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Rudran B, Magill H, Ponugoti N, Williams A, Ball S. Functional outcomes in patient specific instrumentation vs. conventional instrumentation for total knee arthroplasty; a systematic review and meta-analysis of prospective studies. BMC Musculoskelet Disord 2022; 23:702. [PMID: 35870913 PMCID: PMC9308296 DOI: 10.1186/s12891-022-05620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Total Knee Arthroplasty (TKA) is an established surgical option for knee osteoarthritis (OA). There are varying perceptions of the most suitable surgical technique for making bone cuts in TKA. Conventional Instrumentation (CI) uses generic cutting guides (extra- and intra-medullary) for TKA; however, patient specific instrumentation (PSI) has become a popular alternative amongst surgeons. Methods A literature search of electronic databases Embase, Medline and registry platform portals was conducted on the 16th May 2021. The search was performed using a predesigned search strategy. Eligible studies were critically appraised for methodological quality. The primary outcome measure was Knee Society Function Score. Functional scores were also collected for the secondary outcome measures: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS) for pain. Review Manager 5.3 was used for all data synthesis and analysis. Results There is no conclusive evidence in the literature to suggest that PSI or CI instrumentation is better for functional outcomes. 23 studies were identified for inclusion in this study. Twenty-two studies (18 randomised controlled trials and 4 prospective studies) were included in the meta analysis, with a total of 2277 total knee arthroplasties. There were 1154 PSI TKA and 1123 CI TKA. The majority of outcomes at 3-months, 6-months and 12 show no statistical difference. There was statistical significance at 24 months in favour of PSI group for KSS function (mean difference 4.36, 95% confidence interval 1.83–6.89). The mean difference did not exceed the MCID of 6.4. KSS knee scores demonstrated statistical significance at 24 months (mean difference 2.37, 95% confidence interval (CI) 0.42—4.31), with a MCID of 5.9. WOMAC scores were found to be statistically significant favouring PSI group at 12 months (mean difference -3.47, 95% confidence interval (CI) -6.57- -0.36) and 24 months (mean difference -0.65, 95% confidence interval (CI) -1.28—-0.03), with high level of bias noted in the studies and a MCID of 10. Conclusions This meta-analysis of level 1 and level 2 evidence shows there is no clinical difference when comparing PSI and CI KSS function scores for TKA at definitive post operative time points (3 months, 6 months, 12 months and 24 months). Within the secondary outcomes for this study, there was no clinical difference between PSI and CI for TKA. Although there was no clinical difference between PSI and CI for TKA, there was statistical significance noted at 24 months in favour of PSI compared to CI for TKA when considering KSS function, KSS knee scores and WOMAC scores. Studies included in this meta-analysis were of limited cohort size and prospective studies were prone to methodological bias. The current literature is limited and insufficiently robust to make explicit conclusions and therefore further high-powered robust RCTs are required at specific time points.
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Does the use of patient-specific instrumentation improve resource use in the operating room and outcome after total knee arthroplasty?–A multicenter study. PLoS One 2022; 17:e0277464. [DOI: 10.1371/journal.pone.0277464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) has been introduced to reduce instruments and surgical time and to improve implant alignment. The aim of this study was to compare TKA with patient-specific and conventional instrumentation with regard to the use of resources in the operating room (OR), alignment and patient-reported outcome. A total of 139 TKA with PSI or conventional instrumentation were included in three centers. Economic variables of the surgery (number of instrument trays, setup and cut-sew-time), radiological alignment and patient reported outcomes (VAS Pain Scale, Oxford Knee Score, EQ-5D) were assessed after 6 weeks, 6 and 12 months. There was a significant reduction of instrument trays and of time in the OR in the PSI group. The reduction varied between the centers. With strict reorganization, more than 50% of the instrument trays could be reduced while using PSI. There were no significant differences in cut-sew-time, implant position, leg axis, pain and function. The use of PSI was associated with significantly less OR resources. However, the savings did not compensate the costs for this technology.
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Clinical outcomes after using patient specific instrumentation: is it worth the effort? A minimum 5-year retrospective review of 298 PSI knees. Arch Orthop Trauma Surg 2022; 143:3409-3422. [PMID: 36214876 PMCID: PMC9549813 DOI: 10.1007/s00402-022-04593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/10/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Use of patient specific instrumentation (PSI) for performing total knee arthroplasty (TKA) has been shown to improve component positioning but there is dearth of evidence regarding clinical outcomes. The aim of our study was to report patient satisfaction and functional outcome scores of patients who underwent PSI TKAs at minimum 5 year follow up. METHODS This is a retrospective study of a prospectively collected data of patients who underwent PSI TKAs between January 2012 and October 2015 under a single surgeon. Patient Reported Outcome Measures (PROMs), patient satisfaction questionnaires, surgeon directed 3D planning changes and intra-operative changes were collected and analysed. RESULTS The cohort included 298 consecutive PSI TKAs performed on 249 patients at a mean age of 71 years (range: 49-93 years). On an average 4 changes were made for each knee during 3D planning compared to preliminary plan. Intra-operative implant size change was required only in 3% (10 knees). The PROM scores were collected at a mean follow-up period of 6.8 years (range: 5.0-8.6 years) for 224 knees. Oxford Knee Score improved from median pre-operative score of 18 (IQR: 13-24) to median post-operative score of 44 (IQR: 40-47) with a median gain of 23 (IQR: 16-30). The median modified Forgotten Joint Score was 87.5 (IQR: 54.4-98.1). For the Beverland questionnaire, 75% (n = 166) reported being "Very Happy" and only 4% (n = 9/222) were 'Never Happy'. CONCLUSION Excellent patient satisfaction and functional scores at mid-term can be achieve d using PSI technique to perform TKA with careful surgeon directed pre-operative planning.
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Sayah SM, Karunaratne S, Beckenkamp PR, Horsley M, Hancock MJ, Hunter DJ, Herbert RD, de Campos TF, Steffens D. Clinical Course of Pain and Function Following Total Knee Arthroplasty: A Systematic Review and Meta-Regression. J Arthroplasty 2021; 36:3993-4002.e37. [PMID: 34275710 DOI: 10.1016/j.arth.2021.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is widely considered a successful intervention for osteoarthritis and other degenerative knee diseases. This study addresses the need for a high-quality meta-analysis that outlines the clinical course of pain and function post-TKA. METHODS The review included prospective cohort studies assessing pain or function of patients undergoing primary TKA at baseline (preoperatively) and at least 2 additional time points including one at least 12 months postoperatively. Two reviewers independently screened references, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. The time course of recovery of pain and function was modeled using fractional polynomial meta-regression. RESULTS In total, 191 studies with 59,667 patients were included, most with low risk of bias. The variance-weighted mean pain score (/100, 0 = no pain) was 64.0 (95% confidence interval [CI] 60.2-67.7) preoperatively, 24.1 (95% CI 20.3-27.9) at 3 months, 20.4 (95% CI 16.7-24.0) at 6 months, and 16.9 (95%CI 13.6-20.3) at 12 months, and remained low (10.1; 95% CI 4.8-15.4) at 10 years postoperatively. The variance-weighted mean function score (/100, 0 = worst function) was 47.1 (95% CI 45.7-48.4) preoperatively, 72.8 (95% CI 71.3-74.4) at 3 months, 76.3 (95% CI 74.7-77.8) at 6 months, and 78.1 (95%CI 76.4-79.7) at 12 months. Function scores were good (79.7; 95% CI 77.9-81.5) at 10 years postoperatively. CONCLUSION Patients undergoing primary TKA can expect a large and rapid but incomplete recovery of pain and function in the first postoperative year. At 10 years, the gains in pain scores may still remain while there is an improvement in function.
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Affiliation(s)
- Said Mohamad Sayah
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paula R Beckenkamp
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Tarcisio F de Campos
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Resource Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Pawar P, Naik L, Sahu D, Bagaria V. Comparative Study of Pinless Navigation System versus Conventional Instrumentation in Total Knee Arthroplasty. Clin Orthop Surg 2021; 13:358-365. [PMID: 34484629 PMCID: PMC8380527 DOI: 10.4055/cios20226] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
Backgroud Optimal placement of the components and achieving a neutral mechanical axis are the main goals of total knee arthroplasty (TKA). Different computerised navigation systems are presently used for these purposes. This aim of this study was to compare the pinless navigation (PNA) TKA performed using iAssist with the conventional instrumented (CIN) TKA in terms of functional and radiological outcomes. Methods A total of 100 knees operated for TKA by a single surgeon were studied retrospectively for a period of 2 years. Weight-bearing postoperative radiographs of the knees along with scanograms of the lower limbs were used for measurements of component positioning, mechanical axis alignment, and number of outliers. Oxford knee scoring was used for functional analysis. Results No statistically significant difference was seen in the mean mechanical axis alignment (hip-knee-ankle angle), coronal alignment (α and β angles) and sagittal alignment (γ and δ angles) of the femoral and tibial components between the two groups. Though the percentage of outliers for mechanical axis alignment was lower in the PNA-TKA group than in the CIN-TKA group, the difference was not statistically significant (p = 0.73). The number of outliers for the femoral and tibial component positioning in coronal and sagittal planes was not statistically significantly different between the two groups. No statistically significant difference (p = 0.68) was noted between the two groups with respect to the Oxford Knee Score. The mean surgical time was greater in the PNA-TKA group by 11 minutes, which was statistically significantly longer (p = 0.018). Complications were seen in 6.89% of the cases in the CIN-TKA group, while none in the PNA-TKA group. Conclusions The accurate mechanical axis alignment and component positioning can be achieved with the conventional instrumentation, so the use of PNA system, which adds to the surgical cost, is questionable. Also, equally good short-term functional outcome can be achieved with the conventional instrumentation. The surgeon must be accustomed with the instrumentation of the PNA system, or it adds to the surgical time.
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Affiliation(s)
- Prashant Pawar
- Department of Orthopaedics, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Lokesh Naik
- Department of Orthopaedics, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Dipit Sahu
- Department of Orthopaedics, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vaibhav Bagaria
- Department of Orthopaedics, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
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Osteoarthritic knees have a highly variable patellofemoral alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:483-490. [PMID: 32162047 DOI: 10.1007/s00167-020-05928-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This systematic review aimed to evaluate the variability of patellofemoral (PF) alignment and trochlear morphology in osteoarthritic knees. METHODS PF alignment of the knee was defined by the following parameters: the sulcus angle (SA), femoral trochlear depth (FTD), patellar tilt angle (PTA), lateral patellofemoral angle (LPFA), lateral femoral trochlear inclination (LFTI) and tibial tubercle-trochlear groove distance (TT-TG). The electronic databases MEDLINE and EMBASE were searched from database inception to the search date (February 19, 2019) and were screened for relevant studies. The PRISMA guidelines were followed. Articles reporting PF alignment measurements of osteoarthritic knees in patients over 40 years old were included. Data were extracted and methodological quality was assessed using a 14-item checklist. RESULTS A total of 8 studies met the inclusion criteria. The studies reported mean values ± SD between 120° and 141.1° ± 7.7 for the SA; 5.8 mm ± 1.4 for the FTD; between - 0.1° ± 3.3 and 10.3° ± 5.7 for the PTA; between 5.8° ± 5.4 and 17° for the LPFA; between 23.2° ± 5.0 and 27.1° ± 4.4 for the LFTI; and 5.8 mm ± 5.4 for the TT-TG. CONCLUSION PF alignment in the osteoarthritic knee is more variable than expected. This finding should encourage surgeons to consider the individual preoperative PF alignment more precisely with the aim of reducing anterior knee pain (AKP) after TKA. 3D-CT imaging might be of great value to analyse the PF alignment in an appropriate way. LEVEL OF EVIDENCE Level III.
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Batailler C, Swan J, Sappey Marinier E, Servien E, Lustig S. New Technologies in Knee Arthroplasty: Current Concepts. J Clin Med 2020; 10:jcm10010047. [PMID: 33375702 PMCID: PMC7795103 DOI: 10.3390/jcm10010047] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- Service de Chirurgie Orthopédique, Université de Lyon, Université Claude Bernard Lyon 1, LBMC UMR_T9406, 69003 Lyon, France
- Cécile BATAILLER, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
- Correspondence:
| | - John Swan
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
| | - Elliot Sappey Marinier
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- Service de Chirurgie Orthopédique, Université de Lyon, Université Claude Bernard Lyon 1, LBMC UMR_T9406, 69003 Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 69100 Villeurbanne, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, 69004 Lyon, France; (J.S.); (E.S.M.); (E.S.); (S.L.)
- Service de Chirurgie Orthopédique, Université de Lyon, Université Claude Bernard Lyon 1, LBMC UMR_T9406, 69003 Lyon, France
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Kizaki K, Shanmugaraj A, Yamashita F, Simunovic N, Duong A, Khanna V, Ayeni OR. Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis. BMC Musculoskelet Disord 2019; 20:561. [PMID: 31759392 PMCID: PMC6875166 DOI: 10.1186/s12891-019-2940-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Total knee arthroplasty using patient-specific instrumentation (TKA-PSI), which are disposable cutting block guides generated to fit each patient's 3-dimensional knee anatomy, has been developed to treat patients with end-stage osteoarthritis of the knee. Surrogate markers such as radiographic malalignment have been well investigated, however, patient-important outcomes are not well examined to elucidate the efficacy of TKA-PSI. The aim of this review is to determine if TKA-PSI improves patient-reported outcome measures (PROM), surgery time, blood loss, transfusion and complications (e.g. surgical site infection, deep venous thrombosis, and revision TKA). METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ongoing clinical trials. For PROMs, surgery time, blood loss, and transfusion rate, we included randomized controlled trials (RCT) comparing TKA-PSI and standard TKA to treat osteoarthritis of the knee. For complications, we also included non-randomized comparative studies (non-RCT). RESULTS This review includes 38 studies, 24 of which were RCT and 14 of which were non-RCT. These included a total of 3487 patients. The predominant population in the included studies highly reflected the general population, with 62% being female, aged over 60 and having end-stage osteoarthritis of the knee. TKA-PSI did not improve PROMs as compared to standard TKA for less than 1-year (mean difference 0.48, 95% confidence interval (CI) -1.92-0.97 in the Oxford knee score, mean 3-month follow-up) and for 1-year or more (mean difference 0.25, 95%CI - 4.39-4.89 in the WOMAC score, mean 29-month follow-up). TKA-PSI did not reduce surgery time (mean difference - 3.09 min, 95%CI -6.73-0.55). TKA-PSI decreased blood loss with a small effect size corresponding to a 0.4 g/dl hemoglobin decrease (95%CI 0.18-0.88), but did not decrease transfusion rate (risk difference - 0.04, 95%CI -0.09-0.01). TKA-PSI did not reduce complication rates (risk difference 0.00, 95%CI - 0.01-0.01 in the composite outcome). CONCLUSIONS TKA-PSI does not improve patient-reported outcome measures, surgery time, and complication rates as compared to standard TKA. TKA-PSI decreases blood loss with a small effect, which is not enough to reduce transfusion rate.
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Affiliation(s)
- Kazuha Kizaki
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.,Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Fumiharu Yamashita
- Department of Orthopaedic surgery and rheumatology, Kyoto Shimogamo Hospital, 17 Shimogamo, Kyoto, 606-0866, Japan
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.,Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Andrew Duong
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Olufemi R Ayeni
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada. .,Division of Orthopaedic Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
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Cozzi Lepri A, Innocenti M, Matassi F, Villano M, Civinini R, Innocenti M. Accelerometer-Based Navigation in Total Knee Arthroplasty for the Management of Extra-Articular Deformity and Retained Femoral Hardware: Analysis of Component Alignment. JOINTS 2019; 7:1-7. [PMID: 31879723 PMCID: PMC6930126 DOI: 10.1055/s-0039-1697610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/07/2019] [Indexed: 10/27/2022]
Abstract
Purpose Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 5.0° (range 3-7). The alignment of the femoral component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 3.0° (range 0-5). Conclusion The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence This is an observational study without a control group, Level III.
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Affiliation(s)
- Andrea Cozzi Lepri
- Orthopaedic Clinic, University of Florence, NeuroMuscoloSkeletal and Sense Organs Department, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, NeuroMuscoloSkeletal and Sense Organs Department, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, NeuroMuscoloSkeletal and Sense Organs Department, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Villano
- Orthopaedic Clinic, University of Florence, NeuroMuscoloSkeletal and Sense Organs Department, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, NeuroMuscoloSkeletal and Sense Organs Department, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Massimo Innocenti
- Orthopaedic Clinic, University of Florence, NeuroMuscoloSkeletal and Sense Organs Department, Orthopaedic Traumatologic Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Lee M, Chen JY, Ying H, Nee PH, Tay DKJ, Chin PL, Lu CS, Nung LN, Jin YS. Quality of life and functional outcome after single-radius and multi-radius total knee arthroplasty. J Orthop Surg (Hong Kong) 2019; 26:2309499018792417. [PMID: 30089417 DOI: 10.1177/2309499018792417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The main objective of this study was to compare quality of life and functional outcome in patients who have undergone a single-radius (SR) or multi-radius (MR) total knee arthroplasty (TKA). The secondary objective was to observe changes in knee range of movement (ROM) and standardized knee scores (KSCs) in these patients. The hypothesis was that there would be no statistically significant difference between the two patient groups in quality of life and functional outcome. METHODS One hundred three SR TKAs were performed by a single surgeon between August 2008 and December 2012. A propensity score matching algorithm was used to select 103 MR TKAs performed during the same period. Preoperative and postoperative variables such as standardized knee and quality of life scores were captured prospectively and then analyzed via both the Student's t-test and paired t-test to look for statistically significant differences between the SR and MR patient groups. RESULTS At 2 years postoperatively, there was no statistically significant difference between the SR and MR patient populations in knee extension, Oxford Knee Score, Knee Society Clinical Rating Scores, and the Physical Component Summary of the Short Form 36 Health Survey (SF-36). There was a statistically significant difference between the two patient groups in postoperative knee flexion in favor of the MR design ( p = 0.011). CONCLUSION While an SR femoral implant design has several theoretical biomechanical advantages, postoperative standardized KSCs and quality of life scores in this single-surgeon series do not show a clear advantage of one design over the other. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Merrill Lee
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hao Ying
- 2 Health Services Research Unit (HSRU), Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pang Hee Nee
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng Jin Tay
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Pak Lin Chin
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chia Shi Lu
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Lo Ngai Nung
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yeo Seng Jin
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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León-Muñoz VJ, Martínez-Martínez F, López-López M, Santonja-Medina F. Patient-specific instrumentation in total knee arthroplasty. Expert Rev Med Devices 2019; 16:555-567. [PMID: 31154870 DOI: 10.1080/17434440.2019.1627197] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic procedures. During the past decade, patient-specific instrumentation (PSI) has been commercially introduced in order to simplify and make TKA surgery more effective, precise and efficient than conventional mechanical instrumentation (CI) and computer-assisted surgery (CAS). Nevertheless, there are critical arguments against PSI for routine use. The aim of the current manuscript is to describe advantages and limitations of PSI for primary TKA. AREAS COVERED By means of a description of the available literature different aspects are discussed (accuracy, clinical and functional outcomes, operative time, blood loss, efficiency and costs). EXPERT OPINION Most publications do not claim a significant increase in PSI accuracy over CI, but they also do not postulate PSIs accuracy is worse either. Regarding clinical aspects, PSI did not appear to give any advantage over standard techniques although, equally, it did not appear to show any disadvantages. PSI seems to reduce operative time, could reduce perioperative blood loss and provides logistical benefits in the operation room. Further studies will be required to more thoroughly assess all the advantages and disadvantages of this promising technology as an alternative to CI and CAS.
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Affiliation(s)
- Vicente J León-Muñoz
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain
| | - Francisco Martínez-Martínez
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain.,b Faculty of Medicine , University of Murcia , Murcia , Spain
| | - Mirian López-López
- c Subdirección General de Tecnologías de la Información. Servicio Murciano de Salud , Murcia , Spain
| | - Fernando Santonja-Medina
- a Orthopaedic Surgery and Traumatology Department , Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain.,b Faculty of Medicine , University of Murcia , Murcia , Spain
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Attard A, Tawy GF, Simons M, Riches P, Rowe P, Biant LC. Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial. BMJ Open Qual 2019; 8:e000493. [PMID: 31206056 PMCID: PMC6542447 DOI: 10.1136/bmjoq-2018-000493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 01/17/2023] Open
Abstract
Aim To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA). Patients and methods Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience. Results PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point. Conclusions PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.
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Affiliation(s)
- Andre Attard
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Gwenllian Fflur Tawy
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
| | - Michiel Simons
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Philip Riches
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Philip Rowe
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Leela C Biant
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, UK
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Hepperger C, Gföller P, Abermann E, Hoser C, Ulmer H, Herbst E, Fink C. Sports activity is maintained or increased following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1515-1523. [PMID: 28341878 DOI: 10.1007/s00167-017-4529-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/20/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of this study was to investigate sports activities and functional abilities in patients following total knee arthroplasty (TKA). It was hypothesized that patients who had undergone TKA would return to a higher activity level as that experienced preoperatively. METHODS Two hundred patients were included in this prospective single-cohort study. All the patients completed subjective questionnaires (Tegner Activity Level, Oxford Knee Score, Visual Analog Scale for pain) prior to surgery as well as at 6, 12, and 24 months postoperatively. Additionally, sports behaviour was evaluated. Sports frequency was divided into four categories: more than 5 times a week, 2-3 times a week, occasionally, and no sports activities. Additionally, the patients were asked to state their three favourite summer and winter sports. RESULTS All patient-reported outcome scores improved significantly over time (p ≤ 0.005). The Tegner Activity Level increased significantly from the preoperative state to 24 months postsurgery (p = 0.005). Six months after surgery, 43% of the patients returned to the same and 35% to a higher Tegner Activity Level than prior to surgery. Gender-related differences were observed for the Tegner Activity Level showing a higher activity level for the male than for the female patients. Overall, 24 months postsurgery 83% of the patients practiced sports in comparison with 79% prior to surgery. CONCLUSIONS Following TKA, the patients were able to increase sports performance, while pain was reduced. Therefore, patients who want to continue their desired sports may safely consider TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Caroline Hepperger
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Peter Gföller
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria.
| | - E Abermann
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Schöpfstraße 41, 6020, Innsbruck, Austria
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
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Rivière C, Iranpour F, Harris S, Auvinet E, Aframian A, Parratte S, Cobb J. Differences in trochlear parameters between native and prosthetic kinematically or mechanically aligned knees. Orthop Traumatol Surg Res 2018; 104:165-170. [PMID: 29223778 DOI: 10.1016/j.otsr.2017.10.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/17/2017] [Accepted: 10/27/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Kinematic (KA) and mechanical (MA) alignment techniques are two different philosophies of implant positioning that use the same TKA implants. This might generate differences in the resulting prosthetic trochleae parameters between the two techniques of alignment. Our study aim was to test the following hypotheses : (1) mechanically or kinematically aligned femoral implant understuffs the native trochlear articular surface and poorly restores the native groove orientation, and (2) the orientation of the prosthetic trochlear groove and trochlear fill are different between MA and KA. METHODS Three-dimensional models of the femur were made from segmentation of preoperative Magnetic Resonance Imaging scans (MRIs) of ten subjects with isolated medial tibiofemoral osteoarthritis. In-house planning and analysis software kinematically and mechanically aligned a modern cruciate retaining femoral component and determined differences in parameters of the trochlear fit between native and prosthetic trochleae, and between KA and MA prosthetic trochleae. RESULTS The MA prosthetic trochleae did not fill (understuffed) the entire length of the native medial facet and the proximal 70% of the native groove and lateral facet, and oriented the trochleae groove 8° more valgus than native. The KA prosthetic trochleae understuffed the proximal 70% of the native trochleae, and had a groove 6° more valgus than native. The KA trochleae understuffed the medial facet distally and oriented the groove 2° less valgus and 3° more internally rotated than the MA trochleae. CONCLUSION MA and KA prosthetic trochleae substantially understuff and create a prosthetic groove more valgus compared to native trochlear anatomy, and they also differed between each other regarding trochleae stuffing and groove alignment. Although randomized trials have not shown differences in patellofemoral complications between KA and MA, a femoral component designed specifically for KA that more closely restores the native trochlear anatomy might improve patient reported satisfaction and function. LEVEL OF EVIDENCE Level 2 controlled laboratory study.
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Affiliation(s)
- C Rivière
- MSK Lab, Charing Cross Hospital, Imperial College London, W6 8RP London, UK.
| | - F Iranpour
- MSK Lab, Charing Cross Hospital, Imperial College London, W6 8RP London, UK
| | - S Harris
- MSK Lab, Charing Cross Hospital, Imperial College London, W6 8RP London, UK
| | - E Auvinet
- MSK Lab, Charing Cross Hospital, Imperial College London, W6 8RP London, UK
| | - A Aframian
- MSK Lab, Charing Cross Hospital, Imperial College London, W6 8RP London, UK
| | - S Parratte
- Service de chirurgie orthopédique, hôpital Sainte-Marguerite, université Aix-Marseille, 13009 Marseille, France
| | - J Cobb
- MSK Lab, Charing Cross Hospital, Imperial College London, W6 8RP London, UK
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Rivière C, Lazic S, Villet L, Wiart Y, Allwood SM, Cobb J. Kinematic alignment technique for total hip and knee arthroplasty: The personalized implant positioning surgery. EFORT Open Rev 2018; 3:98-105. [PMID: 29657851 PMCID: PMC5890135 DOI: 10.1302/2058-5241.3.170022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality. Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined. By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity. The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation. The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy. The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK; South West London Elective Orthopaedic Center, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Center, UK
| | | | - Yann Wiart
- Unfallchirurgie, Theresienkrankenhauss Mannheim, Germany
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Rivière C, Iranpour F, Auvinet E, Aframian A, Asare K, Harris S, Cobb J, Parratte S. Mechanical alignment technique for TKA: Are there intrinsic technical limitations? Orthop Traumatol Surg Res 2017; 103:1057-1067. [PMID: 28888523 DOI: 10.1016/j.otsr.2017.06.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/15/2017] [Accepted: 06/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mechanically aligned (MA) total knee arthroplasty (TKA) is affected by disappointing functional outcomes in spite of the recent improvements in surgical precision and implant designs. This might suggest the existence of intrinsic technical limitations. Our study aims to compare the prosthetic and native trochlear articular surfaces and to estimate the extent of collateral ligament imbalance, which is technically uncorrectable by collateral ligament release when TKA implants are mechanically aligned. STUDY HYPOTHESIS Conventional MA technique generates a high rate of prosthetic overstuffing of the distal groove, distal lateral trochlear facet and distal lateral femoral condyle (Hypothesis 1), and technically uncorrectable collateral ligament imbalance (hypothesis 2)? Disregarding the distal femoral joint line obliquity (DFJLO) when performing femoral cuts explains distal lateral femoral prosthetic stuffing and uncorrectable imbalance (hypothesis 3)? METHODS Twenty patients underwent a conventional MA TKA. Pre-operative MRI-based 3D knee models were generated and MA TKA was simulated. Native and prosthetic trochlear articular surfaces were compared using in-house analysis software. Following the automatic determination by the planning software of the size of the extension and flexion gaps, an algorithm was applied to balance the gaps and the frequency and amplitude of technically uncorrectable knee imbalance were estimated. RESULTS The conventional MA technique generates a significant slight distal lateral femoral prosthetic overstuffing (mean 0.6mm, 0.8mm, 1.25mm for the most distal lateral facet point, groove, and at the most distal point of lateral femoral condyle, respectively) and a high rate of type 1 and 2 uncorrectable knee imbalance (30% and 40%, respectively). The incidence of distal lateral prosthetic overstuffing (trochlea and condyle) and uncorrectable knee imbalance were strongly to very strongly correlated with the DFJLO (r=0.53 to 0.89). CONCLUSION Conventional MA technique for TKA generates frequent lateral distal femoral prosthetic overstuffing and technically uncorrectable knee imbalance secondary to disregarding the DFJLO when adjusting the femoral component frontal and axial rotations, respectively. LEVEL OF EVIDENCE level 4.
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MESH Headings
- Aged
- Aged, 80 and over
- Algorithms
- Arthroplasty, Replacement, Knee/instrumentation
- Arthroplasty, Replacement, Knee/methods
- Female
- Humans
- Imaging, Three-Dimensional
- Knee Joint/diagnostic imaging
- Knee Joint/surgery
- Knee Prosthesis
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Models, Anatomic
- Osteoarthritis, Knee/diagnostic imaging
- Osteoarthritis, Knee/surgery
- Software
- Surgery, Computer-Assisted/instrumentation
- Surgery, Computer-Assisted/methods
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Affiliation(s)
- C Rivière
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom.
| | - F Iranpour
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom
| | - E Auvinet
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom
| | - A Aframian
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom
| | - K Asare
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom
| | - S Harris
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom
| | - J Cobb
- The MSK Lab, Charing Cross Camus, Imperial College London, Laboratory Block, W6 8RP London, United Kingdom
| | - S Parratte
- Service de chirurgieorthopédique, hôpital Sainte-Marguerite, université Aix-Marseille, 20, avenue Viton, 13009 Marseille, France
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Zhu M, Chen JY, Chong HC, Yew AKS, Foo LSS, Chia SL, Lo NN, Yeo SJ. Outcomes following total knee arthroplasty with CT-based patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc 2017; 25:2567-2572. [PMID: 26410097 DOI: 10.1007/s00167-015-3803-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/16/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE A 24-month prospective follow-up study was carried out to compare perioperative clinical outcomes, radiographic limb alignment, component positioning, as well as functional outcomes following total knee arthroplasty (TKA) between patient-specific instrumentation (PSI) and conventional instrumentation (CI). METHODS Ninety consecutive patients, satisfying the inclusion and exclusion criteria, were scheduled to undergo TKA with either PSI or CI. A CT-based PSI was used in this study, and a senior surgeon performed all surgeries. Patients were clinically and functionally assessed preoperatively, 6 and 24 months post-operatively. Perioperative outcomes were also analysed, including operating time, haemoglobin loss, the need for blood transfusion, length of hospitalisation, and radiographic features. RESULTS At 24-month follow-up, clinical and functional outcomes were comparable between the two groups. PSI performed no better than CI in restoring lower limb mechanical alignment or improving component positioning. There were no differences in operating time, haemoglobin loss, transfusion rate, or length of hospitalisation between PSI and CI. CONCLUSION No significant clinical benefit could be demonstrated in using PSI over CI after 24 months, and routine use of PSI is not recommended in non-complicated TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Meng Zhu
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Hwei Chi Chong
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Leon Siang Shen Foo
- Island Orthopaedic Consultants, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore, 228510, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
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Thienpont E, Schwab PE, Fennema P. Efficacy of Patient-Specific Instruments in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2017; 99:521-530. [PMID: 28291186 DOI: 10.2106/jbjs.16.00496] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) was introduced with the aim of making the procedure of total knee arthroplasty more accurate and efficient. The purpose of this study was to compare PSI and standard instrumentation in total knee arthroplasty with regard to radiographic and clinical outcomes as well as operative time and blood loss. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed and Embase were searched from 2011 through 2015. We included randomized controlled trials and cohort studies that reported the effect of PSI on the aforementioned outcomes. The primary end point was deviation from the mechanical axis by >3°. Random and fixed-effect models were used for analysis. RESULTS A total of 44 studies, which included 2,866 knees that underwent surgery with PSI and 2,956 knees that underwent surgery with standard instrumentation, were evaluated. The risk of mechanical axis malalignment was significantly lower for PSI, with a pooled relative risk of 0.79 (p = 0.013). The risk of tibial sagittal-plane malalignment was higher for PSI than for standard instrumentation (relative risk = 1.32, p = 0.001), whereas the risk of femoral coronal-plane malalignment was significantly lower (relative risk = 0.74, p = 0.043). The risk of tibial coronal-plane malalignment was significantly higher for PSI only when employing fixed-effect meta-analysis (relative risk = 1.33, p = 0.042). Minor reductions in total operative time (-4.4 minutes, p = 0.002) and blood loss (-37.9 mL, p = 0.015) were noted for PSI. CONCLUSIONS PSI improves the accuracy of femoral component alignment and global mechanical alignment, but at the cost of an increased risk of outliers for the tibial component alignment. The impact of the increased probability of tibial component malalignment on implant longevity remains to be determined. Meta-analyses indicated significant differences with regard to operative time and blood loss in favor of PSI. However, these differences were minimal and, by themselves, not a substantial justification for routine use of the technology. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Emmanuel Thienpont
- 1University Hospital Saint Luc, Brussels, Belgium 2AMR Advanced Medical Research, Männedorf, Switzerland
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19
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Goyal T, Tripathy SK. Does Patient-Specific Instrumentations Improve Short-Term Functional Outcomes After Total Knee Arthroplasty? A Systematic Review and Meta-Analysis. J Arthroplasty 2016; 31:2173-80. [PMID: 27129762 DOI: 10.1016/j.arth.2016.03.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/10/2016] [Accepted: 03/22/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patient-specific instrumentation (PSI) has been recently introduced in knee arthroplasty. There is no strong evidence from meta-analysis on comparison of functional outcomes between PSI and conventional instrumentation. METHODS Literature search of electronic databases PubMed, MEDLINE, and Cochrane Library for published randomized controlled trials was undertaken. Search was done using a predesigned search strategy. Eligible studies were critically appraised for the methodological quality using Cochrane Collaboration's tool. Functional scores used for meta-analysis were Knee Society Knee Score, Knee Society Function Scores, Oxford Knee Score, Western Ontario and McMaster Universities Arthritis Index, and Visual Analogue Scale score for pain (0-10 scale). RESULTS Five randomized controlled trials involving 379 total knee arthroplasties were eligible to be included in the meta-analysis. No significant improvement in short-term functional outcomes was seen after using PSI compared to the control group in terms of Knee Society Knee Score (weighted mean difference 0.65, 95% CI -4.41 to 5.70, P = .80) and Knee Society Function scores (weighted mean difference 0.01, 95% CI -3.26 to 3.28, P = .99), Oxford Knee Score (weighted mean difference 3.36, 95% CI -3.48 to 10.00, P = .34), Western Ontario and McMaster Universities Arthritis Index (weighted mean difference -7.47, 95% CI -23.94 to 8.99, P = .37), and Visual Analogue Scale score for pain (weighted mean difference -0.10, 95% CI -0.41 to 0.21, P = .53). CONSLUSION Current literature is insufficient to address whether there is a benefit of PSI in total knee arthroplasty in terms of improvement in functional outcomes.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Sujit K Tripathy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India
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20
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Boonen B, Schotanus MGM, Kerens B, van der Weegen W, Hoekstra HJ, Kort NP. No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively. Bone Joint J 2016; 98-B:939-44. [DOI: 10.1302/0301-620x.98b7.37274] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/09/2016] [Indexed: 11/05/2022]
Abstract
Aims We wished to compare the clinical outcome, as assessed by questionnaires and the rate of complications, in total knee arthroplasty (TKA) undertaken with patient-matched positioning guides (PMPGs) or conventional instruments. Patients and Methods A total of 180 patients (74 men, 106 women; mean age 67 years) were included in a multicentre, adequately powered, double-blind, randomised controlled trial. The mean follow-up was 44 months (24 to 57). Results There were no significant or clinically relevant differences between the two groups for all outcome measures (Knee Society Score, p = 0.807; Oxford Knee Score, p = 0.304; Western Ontario and McMaster osteoarthritis index, p = 0.753; visual analogue scale for pain, p = 0.227; EuroQol-5D-3L index score, p = 0.610; EuroQol-5D-3L VAS health, p = 0.968.) There was no difference in the rate of complications (p = 0.291). Conclusion PMPGs are already in relatively common use and their short-term clinical results are equal to conventional instrumented TKA. Cite this article: Bone Joint J 2016;98-B:939–44.
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Affiliation(s)
- B. Boonen
- Zuyderland Medical Center, Prinsenbaan
145, 6104 BD, Koningsbosch, Netherlands
/ Dr. H. vd Hoffplein 1, 6162 BG Sittard-Geleen, The
Netherlands
| | - M. G. M. Schotanus
- Zuyderland Medical Center, Dr.
H. vd Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
| | - B. Kerens
- AZ Monica, Florent
Pauwelslei 1, 2100 Deurne, Belgium
| | | | - H. J. Hoekstra
- St. Anna Hospital, Bogardeind
2, 5664 EH Geldrop, The
Netherlands
| | - N. P. Kort
- Zuyderland Medical Center, Dr.
H. vd Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
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Beal MD, Delagramaticas D, Fitz D. Improving outcomes in total knee arthroplasty-do navigation or customized implants have a role? J Orthop Surg Res 2016; 11:60. [PMID: 27216272 PMCID: PMC4877731 DOI: 10.1186/s13018-016-0396-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/07/2016] [Indexed: 01/15/2023] Open
Abstract
Modern total knee arthroplasty is effective at treating the pain and disability associated with osteoarthritis. The number of total knee replacements done in the USA continues to increase. Despite the great care taken during all of these procedures, some patients remain dissatisfied with their outcome. While this dissatisfaction is likely multifactorial, malalignment of the prosthetic components is a major cause of postoperative complications. A neutral mechanical axis plus or minus 3° is felt to have a positive impact on the survivorship of the prosthesis. Conventional instrumentation has been shown to have a significant number of total knee replacements that lie well outside a neutral coronal alignment. With that in mind, significant effort has been placed into the development of technology to improve the overall alignment of the prosthesis. In order to reduce the number of outliers, several companies have developed cost-effective systems to aid the surgeon in achieving a more predictably aligned prosthesis in all three planes. We will review the literature that is available regarding several of these tools to examine if navigation or custom guides improve outcomes in total knee arthroplasty. Our review supports that while both navigation and custom implants guides seem to be a cost effective way to achieve a predictable mechanical alignment of a total knee prosthesis therefore reducing the number of outliers, the cost may be increased operative times with no perceived difference in patient satisfaction with navigation custom guides.
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Affiliation(s)
- Matthew D Beal
- Northwestern University Feinberg School of Medicine, Chicago, USA.
| | | | - David Fitz
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Desseaux A, Graf P, Dubrana F, Marino R, Clavé A. Radiographic outcomes in the coronal plane with iASSIST™ versus optical navigation for total knee arthroplasty: A preliminary case-control study. Orthop Traumatol Surg Res 2016; 102:363-8. [PMID: 27033838 DOI: 10.1016/j.otsr.2016.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The new navigation system iASSIST™ for total knee arthroplasty (TKA) relies on accelerometers and gyroscopes. The objective of this prospective study was to compare the accuracy of iASSIST™ to that of the conventional optical navigation system Navitrack™ by determining the rate of mechanical axis restoration (±3°), postoperative mean mechanical alignment, rate of adequate femoral and tibial component positioning, mean operative time, and occurrence of navigation-related adverse events. HYPOTHESIS The rate of mechanical axis restoration (±3°) is not lower with iASSIST™ than with the conventional navigation system Navitrack™. MATERIAL AND METHODS Of 40 patients who underwent primary TKA between October 2013 and March 2014, 20 had navigation using iASSIST™ and 20 using Navitrack™. Six months after TKA, an independent observer measured three parameters on coronal radiographs: the hip-knee-ankle angle (HKA), the mechanical lateral distal femoral angle (mLDFA), and the mechanical medial proximal tibial angle (mMPTA). RESULTS The two groups showed no significant differences for the rates of HKA restoration (P=0.3), adequate coronal positioning of the femoral component (P=0.12) and tibial component (P=0.12), or optimal success (P=0.09). Significant differences in favour of iASSIST™ were demonstrated for the values and angular deviations of the HKA (P=0.02) and mMPTA (P=0.01), whereas no significant difference was found for mLDFA. There were no significant differences regarding the mean operative time (P=0.06) or the occurrence of navigation-related adverse events (P=0.18). DISCUSSION The iASSIST™ system provides a neutral mechanical axis and optimal component position in the coronal plane in 95% of cases, indicating that it is as accurate as the optical navigation system Navitrack™. LEVEL OF EVIDENCE III, prospective case-control study.
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Affiliation(s)
- A Desseaux
- Université de Bretagne occidentale, faculté de médecine, 22, avenue Camille-Desmoulins, 29200 Brest, France; CHRU de Brest, service de chirurgie orthopédique et traumatologique, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - P Graf
- Clinique Pasteur-Lanroze, 32, rue Kervern, 29200 Brest, France
| | - F Dubrana
- Université de Bretagne occidentale, faculté de médecine, 22, avenue Camille-Desmoulins, 29200 Brest, France; CHRU de Brest, service de chirurgie orthopédique et traumatologique, boulevard Tanguy-Prigent, 29200 Brest, France
| | - R Marino
- Zimmer CAS, 75, Queen Street, Montreal, QC H3C2N6, Canada
| | - A Clavé
- Université de Bretagne occidentale, faculté de médecine, 22, avenue Camille-Desmoulins, 29200 Brest, France; CHRU de Brest, service de chirurgie orthopédique et traumatologique, boulevard Tanguy-Prigent, 29200 Brest, France; LaTIM, Inserm UMR 1101, 2, avenue Foch, 29609 Brest cedex, France
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Chen JY, Chin PL, Tay DKJ, Chia SL, Lo NN, Yeo SJ. Reply to Letter to the Editor on "Functional Outcome and Quality of Life After Patient-Specific Instrumentation in Total Knee Arthroplasty". J Arthroplasty 2016; 31:924-5. [PMID: 26725139 DOI: 10.1016/j.arth.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Pak Lin Chin
- The Orthopaedic Centre, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Prakash J. Functional Outcome and Quality of Life After Patient-Specific Instrumentation in Total Knee Arthroplasty. J Arthroplasty 2016; 31:923-4. [PMID: 26777571 DOI: 10.1016/j.arth.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Jatin Prakash
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
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Vaishya R, Vijay V, Agarwal AK. "Functional Outcome and Quality of Life After Patient-Specific Instrumentation (PSI) in Total Knee Arthroplasty (TKA)": Our Concerns. J Arthroplasty 2016; 31:924. [PMID: 26725138 DOI: 10.1016/j.arth.2015.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Joint Replacement and Arthroscopy, Indraprastha Apollo Hospital, New Delhi, India
| | - Vipul Vijay
- Department of Orthopaedics, Joint Replacement and Arthroscopy, Indraprastha Apollo Hospital, New Delhi, India
| | - Amit K Agarwal
- Department of Orthopaedics, Joint Replacement and Arthroscopy, Indraprastha Apollo Hospital, New Delhi, India
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