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Tibesku CO, Haas SB, Saunders C, Harwood DA. Comparison of clinical outcomes of VISIONAIRE patient-specific instrumentation with conventional instrumentation in total knee arthroplasty: a systematic literature review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:4379-4393. [PMID: 36449066 PMCID: PMC10293358 DOI: 10.1007/s00402-022-04698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Malalignment and resulting complications are major challenges in total knee arthroplasty (TKA) which patient-specific instrumentation (PSI) is proposed to alleviate. Previous PSI meta-analyses of TKA outcomes typically do not differentiate between PSI systems and assess relatively few outcomes, so the value of their findings is limited. VISIONAIRE™ cutting guides (Smith + Nephew Inc., Memphis, TN, USA) is a PSI system based on preoperative magnetic resonance and X-ray imaging. A systematic literature review (SLR) and meta-analysis, focussed specifically on VISIONAIRE, were conducted to assess TKA accuracy, intraoperative outcomes, and postoperative outcomes, compared with conventional instrumentation (CI). MATERIALS AND METHODS The SLR was performed using PubMed, Embase, and Google Scholar databases to identify relevant studies published until March 2022. Depending on statistical heterogeneity, meta-analyses were performed for outcome measures with fixed effect (I2 < 50%) or random-effects models (I2 ≥ 50%). Dichotomous outcomes were reported as odds ratios and continuous outcomes were reported as mean differences. Descriptive analyses were performed for outcomes not amenable to meta-analysis. RESULTS Outcomes for VISIONAIRE versus CI were reported in 25 studies. Compared with CI, VISIONAIRE reduced odds of mechanical outliers by 40% (p < 0.0001), with no statistically significant differences in odds of overall coronal, sagittal, or rotational plane component outliers. VISIONAIRE improved surgical efficiency (operating room, turnover, and tourniquet times reduced by 7.3% (p = 0.02), 42% (p = 0.022), and 15.9% (p = 0.01), respectively), lowering the odds of blood transfusion by 53% (p = 0.01) and shortening patients' hospital stays (11.1% reduction; p < 0.0001). There were no significant differences between groups in incidence of postoperative complications and (descriptively analyzed) return-to-function outcomes. CONCLUSION Options for PSI in TKA differ substantially, and it is important to assess the outcomes of individual systems. The current findings suggest that VISIONAIRE guides can lead to improved alignment accuracy and surgical efficiency compared with CI, without compromising postoperative safety and return-to-function outcomes.
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Affiliation(s)
| | - Steven B Haas
- Knee Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
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Kato M, Warashina H, Kataoka A, Mitamura S. Comparison of weight-bearing full-length radiography and three-dimensional computed tomography scan-based models to assess knee joint coronal alignment following total knee arthroplasty. Knee 2023; 42:227-235. [PMID: 37086539 DOI: 10.1016/j.knee.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The validity of standing long-leg radiography (LLR) - the standard method for evaluating coronal alignment after total knee arthroplasty (TKA) - remains controversial. We evaluated the measurement reliability and validity of LLR following TKA by comparing postoperative radiographs with three-dimensional computed tomography (3DCT) scans of the lower extremities. METHODS We retrospectively collected the data of 55 knees from 44 patients who underwent postoperative 3DCT and 5-day and 6-month LLR for coronal alignment evaluation following TKA. The coronal femoral component angle (CFA) and coronal tibial component angle (CTA) were measured using 3DCT and LLR images. Correlations between the hip-knee-ankle angle (HKAA), CFA and CTA were analysed using Pearson's correlation coefficient (PCC); Bland-Altman plots were constructed to assess agreement between 5-day and 6-month radiographic and 3DCT scan measurements. RESULTS The mean difference in HKAA between 3DCT, and 5-day and 6-month LLR was 1.3 ± 1° and 1.1 ± 0.7°, respectively. Differences of >1° in HKAA between 3DCT, and 5-day and 6-month LLR were observed in 31 (56.4%) and 28 (50.9%) knees, respectively; differences of >2° in these parameters were observed in 15 (27.3%) and nine (16.4%) knees, respectively. The 3DCT scan and radiograph measurements of HKAA, CFA and CTA were strongly correlated (PCC, 0.81-0.92; P < 0.001). Bland-Altman plot validity was within acceptable limits. CONCLUSION LLR shows good reliability and validity for measuring coronal alignment. When comparing 3DCT scans and radiographs, a high number of HKAA values differed by more than 1° and 2°; this indicates that rigorous alignment evaluation requires 3DCT measurements.
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Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, Aichi, Japan.
| | | | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, Aichi, Japan
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Accuracy of a Three-Dimensional (3D)-Printed Patient-Specific (PS) Femoral Osteotomy Guide: A Computed Tomography (CT) Study. Bioengineering (Basel) 2022; 9:bioengineering9110667. [PMID: 36354578 PMCID: PMC9687720 DOI: 10.3390/bioengineering9110667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Femoral neck osteotomy creates a critical anatomical landmark for surgeons performing primary Total Hip Arthroplasty (THA); it affects the final height and position of the femoral component. Patient Specific Instrumentation (PSI) has been developed to guide the osteotomy. We aimed to assess the accuracy of a patient-specific (PS) femoral osteotomy guide in primary THA using three-dimensional (3D) computed tomography (CT) analysis. We included pre- and post-operative CT data of 103 THAs. All patients underwent 3D planning to define the optimal femoral neck osteotomy level. Our primary objective was to quantify the discrepancy between the achieved and planned osteotomy level; our secondary objective was to evaluate the clinical outcome. The median (Interquartile Range—IQR) discrepancy between the achieved and planned osteotomy level was 0.3 mm (−1 mm to 2 mm). We found a strong positive correlation between the planned and achieved osteotomy level (R2 = 0.9, p < 0.001). A satisfactory clinical outcome was recorded. Our findings suggest that surgeons can use 3D-printed PS guides to achieve a femoral neck osteotomy with a high level of accuracy to the plan.
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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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Li JT, Gao X, Li X. Comparison of iASSIST Navigation System with Conventional Techniques in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Radiographic and Clinical Outcomes. Orthop Surg 2019; 11:985-993. [PMID: 31755245 PMCID: PMC6904605 DOI: 10.1111/os.12550] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
The iASSIST navigation system is a handheld accelerometer‐based navigation system that has been applied in clinical practice in recent five years. This meta‐analysis aimed to compare the radiographic and clinical outcomes of iASSIST navigation with conventional surgical techniques for patients undergoing total knee arthroplasty (TKA) and to compare the surgery time between an iASSIST group and a conventional treatment group. This systematic review and meta‐analysis included all comparative prospective and retrospective studies published in Pubmed, Embase, the Cochrane Central Register of Controlled Trials, the Web of Science and the CNKI databases over the past 20 years. Inclusion criteria were studies that compared the iASSIST navigation system with conventional TKA. The primary outcomes were mechanical axis (MA) and outliers, which means postoperative MA varus or valgus of more than 3°. Secondary outcomes were coronal femoral angle (CFA) and coronal tibial angle (CTA). Knee Society Score (KSS) was used to evaluate functional outcome. The Newcastle–Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Eight studies involving 558 knees were included in this meta‐analysis. Of these, 275 patients used the iASSIST navigation system and 283 used conventional surgical techniques. A total of 5 studies were considered high quality and the other 3 were considered to be of moderate quality. The occurrence of malalignment of >3° in the iASSIST group was 13.3%, compared with 29.04% in the conventional group. Postoperative MA of the iASSIST group was significantly better than that of the conventional group (I2 = 19%, OR = −0.92, 95% CI = −1.09 to −0.75, P < 0.00001). The iASSIST navigation system provided significantly increased accuracy in the coronal femoral angle (I2 = 79%, OR = −0.88, 95% CI = −1.21 to −0.54, P < 0.00001) and the coronal tibial angle (I2 = 34%, OR = 0.39, 95% CI = −0.48 to −0.30, P < 0.00001) compared with conventional techniques. However, the duration of surgery using the iASSIST procedure was longer and there was no significant difference in the short‐term KSS in the iASSIST group compared with the conventional group. We found that when pooling the data of included studies, the number of outliers was fewer in the iASSIST group, and compared with conventional TKA techniques, the iASSIST system significantly improved the accuracy of lower limb alignment but the duration of surgery was prolonged in addition to there being no apparent advantage in terms of short‐term functional score.
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Affiliation(s)
- Jun-Tan Li
- Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
| | - Xiang Gao
- Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
| | - Xu Li
- Department of Orthopaedics, The First Hospital of China Medical University, Shenyang, China
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Gong S, Xu W, Wang R, Wang Z, Wang B, Han L, Chen G. Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1083-1095. [PMID: 30377714 PMCID: PMC6435625 DOI: 10.1007/s00167-018-5256-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the present study was to compare patient-specific instrumentation (PSI) with standard instrumentation (SI) in patients undergoing total knee arthroplasty (TKA). PSI is hypothesized to have advantages with respect to component alignment; number of outliers (defined as alignment > 3° from the target alignment); operative time; perioperative blood loss; and length of hospital stay. This new surgical technique is expected to exhibit superior performance. METHODS A total of 23 randomized controlled trials (RCTs) involving 2058 knees that compared the clinical outcomes of TKA between PSI and SI were included in the present analysis; these RCTs were identified via a literature search of the PubMed, Embase, and Cochrane Library databases through March 1, 2018. The outcomes of interest included coronal, sagittal and axial component alignment (presented as the angle of deviation from the transcondylar line); number of outliers; operative time; perioperative blood loss; and length of hospital stay. RESULTS There was a significant difference in postoperative femoral axial alignment between PSI and SI patients (95% CI - 0.71 to - 0.21, p = 0.0004, I2 = 48%). PSI resulted in approximately 0.4° less deviation from the transcondylar line than SI. Based on our results, PSI reduced operative time by a mean of 7 min compared with SI (95% CI - 10.95 to - 3.75, p < 0.0001, I2 = 78%). According to the included literature, PSI reduced perioperative blood loss by approximately 90 ml compared with SI (95% CI - 146.65 to - 20.18, p = 0.01, I2 = 74%). We did not find any differences between PSI and SI with respect to any other parameters. CONCLUSIONS PSI has advantages in axial alignment of the femoral component, operative time, and perioperative blood loss relative to SI. No significant differences were found between PSI and SI with respect to alignment of the remaining components, number of outliers, or length of hospital stay. LEVEL OF EVIDENCE Therapeutic study (systematic review and meta-analysis), Level I.
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Affiliation(s)
- Song Gong
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Weihua Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ruoyu Wang
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Zijian Wang
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Bo Wang
- 0000 0004 0368 7223grid.33199.31Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Lizhi Han
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Guo Chen
- 0000 0004 0368 7223grid.33199.31Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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Tomita T. Commentary: Clinical benefits of patientmatched instrumentation for total knee arthroplasty. J Orthop Surg (Hong Kong) 2016; 24:145. [PMID: 27574250 DOI: 10.1177/1602400203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- T Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
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