J Knee Surg 2016; 29(04): 341-345
DOI: 10.1055/s-0035-1558859
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient-Specific Instrumentation in Total Knee Arthroplasty: What Is the Evidence?

Bartlomiej Szczech
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
,
James D. McDermott
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
,
Kimona Issa
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
,
Aiman Rifai
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
,
Anthony Festa
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
,
William A. Matarese
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
,
Vincent K. McInerney
1   Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, New Jersey
› Author Affiliations
Further Information

Publication History

27 April 2015

26 May 2015

Publication Date:
17 September 2015 (online)

Abstract

With a steady increase in the demand for primary and revision total knee arthroplasty (TKA), any potential reduction in the number of failures can be a topic of significant clinical importance. Patient-specific instrumentation (PSI) is introduced to potentially achieve more reproducible alignment with reduced outliers by creating more accurate and patient-specific femoral and tibial cuts based on neutral mechanical axis. However, there is no widely accepted consensus on the efficacy and indication of using PSI in TKA. The purpose of this review was to assess the current literature on patient-specific TKA and its effect on perioperative outcomes, including templating and preoperative planning, mechanical alignment, clinical outcomes, perioperative blood loss, and economic evaluations. Based on the current literature, more prospective studies are necessary to evaluate the routine use of PSI in TKA.

 
  • References

  • 1 Iorio R, Robb WJ, Healy WL , et al. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am 2008; 90 (7) 1598-1605
  • 2 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
  • 3 Issa K, Pivec R, Kapadia BH , et al. Does obesity affect the outcomes of primary total knee arthroplasty?. J Knee Surg 2013; 26 (2) 89-94
  • 4 Mont MA, Sayeed SA, Osuji O , et al. Total knee arthroplasty in patients 40 years and younger. J Knee Surg 2012; 25 (1) 65-69
  • 5 Mahoney OM, Clarke HD, Mont MA , et al. Primary total knee arthroplasty: the impact of technique. J Bone Joint Surg Am 2009; 91 (Suppl. 05) 59-61
  • 6 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
  • 7 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452) 35-43
  • 8 Berend ME, Ritter MA, Meding JB , et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; (428) 26-34
  • 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
  • 10 Ritter MA, Davis KE, Davis P , et al. Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Joint Surg Am 2013; 95 (2) 126-131
  • 11 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
  • 12 Issa K, Rifai A, McGrath MS , et al. Reliability of templating with patient-specific instrumentation in total knee arthroplasty. J Knee Surg 2013; 26 (6) 429-433
  • 13 Johnson DR. The benefits of customized patient instrumentation to lower-volume joint replacement surgeons: results from practice. Am J Orthop 2011; 40 (11, Suppl): 13-16
  • 14 Bankes MJ, Back DL, Cannon SR, Briggs TW. The effect of component malalignment on the clinical and radiological outcome of the Kinemax total knee replacement. Knee 2003; 10 (1) 55-60
  • 15 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
  • 16 Voleti PB, Hamula MJ, Baldwin KD, Lee GC. Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty. J Arthroplasty 2014; 29 (9) 1709-1712
  • 17 Sassoon A, Nam D, Nunley R, Barrack R. Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res 2015; 473 (1) 151-158
  • 18 Noble Jr JW, Moore CA, Liu N. The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 2012; 27 (1) 153-155
  • 19 Daniilidis K, Tibesku CO. Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop 2013; 37 (1) 45-50
  • 20 Thienpont E, Schwab PE, Fennema P. A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Joint J 2014; 96-B (8) 1052-1061
  • 21 Hofmann S, Romero J, Roth-Schiffl E, Albrecht T. Rotational malalignment of the components may cause chronic pain or early failure in total knee arthroplasty [in German]. Orthopade 2003; 32 (6) 469-476
  • 22 Heyse TJ, Tibesku CO. Improved femoral component rotation in TKA using patient-specific instrumentation. Knee 2014; 21 (1) 268-271
  • 23 Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson JN. Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2213-2219
  • 24 Vundelinckx BJ, Bruckers L, De Mulder K, De Schepper J, Van Esbroeck G. Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplasty 2013; 28 (6) 964-970
  • 25 Yaffe M, Luo M, Goyal N , et al. Clinical, functional, and radiographic outcomes following total knee arthroplasty with patient-specific instrumentation, computer-assisted surgery, and manual instrumentation: a short-term follow-up study. Int J CARS 2014; 9 (5) 837-844
  • 26 Thienpont E, Grosu I, Paternostre F, Schwab PE, Yombi JC. The use of patient-specific instruments does not reduce blood loss during minimally invasive total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2014; ; [E-pub ahead of print]
  • 27 Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP. Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2206-2212
  • 28 Nunley RM, Ellison BS, Ruh EL , et al. Are patient-specific cutting blocks cost-effective for total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (3) 889-894
  • 29 DeHaan AM, Adams JR, DeHart ML, Huff TW. Patient-specific versus conventional instrumentation for total knee arthroplasty: peri-operative and cost differences. J Arthroplasty 2014; 29 (11) 2065-2069