No Benefit of Patient-specific Instrumentation in TKA on Functional and Gait Outcomes: A Randomized Clinical Trial

Abdel, Matthew P.; Parratte, Sébastien; Blanc, Guillaume Le; Ollivier, Matthieu; Pomero, Vincent; Viehweger, Elke; Argenson, J.-N.

doi:10.1007/s11999-014-3544-7

Cited by 79 publications

(46 citation statements)

References 56 publications

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“…Recently, Woolson et al [40] reported the results of a randomized clinical trial of 22 TKAs performed using a CT-based CCG system ( TKAs performed using standard instrumentation to assess early patient-reported and gait analysis outcomes. They found no difference in the new KSS, KOOS, SF-12, or 3-D gait parameters assessed at 3 months postoperatively between the two cohorts, but noted their results could not predict the presence of additional variances that could emerge at an intermediate followup period [1]. Thus, our study had larger cohorts with longer followup and corroborated these prior reports because no improvements in functional outcomes were seen with the use of CCGs at a mean followup of greater than 2 years.…”

Section: Discussionmentioning

confidence: 93%

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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Section: Discussionmentioning

confidence: 93%

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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“…Patients were randomized to either the PSI or conventional instrumentation group by the hospital's informatics department using a previously described systematic sampling method [1]. No differences in terms of anthropometric and radiological (preoperative) parameters were found in the two groups (Table 1).…”

Section: Methodsmentioning

confidence: 99%

The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial

Ollivier

Parratte

Lunebourg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Component alignment can influence implant longevity as well as perhaps pain and function after unicompartmental knee arthroplasty (UKA), but correct alignment is not consistently achieved. To increase the likelihood that good alignment will be achieved during surgery, smart tools such as robotics or patient-specific instrumentation (PSI) have been introduced. Questions/purposes We hypothesized that UKA performed with PSI would result in improved level gait as ascertained with three-dimensional analysis, implant positioning, and patient-reported outcomes measured by a validated scoring system when compared with conventional instrumentation 3 months and 1 year after surgery. Methods We randomized 60 patients into two groups using either the PSI technique or a conventional technique. All patients were operated on using the same technique and the same cemented metal-backed implant. Mean age of the patients was 63 ± 4 years (range, 54-72 years) and mean body mass index was 28 ± 3 kg/m 2 . Patients were evaluated preoperatively, at 3 months, and 1 year after surgery by an independent observer blind to the type of technique. Gait parameters were assessed with threedimensional analysis during level walking preoperatively and at 1 year, frontal and sagittal position of the implant was evaluated on full-length radiographs at 3 months, and subjective functional outcome and quality of life using routine questionnaires (SF-12, new Knee Society Score [KSS], Knee Injury and Osteoarthritis Outcome Score) at 3 months and 1 year. This study had 80% power to detect a 15% difference in walking speed at the p \ 0.05 level. Results One year after surgery, there were no differences between the two groups in the analyzed gait spatiotemporal parameters, respectively, for PSI UKA and conventional UKA : double limb support 31% (25%-54%) versus 30% (23%-56%; p = 0.67) and walking speed ( No difference was observed between the two groups in terms of lower limb alignment (PSI group 178°± 3°, conventional group 178°± 4°; p = 0.24) or implant positioning on mediolateral and anteroposterior radiographs. There were no differences in the functional score between the PSI and conventional TKA groups at 3 months and 1 year after surgery: KSS objective knee scores (PSI: 85 ± 8 points at 3 months, 87 ± 5 points at 1 year and conventional

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“…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.…”

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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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No Benefit of Patient-specific Instrumentation in TKA on Functional and Gait Outcomes: A Randomized Clinical Trial

Abstract: Level I, therapeutic study. See the Instructions to Authors for a complete description of levels of evidence.

Cited by 79 publications

References 56 publications

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

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

The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial

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

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