Download PDF
J Knee Surg 2014; 27(06): 501-504
DOI: 10.1055/s-0034-1368143
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient-Specific Instrumentation Does Not Improve Alignment in Total Knee Arthroplasty

Robert Russell
1   Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas
,
Timothy Brown
1   Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas
,
Michael Huo
1   Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas
,
Richard Jones
1   Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Further Information

Publication History

04 November 2013

01 January 2014

Publication Date:
06 February 2014 (online)

    Permissions and Reprints

Abstract

Patient-specific instrumentation (PSI) was developed to improve the accuracy of component positioning in total knee arthroplasty (TKA). A meta-analysis of level I and level II studies was performed to determine if PSI improves the mechanical alignment of the leg compared with conventional instrumentation (CI) in TKA. Seven studies met inclusion criteria evaluating 559 patients undergoing TKA. Mean coronal alignment was within 1 degree of neutral mechanical alignment in both groups (PSI, 0.78 degrees; CI, 0.81 degrees). There were fewer outliers in the PSI group (21.1%) than in the CI group (23.2%), but this was not statistically significant (p = 0.59). On the basis of the data from this analysis, PSI does not significantly improve the postoperative mechanical alignment of the limb after TKA. Moreover, PSI does not decrease the number of outliers compared with CI.

Keywords

patient-specific instrumentation - conventional instrumentation - total knee arthroplasty - mechanical alignment - outlier
 

  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (4) 780-785
    CrossrefPubMedGoogle Scholar
  • 2 Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983; 173 (173) 178-183
    PubMedGoogle Scholar
  • 3 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59 (1) 77-79
    PubMedGoogle Scholar
  • 4 Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994; 299 (299) 153-156
    PubMedGoogle Scholar
  • 5 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; 404 (404) 7-13
    CrossrefPubMedGoogle Scholar
  • 6 Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ. The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 2005; 38 (2) 349-355
    CrossrefPubMedGoogle Scholar
  • 7 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (4) 560-569
    CrossrefPubMedGoogle Scholar
  • 8 Huang NF, Dowsey MM, Ee E, Stoney JD, Babazadeh S, Choong PF. Coronal alignment correlates with outcome after total knee arthroplasty: five-year follow-up of a randomized controlled trial. J Arthroplasty 2012; 27 (9) 1737-1741
    CrossrefPubMedGoogle Scholar
  • 9 Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty 2009; 24 (4) 570-578
    CrossrefPubMedGoogle Scholar
  • 10 Chareancholvanich K, Narkbunnam R, Pornrattanamaneewong C. A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement. Bone Joint J 2013; 95-B (3) 354-359
    CrossrefPubMedGoogle Scholar
  • 11 Chen J, Foo S, Yap A , et al. Can MRI-Based and CT-Based Patient Specific Instruments Deliver Their Proposed Advantages?. 2013 AAOS Annual meeting of the American Academy of Orthopaedic Surgeons; Chicago, IL; 2013
    PubMedGoogle Scholar
  • 12 Hamadouche M, Abane L, Boisgard S, Descamps S, Courpied JP, Anract P. RCT Multicenter Comparison of Primary TKA Using Patient Specific versus Conventional Instrumentation. Annual Meeting of the American Association of Hip and Knee Surgeons; Dallas, TX; 2012
    PubMedGoogle Scholar
  • 13 Hamilton WG, Parks NL, Saxena A. Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty 2013; 28 (8, Suppl): 96-100
    CrossrefPubMedGoogle Scholar
  • 14 Noble Jr JW, Moore CA, Liu N. The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 2012; 27 (1) 153-155
    CrossrefPubMedGoogle Scholar
  • 15 Roh YW, Kim TW, Lee S, Seong SC, Lee MC. Is TKA using patient-specific instruments comparable to conventional TKA? A randomized controlled study of one system. Clin Orthop Relat Res 2013; 471 (12) 3988-3995
    CrossrefPubMedGoogle Scholar
  • 16 Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J. Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res 2014; 472 (1) 263-271
    CrossrefPubMedGoogle Scholar
  • 17 Bauwens K, Matthes G, Wich M , et al. Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 2007; 89 (2) 261-269
    CrossrefPubMedGoogle Scholar
  • 18 Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi Jr AV. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 2012; 470 (1) 99-107
    CrossrefPubMedGoogle Scholar
  • 19 Parratte S, Pagnano MW, Trousdale RT, Berry DJ. Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 2010; 92 (12) 2143-2149
    Google Scholar
  • 20 Barrack RL, Ruh EL, Williams BM, Ford AD, Foreman K, Nunley RM. Patient specific cutting blocks are currently of no proven value. J Bone Joint Surg Br 2012; 94 (11, Suppl A): 95-99
    CrossrefPubMedGoogle Scholar
  • 21 Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (3) 895-902
    CrossrefPubMedGoogle Scholar
  • 22 Stryker Orthopaedics—ShapeMatch Cutting Guide Class 1 Recall. U.S. Food and Drug Administration; 2013
  • 23 Stronach BM, Pelt CE, Erickson J, Peters CL. Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res 2013; 471 (1) 169-174
    CrossrefPubMedGoogle Scholar
  • 24 Watters TS, Mather III RC, Browne JA, Berend KR, Lombardi Jr AV, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv 2011; 20 (2) 112-116
    PubMedGoogle Scholar