Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Nunley, Ryan M.; Ellison, Bradley S.; Zhu, Jinjun; Ruh, Erin L.; Howell, Stephen M.; Barrack, Robert L.

doi:10.1007/s11999-011-2222-2

Cited by 211 publications

(182 citation statements)

References 29 publications

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“…They are in line with other studies of PSI which reported improved alignment [16,30,38]. Although it should be noted that other studies have failed to show a clear advantage for PSI technology [24,32], and that one study with the technology employed in the current analysis observed only a fair rate of accuracy, with higher risk of error >3°in the sagittal plane [11], there does appear to be an overall trend for the superiority of these new technologies over earlier instrumentation methods.…”

Section: Discussionsupporting

confidence: 89%

A comparison of conventional and patient-specific instruments in total knee arthroplasty

Daniilidis

Tibesku

2013

International Orthopaedics (SICOT)

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Purpose Several authors have observed that standard instrumentation (SI) may be insufficient for addressing component malalignment. Patient-matched cutting blocks (PMCB) technology was introduced to improve surgeons' ability to achieve a neutral postoperative mechanical axis following total knee arthroplasty (TKA). The current retrospective study was designed to compare the ability of SI and PMCB to achieve a hip-knee-ankle angle (HKA) within ±3°of the ideal alignment of 180°. Methods Between October 2009 and December 2012, 170 TKAs in 166 patients (four bilateral) using VISIONAIRE (Smith & Nephew) PMCB technology were performed. Additionally, 160 TKAs in 160 consecutive patients that had received a total knee arthroplasty using SI during the same time period were used as a control group, All surgeries were performed by the same surgeon. Standardized pre-and postoperative long-leg standing x-rays were retrospectively evaluated to compare the two patient cohorts. Results X-rays were available for analysis for 156 knees in the SI group and 150 in the PMCB group. The average postsurgical HKA was 178.7±2.5 in the SI group and 178.4±1.5 in the PMCB group. However, the rate of±3°outliers was 21.2 % in the SI group and 9.3 % in the PMCB group. There were no intraoperative complications with the use of PMCB technology or SI. Conclusions PMCB technology proved superior to conventional instrumentation in achieving a neutral mechanical axis following TKA. Further follow-up will be needed to ascertain the long-term impact of these findings.

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Section: Discussionsupporting

confidence: 89%

A comparison of conventional and patient-specific instruments in total knee arthroplasty

Daniilidis

Tibesku

2013

International Orthopaedics (SICOT)

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“…Our study was designed to verify the utility of CT-based Signature™ PSI for precise implant positioning. In general, results of studies on PSI are equivocal [8,15,[25][26][27][28]. We believe that results obtained with one particular PSI system are not automatically applicable to other systems and should not be generalised [14,23].…”

Section: Discussionmentioning

confidence: 93%

“…At the moment, several companies offer various PSI systems for TKA. Custom-made guides may be designed to align components along the mechanical axis or in relation to a natural transcylindrical axis [8,29,30 ]. There are pinning systems that determine accurate pin placement for the standard resection instrumentation, and cutting guides with immediately integrated resection blocks [3,17,29].…”

Section: Discussionmentioning

confidence: 99%

“…The prerequisites for stable positioning of an implant are restoring neutral limb alignment and establishing adequate soft tissue balance [3,4]. Malalignment may be related to pain, stiffness, instability, wear, osteolysis and increased risk of loosening [5][6][7][8]. It has been demonstrated that a varus or valgus malalignment of the mechanical axis of the operated limb > 3°is associated with up to 20 % higher incidence of implant loosening [9,10].…”

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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“…All patients received postoperative coronal scout CT scans of the HKA with the extremities rotated into a neutral position to standardize the measurements using a previously described method [26]. The HKA axis, which is the angle formed between the mechanical axis of the femur (the line connecting the center of the femoral head with the center of the knee) and the mechanical axis of the tibia (the line connecting the center of the ankle mortise to the center of the knee), was measured in all patients with a targeted postoperative HKA alignment of 0°± 3°.…”

Section: Methodsmentioning

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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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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Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Cited by 211 publications

References 29 publications

A comparison of conventional and patient-specific instruments in total knee arthroplasty

A comparison of conventional and patient-specific instruments in total knee arthroplasty

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

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

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