Patient-Specific Instrumentation Does Not Shorten Surgical Time: A Prospective, Randomized Trial

Hamilton, William G.; Parks, Nancy L.; Saxena, Arjun

doi:10.1016/j.arth.2013.04.049

Cited by 107 publications

(109 citation statements)

References 20 publications

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“…Thus, our study had larger cohorts with longer followup and corroborated these prior reports because no improvements in functional outcomes were seen with the use of CCGs at a mean followup of greater than 2 years. Our study supports prior studies demonstrating CCGs to confer no additional benefit in achieving a neutral mechanical alignment postoperatively [10,17,28,41]. Again, although prior reports to this regard are mixed [23,24], CCGs do not consistently demonstrate a radiological advantage.…”

Section: Discussionsupporting

confidence: 84%

“…Supporters of CCGs note improved surgical efficiency and subsequent cost-efficiency as potential advantages, yet prior Level I studies assessing these outcomes have been mixed [10,17,24]. Although Noble et al [24] noted a decrease in operative times with the use of CCGs by 7 minutes, Hamilton et al [17] found the use of traditional instrumentation to be shorter than CCGs by 4 minutes. In addition, the results of several Level II and Level II studies have also been mixed to this regard [6,8,11,25].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Nam

Park

Stambough

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Custom cutting guides (CCGs; sometimes called patient-specific instrumentation [PSI]) in total knee arthroplasty (TKA) use preoperative three-dimensional imaging to fabricate cutting blocks specific to a patient's native anatomy. Questions/purposes The purposes of this study were to determine if CCGs (1) improve clinical outcomes as measured by UCLA activity, SF-12, and Oxford knee scores; and (2) coronal mechanical alignment versus standard alignment guides. Methods This was a retrospective cohort study of patients undergoing primary TKA using the same cruciate-retaining, cemented TKA system between January 2009 and April 2012. Patients were included if they were candidates for a unilateral, cruciate-retaining TKA and met other prespecified criteria; patients were allowed to self-select either an MRI-based CCG procedure or standard TKA. Ninety-seven of 120 (80.8%) patients in the standard and 104 of 124 (83.9%, p = 0.5) in the CCG cohort with a minimum of 1-year followup were available for analysis. The first 95 patients in the standard (mean followup, 3 years; range, 1-4 years) and CCG (mean followup, 2 years; range, 1-4 years) cohorts were compared. The alignment goal for all TKAs was a hip-knee-ankle (HKA) angle of 0°. UCLA, SF-12, and Oxford knee scores were collected preoperatively and at each patient's most recent followup visit. Postoperative, rotationally controlled coronal scout CT scans were used to measure HKA alignment. Independent-sample t-tests and chi-square tests were used

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Nam

Park

Stambough

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…Although there were some discrepancies among the studies we included that addressed this question, the preponderance of the stronger evidence evaluated failed to show an association between PSI and more reliable achievement of neutral mechanical axis when compared with conventional cutting blocks. One of the three Level I studies demonstrated no difference in postoperative mechanical alignment [13]. Another Level I study demonstrated no difference in tibiofemoral or femoral component alignment but did note a difference in tibial component alignment with PSI being closer to neutral than standard instrumentation (89.8°versus 90.5°); however, this was deemed clinically insignificant by the authors [7].…”

mentioning

confidence: 66%

“…All three Level I studies addressed operative time with mixed results. The first demonstrated no benefit with PSI [13]. The second study noted decreased operative time by 5 minutes; however, this improvement was marginalized and deemed not clinically or financially significant by the authors [7].…”

Section: Domentioning

confidence: 99%

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Sassoon

Nam

Nunley

et al. 2015

Clinical Orthopaedics &Amp; Related Research

177

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Background Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions. Questions/purposes We asked: (1) Do patient-specific cutting blocks achieve neutral mechanical alignment more reliably during TKA when compared with conventional methods? (2) Does patient-specific instrumentation (PSI) provide financial benefit through improved surgical efficiency? (3) Does the use of patient-specific cutting blocks translate to improved clinical results after TKA when compared with conventional instrumentation? Methods We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE 1 and EM-BASE 1 with respect to patient-specific cutting blocks and their effect on alignment, cost, operative time, clinical outcome scores, complications, and survivorship. Sixteen studies (Level I-III on the levels of evidence rubric) were identified and used in addressing the first question, 13 (Level I-III) for the second question, and two (Level III) for the third question. Qualitative assessment of the selected Level I studies was performed using the modified Jadad score; Level II and III studies were rated based on the Newcastle-Ottawa scoring system. Results The majority of studies did not show an improvement in overall limb alignment when PSI was compared with standard instrumentation. Mixed results were seen across studies with regard to the prevalence of alignment outliers when PSI was compared with conventional cutting blocks with some studies demonstrating no difference, some showing an improvement with PSI, and a single study showing worse results with PSI. The studies demonstrated mixed results regarding the influence of PSI on operative times. Decreased operative times were not uniformly observed, and when noted, they were found to be of minimal clinical or financial significance. PSI did reliably reduce the number of instrument trays required for processing perioperatively. The accuracy of the preoperative plan, generated by the PSI manufacturers, was found lacking, often leading to multiple intraoperative changes, thereby disrupting the flow of the operation and negatively impacting efficiency. Limited data exist with regard to the effect of PSI on postoperative function, improvement in pain, and patient

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“…A recent systematic review on PSI reported mixed findings in terms of procedure time [38]. Of the level I studies, one reported no difference in operative time [13], and others noted differences of only 5-7 min for PSI compared to conventional methods [5,31].…”

Section: Discussionmentioning

confidence: 99%

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study

et al. 2016

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Background: Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery. Questions/Purposes: The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV). Methods: After IRB approval, 49 consecutive PSI TKAs (40 patients) were matched based on preoperative characteristics to 49 NAV TKAs (40 patients) performed by a single surgeon. A blinded observer measured alignment on digital radiographs. Operating room records were reviewed for procedure times. Two-tailed paired sample t tests and McNemar's test were used as appropriate. Alpha level was 0.05 for all tests. Results: Preoperative cohort characteristics were not different. Mean postoperative long-leg mechanical alignment was within ±1°of neutral for both groups, although statistically different (p = 0.026). There were no other significant differences in coronal alignment. PSI exhibited significantly greater posterior tibial slope (4.4°) compared to NAV (2.7°) (p = 0.004); PSI resulted in significantly more outliers (>6°; p = 0.004). Procedure time for unilateral TKAs was lower for PSI (74.4 min) compared to that for NAV (80.6 min; p = 0.023). Conclusion: NAV and PSI technologies provided excellent coronal plane alignment. NAV was better for sagittal tibial slope, while PSI procedure times were shorter for unilateral TKA. The impact of these technologies on patientreported outcomes and TKA survivorship is controversial and should be the focus of future research.

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Patient-Specific Instrumentation Does Not Shorten Surgical Time: A Prospective, Randomized Trial

Cited by 107 publications

References 20 publications

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study

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