The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty

Chen, Jerry; Yeo, Seng Jin; Yew, Andy Khye Soon; Tay, Darren Keng Jin; Chia, Shi‐Lu; Lo, Ngai Nung; Chin, Pak Lin

doi:10.1007/s00167-013-2638-1

Cited by 76 publications

(87 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although Noble et al [24] noted a decrease in operative times with the use of CCGs by 7 minutes, Hamilton et al [17] found the use of traditional instrumentation to be shorter than CCGs by 4 minutes. In addition, the results of several Level II and Level II studies have also been mixed to this regard [6,8,11,25]. No difference in either tourniquet time or total operative time was seen in our study.…”

Section: Discussionmentioning

confidence: 46%

“…Most reports have focused on the avoidance of alignment outliers and the potential cost-effectiveness of this technology, demonstrating mixed results [6, 14, 23-25, 33-35, 39]. With regard to component and overall alignment, studies have failed to consistently demonstrate an improved accuracy with the use of CCGs versus standard instrumentation [6,11,18,24,40]. Furthermore, the costeffectiveness of this technology has not been proven, because the potentially decreased operative times and instrument trays required might not offset the additional costs of preoperative imaging and CCG fabrication [6,33,39].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous potential benefits of CCGs exist compared with both standard and computer-assisted surgical instrumentation, including their ease of use; a decrease in operative times and instrument trays; the ability to preoperatively plan for component size, alignment, and position; and an improvement in postoperative alignment versus the use of standard alignment methods [4,18,23]. However, to date the majority of reports have not confirmed these proposed benefits [6,11,33,37,39,41].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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

show abstract

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Three of five Level II studies demonstrated no benefit with PSI [2,3,25] and one study demonstrated improved tibial component rotation [30]. The final Level II study demonstrated a greater number of alignment outliers when PSI was used [8].…”

Section: Domentioning

confidence: 93%

“…Among the studies providing a lower level of evidence, the results were again split. A Level II study [3] and two Level III studies [5,21] demonstrated faster operative times with PSI, whereas another Level II [8] and a Level III study failed to demonstrate quicker surgery with PSI [1].…”

Section: Domentioning

confidence: 99%

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Sassoon

Nam

Nunley

et al. 2015

Clinical Orthopaedics &Amp; Related Research

183

View full text Add to dashboard Cite

Background Patient-specific cutting blocks have been touted as a more efficient and reliable means of achieving neutral mechanical alignment during TKA with the proposed downstream effect of improved clinical outcomes. However, it is not clear to what degree published studies support these assumptions. Questions/purposes We asked: (1) Do patient-specific cutting blocks achieve neutral mechanical alignment more reliably during TKA when compared with conventional methods? (2) Does patient-specific instrumentation (PSI) provide financial benefit through improved surgical efficiency? (3) Does the use of patient-specific cutting blocks translate to improved clinical results after TKA when compared with conventional instrumentation? Methods We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE 1 and EM-BASE 1 with respect to patient-specific cutting blocks and their effect on alignment, cost, operative time, clinical outcome scores, complications, and survivorship. Sixteen studies (Level I-III on the levels of evidence rubric) were identified and used in addressing the first question, 13 (Level I-III) for the second question, and two (Level III) for the third question. Qualitative assessment of the selected Level I studies was performed using the modified Jadad score; Level II and III studies were rated based on the Newcastle-Ottawa scoring system. Results The majority of studies did not show an improvement in overall limb alignment when PSI was compared with standard instrumentation. Mixed results were seen across studies with regard to the prevalence of alignment outliers when PSI was compared with conventional cutting blocks with some studies demonstrating no difference, some showing an improvement with PSI, and a single study showing worse results with PSI. The studies demonstrated mixed results regarding the influence of PSI on operative times. Decreased operative times were not uniformly observed, and when noted, they were found to be of minimal clinical or financial significance. PSI did reliably reduce the number of instrument trays required for processing perioperatively. The accuracy of the preoperative plan, generated by the PSI manufacturers, was found lacking, often leading to multiple intraoperative changes, thereby disrupting the flow of the operation and negatively impacting efficiency. Limited data exist with regard to the effect of PSI on postoperative function, improvement in pain, and patient

show abstract

Uni- und bikondylärer Oberflächenersatz

Köster¹,

Biro²

2016

Orthopäde

View full text Add to dashboard Cite

PSI using the applied technique proved to be practicable and reliable. The advantages of precise planning became obvious. Results concerning alignment are inconsistent in the literature. Soft tissue balancing has only been included in the technique to a limited degree so far. PSI is still in an early stage of development and further development opportunities should be exploited before final assessment.

show abstract

The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty

Abstract: II.

Cited by 76 publications

References 24 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

Systematic Review of Patient-specific Instrumentation in Total Knee Arthroplasty: New but Not Improved

Uni- und bikondylärer Oberflächenersatz

Contact Info

Product

Resources

About