Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Abstract

Objective. To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods. RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results. 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P=0.04 and P=0.003, respectively). PSI reduced operative time (P=0.03) and blood loss (P=0.002) and improve the KSS (P=0.02) compared with CI, but for CT-based PSI, the difference of operative time becomes insignificant. PSI showed no significant difference with CI regarding risk of complication, length of stay in hospital, and functional outcomes of OKS. Conclusion. PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.

Knee Prosthesis in the Computer Era

“…High-quality comparative studies on different PSI models are needed to highlight the different technological aspects of each PSI model and their impact on radiological and clinical results. PSI is assumed to be associated with decreased blood loss, which eliminates the need to open the femoral intramedullary canal 52,48 . Thienpont et al conducted a study that included 75 PSI-TKA patients, to determine if there was any influence of PSI on blood loss.…”

“…In addition, comparable clinical and radiological outcomes with CAS systems were reported in the literature on conventional TKA. Recent high-quality studies comparing conventional TKA and CAS-TKA have reported many controversies regarding which technique yields better clinical and radiological results [47][48][49][50] . However, the CAS-TKA has already provided outcomes equivalent to those of experienced surgeons using traditional TKA, with the potential for improvements with further technological advances 51 .…”

Could surgical transepicondylar axis be identified accurately in preoperative 3D planning for total knee arthroplasty? A reproducibility study based on 3D-CT

“…The application of computer-assisted techniques in TKA is growing as the importance of bone cut precision in gap-balancing has been increasingly recognized [ 32 ]. When a surgeon uses measured resection technique to perform TKA with the assistance of image-based navigation, PSI or robotics, the determination of femoral component rotation plan is relied on the identification of sTEA on the basis of preoperative imaging data (CT or Magnetic Resonance Imaging) [ 25 – 28 ]. However, previous studies on reproducibility of sTEA were carried out on cadaveric knees or patients’ knees during TKA [ 18 – 20 , 22 – 24 ].…”

“…In order to achieve better femoral component rotation and flexion gap, more precise measurement is needed to locate femoral rotation axis based on sTEA methodology. With wider application of navigation, patient-specific instrumentation (PSI), robotics or other computer-assisted surgical techniques [ 25 – 28 ], sTEA could be identified by surgeons or engineers during preoperative planning with assistance of three-dimensional (3D) images. Intraoperative femoral rotation osteotomy could be guided by robot, PSI or navigation after identification of sTEA preoperatively or intraoperatively [ 29 ].…”

Surgical Treatment of Bone Sarcoma

“…While these are estimated to be generally around 10% [ 116 ], even higher rates have been reported in the literature depending on the collective, surgical time, and surgical site [ 117 , 118 ], with the highest rates reported for pelvic implants, with infection rates of up to 42% [ 118 ]. For both complications, new design concepts offer a much better perspective for future patients treated with such implants: Patient-specific instrumentation and patient-specific implants can shorten the surgical time required for these procedures [ 119 , 120 , 121 ], thus also possibly reducing the risk of perioperative infection [ 118 ]. They also allow us to mechanically better address even complex defects than do prefabricated solutions, thus possibly also leading to better long-term survival.…”