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

Sharareh, Behnam; Schwarzkopf, Ran

doi:10.1177/230949901502300123

Cited by 27 publications

(20 citation statements)

References 28 publications

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“…In addition to that, PSI finds its indication when intra-medullary guides cannot be used. For example, when there is a post-traumatic femoral deformity ( Figure 1) (2). PSI facilitates cutting guides by creating a 3-dimensional (3D) model of the knee preoperatively, using CT or MRI and a full-leg antero-posterior radiograph.…”

Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

Patient specific instrumentation in total knee arthroplasty: a state of the art

Mattei¹,

Pellegrino²,

Calò³

et al. 2016

Ann. Transl. Med.

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Patient specific instrumentation (PSI) is a modern technique in total knee arthroplasty (TKA) aiming to facilitate the implant of the prosthesis. The customized cutting blocks of the PSI are generated from pre-operative three-dimensional model, using computed tomography (CT) or magnetic resonance imaging (MRI). A correct surgical plan is mandatory for a good surgical implant. The PSI guide takes into account any slight deformities or osteophytes and applies preoperative planning for bone resection, using the pre-determined implant size, position, and rotation. The apparent benefits of this technology are that neutral postoperative alignment is more reproducible, surgical time is decreased, and the entire procedure results more efficient and cost-effective. The use of PSI is indicated when advanced osteoarthritis, severe pain, and limited function/walking ability are present, such as in a standard instrumentation TKA. In addition to that, PSI finds its indication when intra-medullary guides cannot be used. For example, when there is a post-traumatic femoral deformity. Large debates have taken place about this topic during the last years and, at the moment, there is no consensus in literature regarding the accuracy and reliability of PSI as many studies have shown controversial and inconsistent results. Literature does not suggest PSI techniques as a gold standard in TKA, and therefore it cannot be recommended as a standard technique in standard, not complicated primary TKA. Moreover, literature does not underline any improvement in components alignment, surgical time, blood loss or functional outcomes. Nevertheless, many patients who underwent TKA suffered a previous trauma. In case of deformities, like femoral or tibial fractures healed with a malalignment, preoperative planning may result difficult, and some intra-operative technical difficulties can occur, such as the use of intra-medullar rod. In these selected cases, PSIs may be very useful to avoid errors in alignment and planning.

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Section: Preoperative Planning and Surgical Techniquementioning

confidence: 99%

Patient specific instrumentation in total knee arthroplasty: a state of the art

Mattei¹,

Pellegrino²,

Calò³

et al. 2016

Ann. Transl. Med.

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show abstract

“…They help surgeons achieve accurate TKA and the ideal alignment of the lower limbs. However, the results are controversial. The advantages of computer‐assisted surgical navigation and patient‐specific instrumentation are to identify the mechanical axis during the surgery based on the preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

“…Patient‐specific instrumentation could reduce many steps during TKA and aims to improve mechanical alignment through preoperative planning and 3‐D printing techniques. In addition, there are no advantages in restoration of the mechanical axis versus conventional instrumentation on the tibial side. Moreover, patient‐specific instrumentation requires extra CT scans or MRI, and 3‐D printing equipment.…”

Section: Introductionmentioning

confidence: 99%

Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double‐Check Technique

Wang

Liang

et al. 2019

Orthopaedic Surgery

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ObjectiveTo compare the efficacy of the restoration of tibial component coronal alignment with a double‐check technique and the conventional surgical technique during total knee arthroplasty (TKA) in knee osteoarthritis patients, and to investigate the distribution of the medial proximal tibial angle (MPTA) after TKA.MethodsA retrospective review was performed of 151 patients (179 knees) with knee osteoarthritis undergoing primary TKA in Beijing Chaoyang Hospital, Capital Medical University from February 2013 to January 2015 to evaluate the differences in MPTA in patients undergoing the conventional TKA and those undergoing a modified TKA with a double‐check technique after the surgery. All patients were evaluated by MPTA, range of motion (ROM), Knee Society Clinical Rating System (KSS) clinical scores, and KSS functional scores. An MPTA deviation of 3° or greater was considered malalignment.ResultsA total of 130 TKA procedures in 119 patients were included in the study: 64 knees treated with conventional TKA and 66 knees treated with the double‐check technique TKA. The mean postoperative MPTA was 88.6° ± 2.2° in the conventional TKA group and 89.1° ± 1.5° in the double‐check TKA group. The mean postoperative MPTA between the two groups was not significantly different. In the conventional TKA group, 79.7% (51 knees) had a postoperative MPTA deviation within 3° and 20.3% (13 knees) had a MPTA deviation greater than 3°. In the double‐check TKA group, 93.9% (62 knees) had a postoperative MPTA deviation within 3°and 6.1% (4 knees) had a MPTA deviation greater than 3°. The postoperative MPTA deviation within 3° showed a statistically significant difference between the two groups. In the double‐check TKA group, a 21.2% (14 knees) tibial malalignment was detected after the first check and a 9.1% (6 knees) tibial malalignment was detected after the second check. The mean postoperative ROM was 118.1° ± 9.2° in the conventional TKA group and 115.7° ± 10.1° in the double‐check TKA group. The mean postoperative KSS clinical score was 89.3 ± 3.5 in the conventional TKA group and 89.0 ± 3.7 in the double‐check TKA group. The mean postoperative KSS functional score was 84.8 ± 10.0 in the conventional TKA group and 84.9 ± 9.0 in the double‐check TKA group. The mean postoperative ROM, KSS clinical scores, and KSS functional scores between the two groups were not statistically significantly different.ConclusionMalalignment of the tibial component can occur after conventional TKA, and the double‐check technique is an effective method to improve tibial component coronal alignment.

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“…There are many studies comparing PSI versus SI in TKA by a number of different outcome measures with no consensus on if these tools are effective. 5-7,9-14 To date, little is known regarding the proportion of PSI cases that require surgeon-directed intraoperative recuts to improve perceived coronal alignment, and more important, whether or not the surgeon-directed recuts resulted in an accurate coronal alignment. There is also a lack of information in literature about functional outcomes after PSI for TKA.…”

Section: Discussionmentioning

confidence: 99%

“…Existing literature comparing PSIs to standard instruments (SIs) reports conflicting results with some studies showing improved alignment, decreased blood loss, and reduced operating room (OR) time, 5-8 while others demonstrate that PSI guides are not superior to SI guides. 9-12 To date, little has been published describing the proportion of PSI procedures that included surgeon-directed intraoperative recuts. 13 In addition, functional outcome comparisons between the PSI and SI systems have also not been widely described.…”

Section: Introductionmentioning

confidence: 99%