Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA

Anderl, Werner; Pauzenberger, Leo; Kölblinger, Roman; Kiesselbach, Gabriele; Brandl, Georg; Laky, Brenda; Kriegleder, Bernhard; Heuberer, Philipp R.; Schwameis, Eva

doi:10.1007/s00167-014-3345-2

Cited by 72 publications

(83 citation statements)

References 67 publications

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“…Therefore, more well-designed, high-quality, long-term RCTs are needed monitor the survival of the prosthesis. A few studies showed a significant reduction in outliers of the mechanical alignment for PSI compared to SI [3, 11, 28, 33, 44]. However, in the present study, no evident difference in outliers of mechanical alignment was found between PSI and SI.…”

Section: Discussioncontrasting

confidence: 83%

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Gong

Wang

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3° from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance.MethodsA total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay.ResultsThere was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI − 0.71 to − 0.21, p = 0.0004, I2 = 48%). PSI resulted in approximately 0.4° less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI − 10.95 to − 3.75, p < 0.0001, I2 = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI − 146.65 to − 20.18, p = 0.01, I2 = 74%). We did not find any differences between PSI and SI with respect to any other parameters.ConclusionsPSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay.Level of evidenceTherapeutic study (systematic review and meta-analysis), Level I.

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Section: Discussioncontrasting

confidence: 83%

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Gong

Wang

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…Reduction in the number of outliers from target rotational femoral component alignment indicates increased precision: controversial results have been obtained regarding this outcome, with some study groups reporting significant differences in favor of PSI and others not. Our study could not identify any difference in the proportion of outliers, both when following the “stricter” (±2°) and “looser” (±3°) criteria to define outliers proposed in the literature.…”

Section: Discussioncontrasting

confidence: 52%

“…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%

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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“…At two years after surgery, the PSI group had a larger improvement in KSFS compared to conventional TKA. However, the KSKS, OKS and WOMAC were comparable between the two groups [13].…”

Section: Score (Kss) and Western Ontario And Mcmaster Universities Armentioning

confidence: 95%

“…There is a paucity of published literature on the clinical outcomes after PSI surgery [7][8][9][10][11][12][13]. Furthermore, these studies are also limited by their short follow-up periods.…”

mentioning

confidence: 99%

Functional Outcome and Quality of Life after Patient-Specific Instrumentation in Total Knee Arthroplasty

Chen

Chin

Tay

et al. 2015

The Journal of Arthroplasty

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Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA

Abstract: Prospective comparative study, Level II.

Cited by 72 publications

References 67 publications

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

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

Functional Outcome and Quality of Life after Patient-Specific Instrumentation in Total Knee Arthroplasty

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