No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively

Boonen, Bert; Schotanus, Martijn G.M.; Kerens, B.; Weegen, Walter van der; Hoekstra, Henk J.; Kort, Nanne P.

doi:10.1302/0301-620x.98b7.37274

Cited by 38 publications

(39 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…of patientsMean age (years)PSISIPSISIAbane et al [1]France5707067.8 (47–84)70.4 (54–83)Boonen et al [4]Netherlands7909069.0 ± 8.065.0 ± 8.8Boonen et al [5]Netherlands7909069.0 ± 8.065.0 ± 8.8Chareancholvanich et al [6]Thailand5404069.5 (55–84)70.3 (53–85)De et al [10]Belgium52024NRNRGan et al [13]China4353568.5 ± 4.867.8 ± 3.4Hamilton et al [15]USA4262668.1 (52–86)68.1 (52–86)Huijbregts et al [16]Australia5696466.7 ± 9.169.0 ± 9.6Khuangsirikul et al [20]Thailand34040NRNRKotela and Kotela [21]Poland54946…”

Section: Resultsmentioning

confidence: 99%

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Gong

Wang

et al. 2018

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeThe purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3° from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance.MethodsA total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay.ResultsThere was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI − 0.71 to − 0.21, p = 0.0004, I2 = 48%). PSI resulted in approximately 0.4° less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI − 10.95 to − 3.75, p < 0.0001, I2 = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI − 146.65 to − 20.18, p = 0.01, I2 = 74%). We did not find any differences between PSI and SI with respect to any other parameters.ConclusionsPSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay.Level of evidenceTherapeutic study (systematic review and meta-analysis), Level I.

show abstract

Section: Resultsmentioning

confidence: 99%

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Gong

Wang

et al. 2018

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…This maneuvering of outcomes is termed ‘spin’ and is common in the medical literature. 3 However, primary outcomes may indeed be negative 4 - 7 and secondary outcomes may be positive, and can legitimately be reported as such. 8 , 9 Transparent registering and reporting of outcomes, whether negative or positive, can alleviate the tendency to ‘spin’ results.…”

mentioning

confidence: 99%

The reporting of outcomes in randomised controlled trials

Ghert

2017

Bone & Joint Research

View full text Add to dashboard Cite

“…Boonen et al. ( 2016 ) did not show a significant difference between the conventional and PSPG operation method when using the Oxford Knee score and did not find a difference for the pain scores and Eq5D either. Woolson et al.…”

Section: Discussionmentioning

confidence: 92%

“…With regard to clinical outcome most studies did not report any difference (Boonen et al. 2016 , Huijbregts et al. 2016 ).…”

mentioning

confidence: 99%

No radiological and clinical advantages with patient-specific positioning guides in total knee replacement

2017

View full text Add to dashboard Cite

Background and purposeAlthough the use of patient-specific positioning guides (PSPGs) in total knee replacement (TKR) in theory is promising, the technique has not yet proven its superior- ity compared with the conventional method. We compared radio- logical alignment and clinical outcome between TKR performed with the use of PSPGs and the conventional operation method.Patients and methods3 hospitals participated in a prospec- tive trial. 109 patients were randomized to either the conventional method or to the use of PSPGs. Postoperatively a full-length standing anteroposterior radiograph and a postoperative CT scan were taken. On the CT scan the alignments were measured for both the femoral and tibial components in the frontal, sagit- tal, and axial plane. The Knee injury and Osteoarthritis Outcome Score (KOOS), the Eurocol-5D-3L (Eq5D) descriptive system and visual analogue scale (VAS), a pain score (NRS), and range of motion (ROM) were recorded preoperatively, and at 3 months, 1, and 2 years. The operation time and length of hospital stay were recorded.Results90 patients were available for postoperative CT mea- surements. A statistically significant difference was found between the conventional TKR instrumentation and the use of PSPGs for the frontal femoral (mean (SD) 0.6° (1.7) vs. –0.3° (2.2), CI 0.08 to 1.69) and tibial (–0.3° (1.5) vs. 0.9° (2.1), CI –1.98 to –0.44) compo- nent angles and for the tibial alignment in the sagittal plane (–3.8° (3.0) vs. –2.2° (2.5), CI –2.72; –0.42). The proportions of outliers were similar between the groups as well as the hip–knee–ankle angle, the KOOS sub scores, the Eq5D, pain (NRS), ROM, opera- tion time, and length of hospital stay.InterpretationThe use of PSPGs requires a preoperative CT scan or MRI and the guides have an additional cost. As this study was not able to prove any extra benefit of the use of PSPGs we recommend the conventional operation method for TKR.

show abstract

No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively

Abstract: PMPGs are already in relatively common use and their short-term clinical results are equal to conventional instrumented TKA. Cite this article: Bone Joint J 2016;98-B:939-44.

Cited by 38 publications

References 28 publications

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

The reporting of outcomes in randomised controlled trials

No radiological and clinical advantages with patient-specific positioning guides in total knee replacement

Contact Info

Product

Resources

About