Three-dimensional analysis of accuracy of component positioning in total knee arthroplasty with patient specific and conventional instruments: A randomized controlled trial

Vloo, R De; Pellikaan, Pim; Dhollander, Aad; Sloten, Jos Vander

doi:10.1016/j.knee.2017.08.059

Cited by 24 publications

(22 citation statements)

References 40 publications

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“…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

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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.

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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

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“…Patient-specific instrumentation has not yet been clearly demonstrated as effective in increasing the accuracy or precision of femoral component rotation: several studies have investigated the effect of PSI on rotational alignment and, with a few exceptions 8,27 , did not find statistical difference with respect to the outliers of femoral component rotation 14,15 and the accuracy in postoperative alignment of femoral rotation [12][13][14]20 . Two recent meta-analyses enrolled only 9 studies that reported femoral rotation as an outcome, and reached conflicting results: Thienpont et al concluded that no differences with regard to the rotational alignment are to be expected in the axial plane with the use of PSI, 28 whereas Huijbregts et al calculated the femoral rotation to be 0.45 more accurate with PSI 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a new technology that could reduce the proportion of incorrectly aligned implants appears appealing. However, there is controversy in the available published literature on the ability of PSI to affect the implant positioning, with some studies showing increased accuracy of femoral rotation with the use of PSI [8][9][10][11] and others revealing no differences from conventional alignment techniques [12][13][14][15][16][17][18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Patient‐specific Instrumentation Affects Rotational Alignment of the Femoral Component in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Cucchi

Menon

Aliprandi³

et al. 2019

Orthopaedic Surgery

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Objective To evaluate whether patient‐specific instrumentation (PSI) improve the accuracy of femoral component rotational alignment with respect to conventionally‐implanted total knee arthroplasty (TKA). Methods Twenty‐four patients were randomized to receive a TKA implanted with PSI or conventional instrumentation. Implant orientation was compared on Computed Tomography (CT). Surgical time, recuts, and component size variations from planning were recorded. Preoperative and postoperative Oxford knee score and visual analogue scale were compared to assess clinical outcomes. Results Femoral components implanted with patient‐specific instrumentation were aligned with greater external rotation than those implanted with conventional instrumentation ( P = 0.022). No significant differences were found in surgical times, number of recuts, and clinical outcomes. Surgeon modifications from the planned size were necessary in 58% of PSI cases. Conclusion Femoral components implanted with PSI had greater external rotation than with conventional instrumentation. Surgeons must carefully evaluate component sizes when using PSI, both in planning and during surgery.

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“…Seon et al [ 16 ] also reported accurate alignments provided by patient-specific guides without intraoperative complication in 38 knees, noting that severe varus deformity and osteophytes may interfere with seating of the guides. In a recent randomized controlled study on 50 patients comparing patient-specific and conventional instruments for the accuracy of component positioning in TKA [ 10 ], patient-specific guides provided more accurate component positioning and prediction of component sizing. Schotanus et al [ 17 ] reported that patient-specific cutting guides increases alignment of the femur component in partial to TKA revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Although patient-specific instruments have been used for TKA to be more efficient and cost-effective, many studies have shown controversial and inconsistent results on the efficiency and accuracy of TKA performed by using patient-specific cutting guides, mostly due to various 3D guide construction techniques or outcome measures that were used in the studies [ 1 ]. As most of the individual clinical studies reported the superiority of patient-specific instrumentation over conventional methods for providing limb alignment [ 2 , 10 ], meta-analyses failed to show significant difference between the 2 techniques [ 1 , 11 ]. In order to increase decisive evidence on the benefits and disadvantages of this innovative technique, more clinical studies are needed.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides

Çalbıyık

2017

Med Sci Monit

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BackgroundPatient-specific instruments have recently gained attention for ensuring the accuracy of osteotomy and correct alignment in total knee arthroplasty (TKA). We aimed to report our experience with TKA performed by using CT-based 3D model of cutting guides in our clinic.Material/MethodsA total of 36 patients (mean age, 67.58±8.46 years; 24 females, 12 males) who underwent TKA with 3D patient-specific cutting guides in our clinic were included in the study. Differences between preoperatively planned bone resections and actual bone resections were calculated. Femoral and tibial component angles were measured on radiographs of the knee. The change in knee pain was evaluated by patients on a 10-point visual analog scale (VAS). Patients were followed up for 6 months postoperatively.ResultsThe actual bone resection was 0.5–1.5 mm higher than the planned resection for all sides, being statistically significant for posterior lateral and distal medial sides (1.1±1.3 mm and 1.5±0.9 mm, respectively; p<0.05). On postoperative radiographs, coronal tibial component angle was 88.8°±0.9° and coronal femoral component angle was 95.2°±1.6°, showing good postoperative alignment. The VAS pain score of patients significantly decreased from preoperative 3.9±0.8 to 1.1±0.9 at 6 months after the operation. One patient developed superficial tissue infection on postoperative follow-up, which was effectively treated. No other pathology was detected in the postoperative period.ConclusionsPatient-specific cutting guides can provide intraoperative guidance for better placement of the implant in TKA and increase the accuracy of osteotomy and postoperative alignment.

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Three-dimensional analysis of accuracy of component positioning in total knee arthroplasty with patient specific and conventional instruments: A randomized controlled trial

Cited by 24 publications

References 40 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

Patient‐specific Instrumentation Affects Rotational Alignment of the Femoral Component in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Clinical Outcome of Total Knee Arthroplasty Performed Using Patient-Specific Cutting Guides

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