis after total knee replacement (TKR) obtained in three groups of patients subjected to conventional, navigated, and robotic surgery. Methods Retrospective analysis. Results 124 knees were included (36 conventional, 41 navigated, 47 robotic). No statistically significant differences were found between the postOp tibiofemoral angle of the conventional, navigated and robotic groups (p = 0.396). A repeated‐measure analysis of preOp‐to‐postOp also found no significant differences (p = 0.387). There were no differences in the proportion of outliers (3‐degree) found (p = 0.211). Nevertheless, a higher proportion of patients in the robotic group improved their mechanical alignment, as compared with conventional surgery (p = 0.023), although no differences were found when comparing with navigation (p = 0.121). Conclusions No statistically significant differences were found with respect to the postOp alignment achieved. However, statistically significant differences were detected between robotic and conventional surgery when considering the percentage of patients with improved limb alignment.

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Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty

Cited by 41 publications

References 16 publications

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

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

Review Article: Patient-Specific versus Standard Instrumentation for Total Knee Arthroplasty

Postoperative limb alignment in total knee replacement. Conventional versus navigated versus robotic techniques

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