Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique

Koch, Peter P.; Müller, Daniel; Pisan, M.; Fucentese, Sandro F.

doi:10.1007/s00167-013-2625-6

Cited by 62 publications

(59 citation statements)

References 22 publications

(46 reference statements)

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“…In the study by Roh et al [14], radiographic outcomes of the CT-based Signature™ PSI group were not statistically different from those of the conventional instrument group across all parameters measured, with 12 % vs. 10 % of outliers in respect to HKA, respectively. Koch et al [18] assessed the radiological results of 301 TKAs performed with CT-based McKnee© PSI and found significant accuracy of implant position in all planes, with 14.4 % of outliers for HKA angle. Barrett et al [20] compared postoperative mechanical alignment achieved using CT-based TruMatch™ PSI with conventional and CAS instruments; postoperative mechanical alignment was comparable across groups.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of CT-based PSI instrumentation, this need is particularly evident, as there is very limited experience with these devices in the world literature. To our knowledge, this is the fifth study to assess radiographic outcomes of TKA performed with CTbased PSI [14,[18][19][20]. The aim of this study was to compare radiological results of TKAs performed with CT-based PSI and conventional technique.…”

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: Introductionmentioning

confidence: 99%

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

Kotela

2014

International Orthopaedics (SICOT)

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“…While there have been studies comparing patient-specific instrumentation with conventional instrumentation the published results are not consistent and most focus on coronal alignment [2,10,14,27,[35][36][37]. There are only a few studies looking at sagittal alignment [10,15,24,27,39] and even fewer looking at rotational alignment [27,39].…”

Section: Introductionmentioning

confidence: 99%

Small Improvements in Mechanical Axis Alignment Achieved With MRI versus CT-based Patient-specific Instruments in TKA: A Randomized Clinical Trial

Pfitzner

Abdel

Roth

et al. 2014

Clinical Orthopaedics &Amp; Related Research

101

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Background Patient-specific instrumentation in TKA has the proposed benefits of improving coronal and sagittal alignment and rotation of the components. In contrast, the literature is inconsistent if the use of patient-specific instrumentation improves alignment in comparison to conventional instrumentation. Depending on the manufacturer, patient-specific instrumentation is based on either MRI or CT scans. However, it is unknown whether one patient-specific instrumentation approach is more accurate than the other and if there is a potential benefit in terms of reduction of duration of surgery. Questions/purposes We compared the accuracy of MRIand CT-based patient-specific instrumentation with conventional instrumentation and with each other in TKAs. The three approaches also were compared with respect to validated outcomes scores and duration of surgery. Methods A randomized clinical trial was conducted in which 90 patients were enrolled and divided into three groups: CT-based, MRI-based patient-specific instrumentation, and conventional instrumentation. The groups were not different regarding age, male/female sex distribution, and BMI. In all groups, coronal and sagittal alignments were measured on postoperative standing long-leg and lateral radiographs. Component rotation was measured on CT scans. Clinical outcomes (Knee Society and WOMAC scores) were evaluated preoperatively and at a mean of 3 months postoperatively and the duration of surgery was analyzed for each patient. MRI-and CT-based patientspecific instrumentation groups were first compared with conventional instrumentation, the patient-specific instrumentation groups were compared with each other, and all three approaches were compared for clinical outcome measures and duration of surgery. Results Compared with conventional instrumentation MRI-and CT-based patient-specific instrumentation showed higher accuracy regarding the coronal limb axis

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“…This perioperative guiding technique eliminates the use of intra-and extra medullar rods to make bony resections. Previous published results on PSG suggest this to be a good alternative to conventional instrumentation with comparable results, improved radiological outcome and reduced operation time and blood loss [7,[13][14][15][16][17][18][19][20][21][22][23] . This prospective study on PSG between different manufacturers and conventional technique for the implantation of TKA was designed to address the following research questions: Is there a significant difference in outliers in alignment in the frontal and lateral plane between PSG and conventional TKA, secondly between the four individual different PSG systems and thirdly between cut-and pin PSG?…”

Section: Introductionmentioning

confidence: 84%

Patient specific guides for total knee arthroplasty are ready for primetime

Schotanus

Boonen

Kort

2016

WJO

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AIM:To present the radiological results of total knee arthroplasty (TKA) with use of patient specific matched guides (PSG) from different manufacturer in patients suffering from severe osteoarthritis of the knee joint. METHODS:This study describes the results of 57 knees operated with 4 different PSG systems and a group operated with conventional instrumentation (n = 60) by a single surgeon. The PSG systems were compared with each other and subdivided into cut-and pin PSG. The biomechanical axis [hip-knee- RESULTS:The inter class correlation coefficient (ICC) revealed that radiographic measurements between both assessors were reliable (ICC > 0.8). Fisher exact test was used to test differences of proportions. The percentage of outliers of the HKA-axis was comparable between both the PSG and conventional groups (12.28% vs 18.33%, P < 0.424) and the cut-and pin PSG groups (14.3% vs 10.3%, P < 1.00). The percentage of outliers of the FFC (0% vs 18.33%, P < 0.000), LFC (15.78% vs 58.33%, P < 0.000) and LTC (15.78% vs 41.67%, P < 0.033) were significant different in favour of the PSG Core tip: Total knee arthroplasty (TKA) is one of the most successful and commonly performed surgical procedure for the treatment of severe knee osteoarthritis with excellent 15-20 years survivorships. This article provides an analysis on patient specific matched guides (PSG) between different manufacturers and the conventional technique and between pin-and cutting guides for TKA. In addition, we compared our results with previous studies (level 1 evidence), which are generally unambiguous, and show no radiological difference. However, in this trial, we do see difference in favour of the PSG technique.Schotanus MGM, Boonen B, Kort NP. Patient specific guides for total knee arthroplasty are ready for primetime. World J Orthop 2016; 7(1): 6168 Available from:

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Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique

Abstract: IV.

Cited by 62 publications

References 22 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

Small Improvements in Mechanical Axis Alignment Achieved With MRI versus CT-based Patient-specific Instruments in TKA: A Randomized Clinical Trial

Patient specific guides for total knee arthroplasty are ready for primetime

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