No difference in mid-term survival and clinical outcome between patient-specific and conventional instrumented total knee arthroplasty: a randomized controlled trial

Schotanus, Martijn G.M.; Boonen, Bert; Weegen, Walter van der; Hoekstra, Harald; Drumpt, R. van; Borghans, Rob; Vos, Rein; Rhijn, L. van; Kort, Nanne P.

doi:10.1007/s00167-018-4968-5

Cited by 19 publications

(25 citation statements)

References 36 publications

(55 reference statements)

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“…Evidences currently suggested that malalignment was strongly related to postoperative complications [41], such as patellar tracking [42] and kinematics [43]. PSI was produced to improve the limb alignment of the TKA [11]. Yet, our work did not detect any significant difference between PSI and CI regarding postoperative complication as well as rate of outliers.…”

Section: Discussioncontrasting

confidence: 57%

“…Unlike their studies, all patients included in our analysis were restricted at a 3-month follow-up. Although data from a long-term outcome could not be extracted, existing RCTs suggest that OKS in 2-year [36] and 5-year [11] follow-up is also statistically not different between PSI and CI.…”

Section: Discussionmentioning

confidence: 99%

“…No substantial heterogeneity was found (I 2 = 0%, P = 0:02) (Figure 6(a)). For postoperative Oxford Knee Score (OKS), 5 studies [11,15,18,19,36] were included and no significant difference between PSI and CI groups was found. The total SMD was 0.07 (95% CI, -0.09 to 0.22, P = 0:4), and there is no heterogeneity found (I 2 = 32%, P = 0:21) (Figure 6(a)).…”

Section: 7mentioning

confidence: 99%

“…), which is not robust enough to determine the superiority of one over another. Furthermore, more randomized controlled trials (RCTs) have been published [10][11][12][13][14][15] recently and need to be integrated to update our knowledge (comprehensive comparison between our work and previous reviews can be found in S2 Supplemental file).…”

Section: Introductionmentioning

confidence: 99%

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Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Lin

Cai

et al. 2020

BioMed Research International

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Objective. To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods. RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results. 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P=0.04 and P=0.003, respectively). PSI reduced operative time (P=0.03) and blood loss (P=0.002) and improve the KSS (P=0.02) compared with CI, but for CT-based PSI, the difference of operative time becomes insignificant. PSI showed no significant difference with CI regarding risk of complication, length of stay in hospital, and functional outcomes of OKS. Conclusion. PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: 7mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Lin

Cai

et al. 2020

BioMed Research International

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“…The Knee Society Score was reported in 16 studies [ 19 – 29 , 31 , 34 , 35 , 37 , 38 ]. KSS Functional score was significantly higher in the PSI group (favouring PSI) at 24 months in the 5 studies compared (mean difference 4.36, 95% confidence interval 1.83–6.89), with moderate heterogeneity (I 2 = 66%) [ 19 , 20 , 22 , 26 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

Functional outcomes in patient specific instrumentation vs. conventional instrumentation for total knee arthroplasty; a systematic review and meta-analysis of prospective studies

Rudran

Magill

Ponugoti

et al. 2022

BMC Musculoskelet Disord

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Background Total Knee Arthroplasty (TKA) is an established surgical option for knee osteoarthritis (OA). There are varying perceptions of the most suitable surgical technique for making bone cuts in TKA. Conventional Instrumentation (CI) uses generic cutting guides (extra- and intra-medullary) for TKA; however, patient specific instrumentation (PSI) has become a popular alternative amongst surgeons. Methods A literature search of electronic databases Embase, Medline and registry platform portals was conducted on the 16th May 2021. The search was performed using a predesigned search strategy. Eligible studies were critically appraised for methodological quality. The primary outcome measure was Knee Society Function Score. Functional scores were also collected for the secondary outcome measures: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS) for pain. Review Manager 5.3 was used for all data synthesis and analysis. Results There is no conclusive evidence in the literature to suggest that PSI or CI instrumentation is better for functional outcomes. 23 studies were identified for inclusion in this study. Twenty-two studies (18 randomised controlled trials and 4 prospective studies) were included in the meta analysis, with a total of 2277 total knee arthroplasties. There were 1154 PSI TKA and 1123 CI TKA. The majority of outcomes at 3-months, 6-months and 12 show no statistical difference. There was statistical significance at 24 months in favour of PSI group for KSS function (mean difference 4.36, 95% confidence interval 1.83–6.89). The mean difference did not exceed the MCID of 6.4. KSS knee scores demonstrated statistical significance at 24 months (mean difference 2.37, 95% confidence interval (CI) 0.42—4.31), with a MCID of 5.9. WOMAC scores were found to be statistically significant favouring PSI group at 12 months (mean difference -3.47, 95% confidence interval (CI) -6.57- -0.36) and 24 months (mean difference -0.65, 95% confidence interval (CI) -1.28—-0.03), with high level of bias noted in the studies and a MCID of 10. Conclusions This meta-analysis of level 1 and level 2 evidence shows there is no clinical difference when comparing PSI and CI KSS function scores for TKA at definitive post operative time points (3 months, 6 months, 12 months and 24 months). Within the secondary outcomes for this study, there was no clinical difference between PSI and CI for TKA. Although there was no clinical difference between PSI and CI for TKA, there was statistical significance noted at 24 months in favour of PSI compared to CI for TKA when considering KSS function, KSS knee scores and WOMAC scores. Studies included in this meta-analysis were of limited cohort size and prospective studies were prone to methodological bias. The current literature is limited and insufficiently robust to make explicit conclusions and therefore further high-powered robust RCTs are required at specific time points.

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Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis

Zheng,

Li,

Yuan

et al. 2024

J. exp. orthop.

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PurposeVarious assistive techniques, such as conventional cutting instruments (CON), computer‐assisted navigation systems (CAS), patient‐specific instruments (PSI) and robot‐assisted systems (RAS), have been developed and applied in primary total knee arthroplasty (TKA). In this study, we aimed to assess the relative accuracy and efficacy of several assistive techniques for TKA through a network meta‐analysis (NMA) based on multiple published randomized controlled trials (RCTs).MethodsThe PubMed, EMBASE and Cochrane databases were searched for RCTs to conduct this NMA from inception to 1 January 2024. We combined direct and indirect comparisons using a Bayesian NMA framework to assess and compare the effects of different assistive techniques on radiological and clinical outcomes. An NMA was conducted, and the study protocol was published online at PROSPERO (CRD42023402882).ResultsOne hundred and twelve RCTs involving 14,968 TKAs with four different assistive techniques (CON, CAS, PSI and RAS) were evaluated. Inconsistency and heterogeneity were acceptable for most outcomes. Based on the surface under the cumulative ranking curve, RAS could be the best technique for accurate mechanical axis alignment and component position, followed by CAS, PSI and CON. We observed no difference in clinical outcome scores. Additionally, CAS was the best intervention for visual analogue scale scores, and PSI had the shortest operative time. No significant differences were observed in postoperative complications, range of motion or total blood loss.ConclusionRAS was most likely to achieve an accurate alignment, followed by CAS, PSI and CON. No differences were observed in clinical outcome scores and postoperative complications among the four assistive techniques.Level of EvidenceLevel I (systematic review of Level‐I randomized controlled studies).

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No difference in mid-term survival and clinical outcome between patient-specific and conventional instrumented total knee arthroplasty: a randomized controlled trial

Abstract: I.

Cited by 19 publications

References 36 publications

Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials

Functional outcomes in patient specific instrumentation vs. conventional instrumentation for total knee arthroplasty; a systematic review and meta-analysis of prospective studies

Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis

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