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

Abstract

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.

Accurate implant fit and leg alignment after cruciate-retaining patient-specific total knee arthroplasty

“…Nonetheless, there are still a number of patients that suffer from postoperative pain and persistent limited range of movement [ 1 , 15 ] In order to improve the overall outcome of patients novel PSI have been developed. Gong et al have recently demonstrated that patient-specific instrumentation is associated with improved axial alignment of the femoral component, operative time and perioperative blood loss after TKA [ 16 ]. Further, Leon-Munoz et al have reported that patient-specific instrumentation might reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room [ 17 ].…”

“…Further, Leon-Munoz et al have reported that patient-specific instrumentation might reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room [ 17 ]. However, no significant differences were found between patient-specific instrumentation and standard instrumentation with respect to alignment of the remaining components, number of outliers or length of hospital stay [ 16 ]. Nonetheless, most of the available studies focus on patient-specific instruments rather than on instruments and the patient-specific implants.…”

Liposomal Bupivacaine Single‐Injection Compared With Continuous Local Anesthetic Nerve Blocks for Painful Surgeries: A Meta‐Analysis of Randomized Controlled Trials and Trial Sequential Analysis

“…We created a risk of bias table that included the following contents: details on methods of random sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and other bias. The overall quality of each study was evaluated as “low risk of bias,” “high risk of bias,” or “unclear risk of bias.” A modified Jadad 7‐point scale was used to assess the quality of RCTs, and a score of <4 points was regarded as low quality 13 . If the number of included RCTs was ≥10, the publication bias was assessed by funnel plot 14 …”

Three-dimensional imaging and three-dimensional printing for plastic preparation of medical interventions

“…However, there is ongoing debate on the efficacy. Some groups show advantages of patient-specific instrumentation for alignment of some but not all prosthesis components as well as for reduction of operative time and perioperative blood loss, but no difference in the length of hospital stay [17]. Contradictorily, other groups report that patient-specific instrumentation does not result in clinically meaningful improvement in alignment, fewer outliers, or better early Given the requisite industrial background and legal considerations in the production and distribution of medical products for permanent or temporary use in patients, widespread on-site manufacturing of metal implants or plastic guides is not yet implemented and radiologists need merely provide ideal 3D-source imaging, as described above.…”