A Meta-analysis of Functional Outcomes in Patient-Specific Instrumented Knee Arthroplasty

Abstract

Alignment data in patient-specific instrumented (PSI) knee arthroplasty have been examined in several meta-analyses, with demonstration of comparative but not improved restitution of a neutral mechanical axis and favorable outcomes in femoral implant axial alignment. To date, no comprehensive synthesis of data has been conducted specifically for functional outcomes. Relevant databases were searched according to Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines during the period 2000 to 2015 of Levels 1 and 2 studies comparing functional outcomes of patient-specific instrumentation (PSI) versus conventional instrumentation. Outcomes of interest included postoperative Knee Society score (KSS) (function), KSS (knee), range of movement (ROM), Oxford knee scores (OKS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Five randomized controlled trials and three prospective-comparative studies were included reporting on a total of 828 knees. All eight studies reported postoperative KSS (function) and seven studies reported KSS (knee). Three studies reported postoperative OKS, four documented ROM, and two reported WOMAC scores. Meta-analysis demonstrated equivalent KSS (function) scores 3 months postsurgery (Z = 1.71, p = 0.09). In addition, no significant differences were found for KSS (function) at 6 months (Z = 0.51, p = 0.61) or 12 to 24 months postsurgery (Z = 0.05, p = 0.96). In addition, no significant differences were found between PSI and conventional instrumentation for postoperative KSS (knee), ROM, or OKS. In summary, this systematic review and meta-analysis demonstrates no conclusive evidence for or against PSI when considering short-term functional outcomes. Further high-quality studies are required to investigate both mid- and long-term outcomes as well as survivorship data.

Keywords

knee functional outcome - knee - meta-analysis

• References

• 1 Rodriguez JA, Bhende H, Ranawat CS. Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 2001; (388) 10-17
• 2 Ranawat CS, Flynn Jr WF, Saddler S, Hansraj KK, Maynard MJ. Long-term results of the total condylar knee arthroplasty. A 15-year survivorship study. Clin Orthop Relat Res 1993; (286) 94-102
• 3 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 (04) 780-785
• 4 Mannan A, Smith TO. Favourable rotational alignment outcomes in PSI knee arthroplasty: a Level 1 systematic review and meta-analysis. Knee 2016; 23 (02) 186-190
• 5 Jiang J, Kang X, Lin Q. , et al. Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics 2015; 38 (04) e305-e313
• 6 Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX. Patient-specific instrumentation does not improve accuracy in total knee arthroplasty. Orthopedics 2015; 38 (03) e178-e188
• 7 Cavaignac E, Pailhé R, Laumond G. , et al. Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty: a meta-analysis. Int Orthop 2015; 39 (08) 1541-1552
• 8 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 [phone]
• 9 Fu H, Wang J, Zhou S. , et al. No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3288-3295
• 10 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 (09) 1709-1712
• 11 Russell R, Brown T, Huo M, Jones R. Patient-specific instrumentation does not improve alignment in total knee arthroplasty. J Knee Surg 2014; 27 (06) 501-504
• 12 Abane L, Anract P, Boisgard S, Descamps S, Courpied JP, Hamadouche M. A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: a multicentre randomised controlled trial. Bone Joint J 2015; 97-B (B1): 56-63
• 13 Yan CH, Chiu KY, Ng FY, Chan PK, Fang CX. Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3637-3645
• 14 Pfitzner T, Abdel MP, von Roth P, Perka C, Hommel H. Small improvements in mechanical axis alignment achieved with MRI versus CT-based patient-specific instruments in TKA: a randomized clinical trial. Clin Orthop Relat Res 2014; 472 (10) 2913-2922
• 15 Woolson ST, Harris AH, Wagner DW, Giori NJ. Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 2014; 96 (05) 366-372
• 16 Kotela A, Lorkowski J, Kucharzewski M. , et al. Patient-specific CT-based instrumentation versus conventional instrumentation in total knee arthroplasty: a prospective randomized controlled study on clinical outcomes and in-hospital data. BioMed Res Int 2015; 2015: 165908
• 17 Anderl W, Pauzenberger L, Kölblinger R. , et al. Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 102-111
• 18 Chen JY, Chin PL, Tay DK, Chia SL, Lo NN, Yeo SJ. Functional outcome and quality of life after patient-specific instrumentation in total knee arthroplasty. J Arthroplasty 2015; 30 (10) 1724-1728
• 19 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 (05) 837-844
• 20 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62 (10) 1006-1012
• 21 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrance Collaboration (updated March 2011). Available at: www.cochrane-handbook.org . Accessed 2011
• 22 Mannan A, Smith TO, Sagar C, London NJ, Molitor PJ. No demonstrable benefit for coronal alignment outcomes in PSI knee arthroplasty: a systematic review and meta-analysis. Orthop Traumatol Surg Res 2015; 101 (04) 461-468
• 23 Hossain FS, Konan S, Patel S, Rodriguez-Merchan EC, Haddad FS. The assessment of outcome after total knee arthroplasty: are we there yet?. Bone Joint J 2015; 97-B (B11): 3-9
• 24 Mizner RL, Petterson SC, Clements KE, Zeni Jr JA, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty 2011; 26 (05) 728-737
• 25 Abdel MP, Parratte S, Blanc G. , et al. No benefit of patient-specific instrumentation in TKA on functional and gait outcomes: a randomized clinical trial. Clin Orthop Relat Res 2014; 472 (08) 2468-2476