Comparison of Clinical, Functional, and Radiological Outcomes of Total Knee Arthroplasty Using Conventional and Patient-Specific Instrumentation

Document Type : RESEARCH PAPER

Authors

1 Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Bone Joint and Related Tissues Research Center, Akhtar Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Recently, patient-specific instrumentation (PSI) systems have been developed in order to increase the
accuracy of component positioning during total knee arthroplasty (TKA); however, the findings of previous studies are
controversial in this regard. In the current randomized clinical study, the outcomes of computer tomography (CT)-based
PS (patient specific)-guided TKA were compared to the results of conventional instrumentation (CVI) TKA. The guides
were designed on the basis of distal femoral and proximal tibial pin orientation of the conventional related guides.
Methods: The present study was carried out on 24 TKA candidates randomly assigned to two PSI (n=12) and CVI
(n=12) groups. The patients were postoperatively followed for 2 years. Then, the hip-knee-ankle angle (HKAA), femoral
component flexion, and orientation of components in the coronal plane were measured. In addition, the Western
Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Knee Society Score (KSS) questionnaire were
completed for all the patients.
Results: The rate of the outliers of the HKAA was higher in the CVI group (41.7% and 8.3%; P=0.077); nevertheless,
the difference was not significant in this regard. The rate of the outliers of other radiographic measurements and
operational time were similar in both groups. Furthermore, there was no significant difference between the two groups
in terms of the WOMAC and KSS.
Conclusion: The CT-based PS-guided TKA may result in the improved postoperative mechanical alignment of the limb
and should be considered in complicated TKAs. However, future studies should investigate whether the results of PSI
TKA support the considerably higher costs of this technique.
Level of evidence: II

Keywords

References

1. Castelli CC, Falvo DA, Iapicca ML, Gotti V. Rotational
alignment of the femoral component in total knee
arthroplasty. Annals of translational medicine. 2016;
4(1).
2. Liu HX, Shang P, Ying XZ, Zhang Y. Shorter survival rate
in varus-aligned knees after total knee arthroplasty.
Knee Surgery, Sports Traumatology, Arthroscopy.
2016; 24(8):2663-71.
3. Gromov K, Korchi M, Thomsen MG, Husted H,
Troelsen A. What is the optimal alignment of the tibial
and femoral components in knee arthroplasty? An
overview of the literature. Acta orthopaedica. 2014;
85(5):480-7.
4. Rienmüller A, Guggi T, Gruber G, Preiss S, Drobny
T. The effect of femoral component rotation on the 
five-year outcome of cemented mobile bearing total
knee arthroplasty. International orthopaedics. 2012;
36(10):2067-72.
5. Lesh ML, Schneider DJ, Deol G, Davis B, Jacobs CR,
Pelligrini Jr VD. The consequences of anterior femoral
notching in total knee arthroplasty: a biomechanical
study. JBJS. 2000; 82(8):1096.
6. Ritter MA, Davis KE, Meding JB, Pierson JL, Berend
ME, Malinzak RA. The effect of alignment and BMI
on failure of total knee replacement. JBJS. 2011;
93(17):1588-96.
7. 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. The 
Journal of arthroplasty. 2012; 27(9):1737-41.
8. Kotela A, Lorkowski J, Kucharzewski M, Wilk-Frańczuk
M, Ś􀆵liwiński Z, Frańczuk B, 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 research
international. 2015; 2015.
9. 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. The bone & joint journal. 2015; 97(1):56-63.
10. 10. Stirling P, Mannambeth RV, Soler A, Batta V,
Malhotra RK, Kalairajah Y. Computerised tomography
vs magnetic resonance imaging for modeling of
patient-specific instrumentation in total knee
arthroplasty. World Journal of Orthopedics. 2015;
6(2):290.
11. Noble Jr JW, Moore CA, Liu N. The value of patientmatched
instrumentation in total knee arthroplasty.
The Journal of arthroplasty. 2012; 27(1):153-5.
12. Ferrara F, Cipriani A, Magarelli N, Rapisarda S, De
Santis V, Burrofato A, et al. Implant positioning
in TKA: comparison between conventional and
patient-specific instrumentation. Orthopedics. 2015;
38(4):e271-80.
13. Vide J, Freitas TP, Ramos A, Cruz H, Sousa JP. Patientspecific
instrumentation in total knee arthroplasty:
simpler, faster and more accurate than standard
instrumentation—a randomized controlled trial.
Knee Surgery, Sports Traumatology, Arthroscopy.
2017; 25(8):2616-21.
14. Anderl W, Pauzenberger L, Kölblinger R, Kiesselbach
G, Brandl G, Laky B, et al. Patient-specific
instrumentation improved mechanical alignment,
while early clinical outcome was comparable
to conventional instrumentation in TKA. Knee
Surgery, Sports Traumatology, Arthroscopy. 2016;
24(1):102-11.
15. Heyse TJ, Tibesku CO. Improved tibial component
rotation in TKA using patient-specific instrumentation.
Archives of Orthopaedic and Trauma Surgery. 2015;
135(5):697-701.
16. Nabavi A, Olwill CM. Early outcome after total knee
replacement using computed tomography–based
patient-specific cutting blocks versus standard
instrumentation. Journal of Orthopaedic Surgery.
2015; 23(2):182-4.
17. Renson L, Poilvache P, Van den Wyngaert H. Improved 
alignment and operating room efficiency with patientspecific
instrumentation for TKA. The knee. 2014;
21(6):1216-20.
18. Rathod PA, Deshmukh AJ, Cushner FD. Reducing blood
loss in bilateral total knee arthroplasty with patientspecific
instrumentation. Orthopedic Clinics. 2015;
46(3):343-50.
19. Chareancholvanich K, Narkbunnam R, Pornrattanamaneewong
C. A prospective randomised
controlled study of patient-specific cutting guides
compared with conventional instrumentation in total
knee replacement. The bone & joint journal. 2013;
95(3):354-9.
20. Abdel MP, von Roth P, Hommel H, Perka C, Pfitzner
T. Intraoperative navigation of patient-specific
instrumentation does not predict final implant
position. The Journal of Arthroplasty. 2015; 30(4):
564-6.
21. Chen JY, Chin PL, Tay DK, Chia SL, Lo NN, Yeo SJ.
Functional outcome and quality of life after patientspecific
instrumentation in total knee arthroplasty.
The Journal of arthroplasty. 2015; 30(10):1724-8.
22. Mihalko WM. Patient-specific cutting guides were not
better than conventional instrumentation for total
knee arthroplasty. JBJS. 2015; 97(22):1891.
23. Zhu M, Chen JY, Chong HC, Yew AK, Foo LS, Chia SL,
et al. Outcomes following total knee arthroplasty
with CT-based patient-specific instrumentation. Knee
Surgery, Sports Traumatology, Arthroscopy. 2017;
25(8):2567-72.
24. Chen JY, Yeo SJ, Yew AK, Tay DK, Chia SL, Lo NN, et
al. The radiological outcomes of patient-specific
instrumentation versus conventional total knee
arthroplasty. Knee Surgery, Sports Traumatology,
Arthroscopy. 2014; 22(3):630-5.
25. Stronach BM, Pelt CE, Erickson J, Peters CL. Patientspecific
total knee arthroplasty required frequent
surgeon-directed changes. Clinical Orthopaedics and
Related Research®. 2013; 471(1):169-74.
26. 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. Orthopaedics & Traumatology: Surgery
& Research. 2015; 101(4):461-8.
27. Zhang QM, Chen JY, Li H, Chai W, Ni M, Zhang ZD, et
al. No evidence of superiority in reducing outliers
of component alignment for patient‐specific
instrumentation for total Knee arthroplasty: a
systematic review. Orthopaedic Surgery. 2015;
7(1):19-25.
The Archives of Bone and Joint Surgery
Volume 8, Issue 5
September 2020
Pages 625-632

Files

History

  • Receive Date: 26 August 2019
  • Revise Date: 18 April 2020
  • Accept Date: 26 April 2020

Share

How to cite

Statistics