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Schippers P, Wunderlich F, Afghanyar Y, Buschmann V, Klonschinski T, Drees P, Eckhard L. High patient satisfaction with Customized Total Knee Arthroplasty at five year follow-up. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06325-y. [PMID: 39320497 DOI: 10.1007/s00264-024-06325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE Despite numerous studies demonstrating promising short-term outcomes of Total Knee Arthroplasty (TKA) with Customized Individually Made (CIM) implants, there is a significant lack of data on their mid-term effectiveness. Given the increasing number of TKAs performed annually, the rising demand for CIM implants, and the associated burden of revision surgeries, understanding the mid-term performance of CIM implants is crucial. Therefore, this study aims to report on the mid-term (minimum 5 years) outcomes of TKA using a CIM implant. METHODS This retrospective cohort study included a consecutive series of 116 patients who received the ConforMIS® iTotal CR implant between 2015 and 2018. Inclusion criteria were end-stage knee osteoarthritis with coronal deformities below 10° and absence of ligamentous instability. Exclusion criteria included simultaneous bilateral TKA. Patients were followed up at a minimum of five years post-surgery. They completed a questionnaire reporting on satisfaction, pain levels using the Visual Analogue Scale (VAS), current weight, the Oxford Knee Score (OKS), and the Forgotten Joint Score for the knee (FJS-knee). Statistical analysis included descriptive statistics for demographic and clinical variables, and outcomes were reported as means with ranges. RESULTS The mean follow-up duration was 5.9 ± 0.8 years (range 5-7.4 years). 90% of patients stated they would undergo the same operation again, and 93% were either satisfied or very satisfied. The mean VAS for pain at rest was 2 ± 1.5 (range 0-6) and during exercise was 3 ± 2 (range 0-8). 58 patients (53%) managed to lose weight. The mean OKS was 41 ± 9 points (range 15-48), and the mean FJS-knee was 67 ± 23 points (range 4-100). No severe complications occurred. CONCLUSION CIM TKA using the ConforMIS® iTotal CR implant can achieve excellent results with 93% of patients being satisfied or very satisfied at mid-term follow-up of five years. Prospective, randomized, and patient-blinded trials comparing off-the-shelf (OTS) TKAs with CIM implants are necessary to evaluate whether these implants are superior or not.
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Affiliation(s)
- Philipp Schippers
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Felix Wunderlich
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Yama Afghanyar
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Victoria Buschmann
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Klonschinski
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Eckhard
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Praxis für Gelenkchirurgie Bad Kreuznach, 55543, Bad Kreuznach, Germany
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Shichman I, Rajahraman V, Chow J, Fabi DW, Gittins ME, Burkhardt JE, Kaper BP, Schwarzkopf R. Clinical, Radiographic, and Patient-Reported Outcomes Associated with a Handheld Image-free Robotic-Assisted Surgical System in Total Knee Arthroplasty. Orthop Clin North Am 2023; 54:141-151. [PMID: 36894287 DOI: 10.1016/j.ocl.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
One of the primary aims of total knee arthroplasty (TKA) is restoration of the mechanical axis of the lower limb. Maintenance of the mechanical axis within 3° of neutral has been shown to result in improved clinical results and implant longevity. Handheld image-free robotic-assisted total knee arthroplasty (HI-TKA) is a novel way of performing TKA in the era of modern robotic-assisted TKA. The aim of this study is to assess the accuracy of achieving targeted alignment, component placement, clinical outcomes, as well as patient satisfaction after HI-TKA.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Floor Suite 1518, New York, NY 10003, USA
| | - Vinaya Rajahraman
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Floor Suite 1518, New York, NY 10003, USA
| | - James Chow
- Chow Surgical LLC, 3700 North 24th Street Suite 160, Phoenix, AZ 85016, USA
| | - David W Fabi
- San Diego Orthopaedic Associates Medical Group, Inc., 4060 Fourth Avenue 7th Floor, San Diego, CA 92103, USA
| | - Mark E Gittins
- OrthoNeuro, 5040 Forest Drive #300, New Albany, OH 43054, USA
| | - Joseph E Burkhardt
- Bronson Orthopedic Specialists, 3600 Capital Avenue Southwest # 101, Battle Creek, MI 49015, USA
| | - Bertrand P Kaper
- Orthopaedic Specialists of Scottsdale, 20401 North 73rd Street Suite 210, Scottsdale, AZ 85255, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Floor Suite 1518, New York, NY 10003, USA.
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Hinloopen JH, Puijk R, Nolte PA, Schoones JW, de Ridder R, Pijls BG. The efficacy and safety of patient-specific instrumentation in primary total knee replacement: a systematic review and meta-analysis. Expert Rev Med Devices 2023; 20:245-252. [PMID: 36736371 DOI: 10.1080/17434440.2023.2177152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Patient-specific instrumentation (PSI) for primary total knee arthroplasty (TKA) surgery has been shown to increase accuracy of component positioning. However, it is unclear whether this also translates to actual benefits for patients in terms of better outcomes (efficacy) or less complications such as revisions (safety). We therefore systematically reviewed the literature to determine the efficacy and safety of PSI in primary TKA. METHODS Randomized controlled trials comparing PSI to non-PSI in primary TKA were included. A random effects model was used with meta-regression in case of heterogeneity. RESULTS Forty-three studies were included with a total of 1816 TKA in the PSI group and 1887 TKA in the control group. There were no clinically relevant differences between the PSI-group and non-PSI group regarding all outcomes. There was considerable heterogeneity: meta-regression analyses showed that the year the study was published was an important effect modifier. Early publications tended to show a positive effect for PSI compared to non-PSI TKA, whereas later studies found the opposite. CONCLUSION Based on evidence of moderate certainty, our study suggested that there were no clinically relevant differences in efficacy and safety between patients treated with PSI TKA and patients treated with non-PSI TKA.
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Affiliation(s)
- J H Hinloopen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - R Puijk
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - P A Nolte
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.,Department Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J W Schoones
- Directorate of Research Policy (Formerly: Walaeus Library), Leiden University Medical Centre, Leiden, The Netherlands
| | - R de Ridder
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Orthopaedics, Reinier Haga Orthopaedic Centre, Zoetermeer, Netherlands
| | - B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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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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Zhang J, Ng N, Scott CEH, Blyth MJG, Haddad FS, Macpherson GJ, Patton JT, Clement ND. Robotic arm-assisted versus manual unicompartmental knee arthroplasty : a systematic review and meta-analysis of the MAKO robotic system. Bone Joint J 2022; 104-B:541-548. [PMID: 35491572 PMCID: PMC9948441 DOI: 10.1302/0301-620x.104b5.bjj-2021-1506.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This systematic review aims to compare the precision of component positioning, patient-reported outcome measures (PROMs), complications, survivorship, cost-effectiveness, and learning curves of MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) with manual medial unicompartmental knee arthroplasty (mUKA). METHODS Searches of PubMed, MEDLINE, and Google Scholar were performed in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta--Analysis statement. Search terms included "robotic", "unicompartmental", "knee", and "arthroplasty". Published clinical research articles reporting the learning curves and cost-effectiveness of MAKO RAUKA, and those comparing the component precision, functional outcomes, survivorship, or complications with mUKA, were included for analysis. RESULTS A total of 179 articles were identified from initial screening, of which 14 articles satisfied the inclusion criteria and were included for analysis. The papers analyzed include one on learning curve, five on implant positioning, six on functional outcomes, five on complications, six on survivorship, and three on cost. The learning curve was six cases for operating time and zero for precision. There was consistent evidence of more precise implant positioning with MAKO RAUKA. Meta-analysis demonstrated lower overall complication rates associated with MAKO RAUKA (OR 2.18 (95% confidence interval (CI) 1.06 to 4.49); p = 0.040) but no difference in re-intervention, infection, Knee Society Score (KSS; mean difference 1.64 (95% CI -3.00 to 6.27); p = 0.490), or Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (mean difference -0.58 (95% CI -3.55 to 2.38); p = 0.700). MAKO RAUKA was shown to be a cost-effective procedure, but this was directly related to volume. CONCLUSION MAKO RAUKA was associated with improved precision of component positioning but was not associated with improved PROMs using the KSS and WOMAC scores. Future longer-term studies should report functional outcomes, potentially using scores with minimal ceiling effects and survival to assess whether the improved precision of MAKO RAUKA results in better outcomes. Cite this article: Bone Joint J 2022;104-B(5):541-548.
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Affiliation(s)
- Junren Zhang
- Tan Tock Seng Hospital, Singapore, Singapore,Correspondence should be sent to Junren Zhang. E-mail:
| | - Nathan Ng
- Edinburgh Orthopedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | | | | - James T. Patton
- Edinburgh Orthopedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Edinburgh Orthopedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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8
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Zhang J, Ndou WS, Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2677-2695. [PMID: 33547914 PMCID: PMC9309123 DOI: 10.1007/s00167-021-06464-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022]
Abstract
This systematic review and meta-analysis were conducted to compare the accuracy of component positioning, alignment and balancing techniques employed, patient-reported outcomes, and complications of robotic-arm assisted total knee arthroplasty (RATKA) with manual TKA (mTKA) and the associated learning curve. Searches of PubMed, Medline and Google Scholar were performed in October 2020 using PRISMA guidelines. Search terms included "robotic", "knee" and "arthroplasty". The criteria for inclusion were published clinical research articles reporting the learning curve for RATKA and those comparing the component position accuracy, alignment and balancing techniques, functional outcomes, or complications with mTKA. There were 198 articles identified, following full text screening, 16 studies satisfied the inclusion criteria and reported the learning curve of rTKA (n=5), component positioning accuracy (n=6), alignment and balancing techniques (n=7), functional outcomes (n=7), or complications (n=5). Two studies reported the learning curve using CUSUM analysis to establish an inflexion point for proficiency which ranged from 7 to 11 cases and there was no learning curve for component positioning accuracy. The meta-analysis showed a significantly lower difference between planned component position and implanted component position, and the spread was narrower for RATKA compared with the mTKA group (Femur coronal: mean 1.31, 95% confidence interval (CI) 1.08-1.55, p<0.00001; Tibia coronal: mean 1.56, 95% CI 1.32-1.81, p<0.00001). Three studies reported using different alignment and balancing techniques between mTKA and RATKA, two studies used the same for both group and two studies did not state the methods used in their RATKA groups. RATKA resulted in better Knee Society Score compared to mTKA in the short-to-mid-term follow up (95%CI [- 1.23, - 0.51], p=0.004). There was no difference in arthrofibrosis, superficial and deep infection, wound dehiscence, or overall complication rates. RATKA demonstrated improved accuracy of component positioning and patient-reported outcomes. The learning curve of RATKA for operating time was between 7 and 11 cases. Future well-powered studies on RATKAs should report on the knee alignment and balancing techniques utilised to enable better comparisons on which techniques maximise patient outcomes.Level of evidence III.
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Affiliation(s)
- Junren Zhang
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
| | - Wofhatwa Solomon Ndou
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Nathan Ng
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Paul Gaston
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Philip M Simpson
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Gavin J Macpherson
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - James T Patton
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Nicholas D Clement
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
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Herndon CL, McCormick KL, Gazgalis A, Bixby EC, Levitsky MM, Neuwirth AL. Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review. Arthroplast Today 2021; 11:239-251. [PMID: 34692962 PMCID: PMC8517286 DOI: 10.1016/j.artd.2021.08.018] [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: 03/29/2021] [Revised: 08/08/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence Level I; Systematic Review.
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Affiliation(s)
- Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Anastasia Gazgalis
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Elise C Bixby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew M Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Schiffman CJ, Prabhakar P, Hsu JE, Shaffer ML, Miljacic L, Matsen FA. Assessing the Value to the Patient of New Technologies in Anatomic Total Shoulder Arthroplasty. J Bone Joint Surg Am 2021; 103:761-770. [PMID: 33587515 DOI: 10.2106/jbjs.20.01853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Publications regarding anatomic total shoulder arthroplasty (TSA) have consistently reported that they provide significant improvement for patients with glenohumeral arthritis. New TSA technologies that have been introduced with the goal of further improving these outcomes include preoperative computed tomography (CT) scans, 3-dimensional preoperative planning, patient-specific instrumentation, stemless and short-stemmed humeral components, as well as metal-backed, hybrid, and augmented glenoid components. The benefit of these new technologies in terms of patient-reported outcomes is unknown. METHODS We reviewed 114 articles presenting preoperative and postoperative values for commonly used patient-reported metrics. The results were analyzed to determine whether patient outcomes have improved over the 20 years during which new technologies became available. RESULTS The analysis did not identify evidence that the results of TSA were statistically or clinically improved over the 2 decades of study or that any of the individual technologies were associated with significant improvement in patient outcomes. CONCLUSIONS Additional research is required to document the clinical value of these new technologies to patients with glenohumeral arthritis. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Pooja Prabhakar
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Ljubomir Miljacic
- The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington
| | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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11
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Patientenspezifische Instrumentierung und Totalendoprothesen am Knie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Hintergrund
Die patientenspezifische Instrumentierung (PSI) ist eine vielversprechende neue Technologie in der orthopädischen Chirurgie, die das Ziel verfolgt, die Implantationstechnik der Knietotalendoprothese (Knie-TEP) im Vergleich zur konventionellen Instrumentierung zu vereinfachen und präziser zu machen. Ziel dieses Artikels ist es, Vorteile und Grenzen der PSI für die primäre Knie-TEP zu beschreiben.
Material und Methoden
Es erfolgte eine umfassende Literaturrecherche zum Thema PSI in der Knieprothetik hinsichtlich Evidenz für Planung, Präzision, klinische Ergebnisse, intraoperative Parameter sowie Kosten und Effizienz.
Ergebnisse
Die dreidimensionale Computertomographie (CT) weist in der präoperativen Planung der Knie-TEP eine höhere Genauigkeit auf als 2‑D-Röntgenaufnahmen. Die meisten Arbeiten postulierten keine signifikanten Effekte zugunsten der Genauigkeit der PSI gegenüber der Standard-Knie-TEP. Aber sie berichteten auch nicht, dass die Genauigkeit mit PSI schlechter sei. Hinsichtlich des klinischen Outcomes gibt es genügend Konsens unter den veröffentlichten Studien, um festzuhalten, dass es kurz- und mittelfristig keinen Unterschied zwischen Patienten gibt, die mit PSI oder konventioneller Technik operiert wurden. Eine große Metaanalyse konnte weder eine kürzere Operationszeit noch eine geringere Komplikationsrate für die PSI-Knie-TEP feststellen. Lediglich der intraoperative Blutverlust erwies sich als niedriger im Vergleich zur Standardtechnik, jedoch mit unveränderter Transfusionsrate. Kosteneffektivitätsanalysen lassen schlussfolgern, dass die PSI aktuell (noch) nicht kosteneffektiv ist.
Diskussion
Obwohl die aktuell vorliegenden Studienergebnisse die PSI-Technologie hinsichtlich vieler messbaren Kriterien nicht eindeutig von der Standardtechnik abheben, zeigt die PSI viele theoretische und praktische Vorteile.
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Moorthy V, Chen JY, Liow MHL, Chin PL, Chia SL, Lo NN, Yeo SJ. Mid-term functional outcomes of patient-specific versus conventional instrumentation total knee arthroplasty: a prospective study. Arch Orthop Trauma Surg 2021; 141:669-674. [PMID: 33386974 DOI: 10.1007/s00402-020-03729-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patient-specific instrumentation (PSI) utilizes three-dimensional imaging to produce total knee arthroplasty cutting jigs which matches patient's native anatomy. However, there are limited mid- to long-term studies examining its clinical efficacy. The aim of this study was to compare functional outcomes of PSI surgery versus conventional TKA surgery at 5-year follow-up. MATERIALS AND METHODS Sixty patients were prospectively recruited into either the MRI-based PSI or conventional TKA group. Functional outcomes were assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS) and Oxford Knee Score (OKS), while quality of life was evaluated with the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 and compared between the two groups at 5-year follow-up. RESULTS Although the PCS was 7 ± 3 points better in the PSI group preoperatively (p = 0.017), it became 5 ± 2 points worse than the conventional group at 5-year follow-up (p = 0.025). As compared to the PSI group, the conventional group showed a significantly greater improvement in PCS at 5 years as compared to before surgery (p = 0.003). There were no significant differences in KSFS, KSKS, OKS or MCS between the two groups. CONCLUSIONS PSI TKA did not result in improved functional outcomes or better quality of life when compared to conventional TKA. The additional costs and waiting time associated with PSI are not justifiable and therefore not recommended as an alternative to conventional TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Pak Lin Chin
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Block 6 Level 7, Outram Road, Singapore, 169608, Singapore
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Walter N, Rupp M, Hierl K, Koch M, Kerschbaum M, Worlicek M, Alt V. Long-Term Patient-Related Quality of Life after Knee Periprosthetic Joint Infection. J Clin Med 2021; 10:jcm10050907. [PMID: 33668957 PMCID: PMC7956307 DOI: 10.3390/jcm10050907] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed to evaluate the impact of knee periprosthetic joint infection (PJI) by assessing the patients' long-term quality of life and explicitly their psychological wellbeing after successful treatment. METHODS Thirty-six patients with achieved eradication of infection after knee PJI were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. RESULTS At a follow-up of 4.9 ± 3.5 years the mean SF-36 score was 24.82 ± 10.0 regarding the physical health component and 46.16 ± 13.3 regarding the mental health component compared to German normative values of 48.36 ± 9.4 (p < 0.001) and 50.87 ± 8.8 (p = 0.003). The mean EQ-5D index reached 0.55 ± 0.33 with an EQ-5D VAS rating of 52.14 ± 19.9 compared to reference scores of 0.891 (p < 0.001) and 68.6 ± 1.1 (p < 0.001). Mean scores of the ISR revealed the psychological symptom burden on the depression scale. CONCLUSION PJI patients still suffer from significantly lower quality of life compared to normative data, even years after surgically successful treatment. Future clinical studies should focus on patient-related outcome measures. Newly emerging treatment strategies, prevention methods, and interdisciplinary approaches should be implemented to improve the quality of life of PJI patients.
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Affiliation(s)
- Nike Walter
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
- Department for Psychosomatic Medicine, University Medical Center Regensburg, 93053 Regensburg, Germany
- Correspondence:
| | - Markus Rupp
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
| | - Katja Hierl
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
| | - Matthias Koch
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
| | - Maximilian Kerschbaum
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
| | - Michael Worlicek
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
| | - Volker Alt
- Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (M.R.); (K.H.); (M.K.); (M.K.); (M.W.); (V.A.)
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Thijs E, Theeuwen D, Boonen B, van Haaren E, Hendrickx R, Vos R, Borghans R, Kort N, Schotanus MGM. Comparable clinical outcome and implant longevity after CT- or MRI-based patient-specific instruments for total knee arthroplasty: a 2-year follow-up of a RCT. Knee Surg Sports Traumatol Arthrosc 2020; 28:1821-1826. [PMID: 31270591 DOI: 10.1007/s00167-019-05616-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient-specific instruments (PSI) are already widespread used in total knee arthroplasty (TKA). Either computed tomography (CT) scans or magnetic resonance imaging (MRI) scans are used pre-operatively to create jigs to guide resection during surgery. This study is a sequel of previous work that showed significantly more radiological outliers for posterior slope when CT-based guides were used. The aim of this study was to assess differences in revision rate and clinical outcome between the two groups at 2-year follow-up. METHODS At the 2-year follow-up, 124 patients were analysed in this prospective, randomised single-blind study. A survival analysis with revision of the TKA as endpoint was performed. Patients fulfilled four patient-reported outcome measurements (PROMs). Scores on the questionnaires were compared between both groups at the different follow-up visits. RESULTS At final follow-up, there was no significant difference in the survival rates of the CT- and MRI-based PSI surgery. Postoperatively, the PROMs significantly improved within each group compared with the pre-operative values. There were no significant differences for the PROMs between both groups at the 2-years follow-up. CONCLUSIONS Although previous results showed more outliers regarding posterior slope for CT-based PSIs, no difference in revision rate or the outcome of PROMs was found at 2-year follow-up. Further research to determine what the influence is of radiological outliers on implant survival and clinical outcomes is necessary. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Elke Thijs
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Dieuwertje Theeuwen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Bert Boonen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Emil van Haaren
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Roel Hendrickx
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob Borghans
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Martijn G M Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands.
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Kalaai S, Scholtes M, Borghans R, Boonen B, van Haaren E, Schotanus M. Comparable level of joint awareness between the bi-cruciate and cruciate retaining total knee arthroplasty with patient-specific instruments: a case-controlled study. Knee Surg Sports Traumatol Arthrosc 2020; 28:1835-1841. [PMID: 31286164 DOI: 10.1007/s00167-019-05613-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/01/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Bi-cruciate-retaining total knee arthroplasty (BCR-TKA) is recognized as an alternative to the cruciate-retaining total knee arthroplasty (CR-TKA) within the pursuit of retrieving the "forgotten artificial knee joint". The aim of this study was to provide a short-term comparison in functional and clinical outcomes between BCR- and CR-TKA. METHODS The cohort consisted of 61 BCR-TKA patients, matched with 61 suitable CR-TKA patients, and operated between 2014 and 2016 due to osteoarthritis. Patient-reported outcome measurements were assessed preoperatively and at 3, 12, 24 and 36 months postoperatively. In addition, perioperative conditions were observed and radiological images were analysed pre- and 1 year postoperatively. Effect size for the FJS-12 was calculated at 3-year follow-up to quantify the difference between BCR- and CR-TKA. RESULTS Patients reported a significant improved health-related quality of life (p = 0.017) and a non-significant difference in joint awareness at 3-year-follow-up with a moderate effect size (0.4). Operating time in BCR-TKA (1:16, ± 0:16) is significantly longer (p < 0.000) than in CR-TKA (0:50, ± 0:12). Blood loss significantly increased (p = 0.005) in BCR-TKA (246.4 cc, 79.8) compared to CR-TKA (195.5 cc, ± 106.2). Comparable length of hospital stay (n.s.) was observed in BCR-TKA (1.1 days, ± 1.1) and CR-TKA (1.3 days, ± 1.3). Outliers of the hip-knee-ankle axis occurred significantly more frequent (P = 0.015) in the BCR group (37.7%) compared to CR-TKA (18.0%). CONCLUSION Joint awareness of the BCR-TKA was not significantly reduced compared to the CR-TKA. However, this study illustrates that bi-cruciate-retaining surgical technique for TKA is a promising step further in the pursuit of reducing joint awareness and retrieving the artificial forgotten total knee. Since a functional ACL increases rotational stability and proprioception, future research should focus on knee kinematics in modern BCR-TKA measured with gait analyses. LEVEL OF EVIDENCE IV therapeutic, retrospective, cohort study.
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Affiliation(s)
- Soufyan Kalaai
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Marlon Scholtes
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Rob Borghans
- Department of Radiology, Zuyderland Medical Centre, Dr. H. van der Hoffplein, 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Bert Boonen
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Emil van Haaren
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Martijn Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
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Turgeon TR, Cameron B, Burnell CD, Hedden DR, Bohm ER. A double-blind randomized controlled trial of total knee replacement using patient-specific cutting block instrumentation versus standard instrumentation. Can J Surg 2020; 62:460-467. [PMID: 31782643 DOI: 10.1503/cjs.018318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Patient-specific cutting blocks in total knee arthroplasty have been promoted to improve mechanical alignment, reduce alignment outliers and improve patient outcomes. The aim of this study was to compare the efficacy of patient-specific instrumentation (PSI) and conventional instrumentation (CI) in achieving neutral alignment and accurate component positioning in total knee arthroplasty. Methods We conducted a double-blinded randomized controlled trial in which patients were randomly assigned to treatment with either PSI or CI. Results Fifty-four patients were included in the study. No relevant improvement in coronal alignment was found between the PSI and CI groups with post-hoc power of 0.91. Tibial slope was found to be more accurately reproduced to the preoperative target of 3° with PSI than with CI (3.8°± 3.1° v. 7.7°± 3.6°, respectively, p < 0.001). There were no differences found in patient-reported outcome measures, surgical time or length of hospital stay. Conclusion Given the added cost of the PSI technique, its use is difficult to justify given the small improvement in only a single alignment parameter. Clinical trial registration Clinicaltrials.gov, no. NCT03416946
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Affiliation(s)
- Thomas R. Turgeon
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - Brett Cameron
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - Colin D. Burnell
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - David R. Hedden
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
| | - Eric R. Bohm
- From the Department of Surgery, Section of Orthopaedics, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); the Concordia Joint Replacement Group, Winnipeg, Man. (Turgeon, Burnell, Hedden, Bohm); and the Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Cameron)
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Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2164371. [PMID: 32258107 PMCID: PMC7085852 DOI: 10.1155/2020/2164371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 02/13/2020] [Indexed: 02/05/2023]
Abstract
Objective To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and Conclusion PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.
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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: 44] [Impact Index Per Article: 8.8] [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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Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 2019; 4:611-617. [PMID: 31754467 DOI: 10.1302/2058-5241.4.190022] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA.Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7-20 robotic TKA cases.Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA.Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA.Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022.
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Affiliation(s)
- Babar Kayani
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Sujith Konan
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Atif Ayuob
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | | | | | - Fares S Haddad
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
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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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Schotanus MGM, Boonen B, van der Weegen W, Hoekstra H, van Drumpt R, Borghans R, Vos R, van Rhijn L, Kort NP. No difference in mid-term survival and clinical outcome between patient-specific and conventional instrumented total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:1463-1468. [PMID: 29725747 DOI: 10.1007/s00167-018-4968-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this multicentre prospective randomized controlled trial was to compare the survival rate and clinical outcome in total knee arthroplasty (TKA) after MRI-based patient-specific instruments (PSI) and conventional instruments 5 years after initial surgery. METHODS At a mean follow-up of 5.1 years (0.4), 163 patients (90.6%) with a mean age of 71.8 years (8.7) were analysed. A survival analysis with revision of the TKA as endpoint was performed. The Knee Society Score (KSS), evaluations on plain radiographs and patient-reported outcome measures (PROMs) were obtained preoperatively and at each FU. RESULTS At final follow-up, one TKA in the PSI- (1.2%) and 3 TKAs in the conventional group (3.8%) had undergone revision surgery (n.s.). No radiological abnormalities were noted at any time point. Postoperatively, the KSS and PROMs significantly improved within each group compared with the preoperative values. There were no clinically relevant differences for the KSS [PSI: 77.4, 9.8 (95% CI 75.0-79.7) vs. conventional: 77.3 10.5 (95% CI 74.9-79.8)] and the PROMs between both groups (n.s.) at 5 years follow-up. CONCLUSION There is still a lack of reliable data on the survival of TKA and clinical evidence, when using PSI for TKA. Longer follow-up studies are, therefore, needed. LEVEL OF EVIDENCE I.
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Affiliation(s)
- M G M Schotanus
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
| | - B Boonen
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands
| | - W van der Weegen
- Department of Orthopedic Surgery and Traumatology, St. Anna Hospital, Geldrop, The Netherlands
| | - H Hoekstra
- Department of Orthopedic Surgery and Traumatology, St. Anna Hospital, Geldrop, The Netherlands
| | - R van Drumpt
- Department of Orthopedic Surgery and Traumatology, St. Anna Hospital, Geldrop, The Netherlands
| | - R Borghans
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - R Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L van Rhijn
- Department of Orthopedic Surgery And Traumatology, Maastricht University Medical Center, Maastricht, The Netherlands
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McAuliffe MJ, Beer BR, Hatch JJ, Crawford RW, Cuthbert AR, Donnelly WJ. Impact of Image-Derived Instrumentation on Total Knee Arthroplasty Revision Rates: An Analysis of 83,823 Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2019; 101:580-588. [PMID: 30946191 DOI: 10.2106/jbjs.18.00326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computer navigation and image-derived instrumentation (IDI) are technology-based methods developed to improve outcomes and potentially reduce revision total knee arthroplasty (TKA). IDI refers to the use of manufactured, patient-specific surgical jigs. Conflicting reports exist on IDI-associated improvements in outcomes. The primary aim of the current study was to compare the rates of revision among TKA cases in which components were initially implanted with use of IDI, computer navigation, or neither of these methods ("other" TKA). The secondary aim was to determine whether the outcomes of IDI differed for specific subgroups. METHODS Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for the 3 TKA groups: IDI, computer-navigated, and other TKA. The study period was from the first IDI procedure recorded by the AOANJRR (April 2010) to December 31, 2016. The analysis was restricted to primary TKA cases undertaken for osteoarthritis and involving patellar resurfacing and the use of a cross-linked polyethylene insert. Subanalyses were performed to evaluate the effects of age, sex, implantation method, IDI manufacturer, prosthetic design, and prosthesis type on the rates of revision. Kaplan-Meier estimates of survivorship described the time to first revision. Hazard ratios (HRs, Cox proportional hazards models) with adjustment for age and sex were used to compare revision rates. RESULTS IDI was used in 5,486 primary TKA procedures. There was no significant difference among the groups in the cumulative percent revision (CPR) at 5 years: 3.3% (95% confidence interval [CI], 2.4% to 4.6%) for IDI, 2.4% (95% CI, 2.2% to 2.7%) for the computer-navigated group, and 2.5% (95% CI, 2.3% to 2.7%) for other TKA. Posterior-stabilized TKA with use of the IDI method had a significantly higher rate of revision at >3 months (HR, 1.45 [95% CI, 1.02 to 2.04]; p = 0.036), as did IDI TKA in the ≤65-year-old patient cohort (HR, 1.52 [95% CI, 1.10 to 2.09]; p = 0.010), compared with computer-navigated TKA. Patellar revision was significantly more likely in the IDI group. CONCLUSIONS IDI TKA demonstrated no overall difference in early to mid-term revision rates compared with standard implantation methods. However, elevated rates of revision were seen with posterior-stabilized TKA, in patients ≤65 years of age, and for patellar revision, meaning that this method should be used with some caution and requires further study. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael J McAuliffe
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Benjamin R Beer
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Joshua J Hatch
- Department of Orthopaedics, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Ross W Crawford
- Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Alana R Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - William J Donnelly
- Department of Orthopaedics, Prince Charles Hospital, Chermside, Queensland, Australia
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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: 43] [Impact Index Per Article: 8.6] [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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Schotanus MGM, Thijs E, Heijmans M, Vos R, Kort NP. Favourable alignment outcomes with MRI-based patient-specific instruments in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:2659-2668. [PMID: 28698929 DOI: 10.1007/s00167-017-4637-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/06/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE Patient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty (TKA) with conventional instrumentation. PSI use requires a preoperative MRI scan, CT scan, or a combination of MRI and a long-leg standing radiograph. However, there is no consensus as to which of these modalities, MRI or CT, is the preferred imaging modality when performing TKA with PSIs. METHODS This systematic literature review and meta-analysis studied the differences in alignment outliers between CT- and MRI-based PSI for TKA. A search of the Cochrane Database of Systematic Reviews, MEDLINE/PubMed and Embase was conducted, without restriction on date of publication. Only level I evidence studies written in English that included TKA with the use of MRI- and CT-based PSI were selected. A meta-analysis was then performed of the rate of outliers in the biomechanical axis and individual femoral and tibial component alignment. Where considerable heterogeneity among studies was present or the data did not provide sufficient information for performing the meta-analysis, a qualitative synthesis was undertaken. RESULTS Twelve randomized controlled trials, studying 841 knees, were eligible for data extraction and meta-analysis. MRI-based PSI resulted in a significantly lower proportion of coronal plane outliers with regard to the lateral femoral component (OR 0.52, 95% CI 0.30-0.89, P = 0.02), without significant heterogeneity (n.s.). There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment. CONCLUSION This systematic review and meta-analysis demonstrate that alignment with MRI-based PSI is at least as good as, if not better than, that with CT-based PSI. To prevent for malalignment, MRI should be the imaging modality of choice when performing TKA surgery with PSI. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Martijn G M Schotanus
- Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands.
| | - Elke Thijs
- Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands
| | - Marion Heijmans
- Zuyderland Academy, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nanne P Kort
- Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands
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25
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26
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Van Leeuwen JAMJ, Snorrason F, Röhrl SM. No radiological and clinical advantages with patient-specific positioning guides in total knee replacement. Acta Orthop 2018; 89:89-94. [PMID: 29161930 PMCID: PMC5810839 DOI: 10.1080/17453674.2017.1393732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Although the use of patient-specific positioning guides (PSPGs) in total knee replacement (TKR) in theory is promising, the technique has not yet proven its superior- ity compared with the conventional method. We compared radio- logical alignment and clinical outcome between TKR performed with the use of PSPGs and the conventional operation method. Patients and methods - 3 hospitals participated in a prospec- tive trial. 109 patients were randomized to either the conventional method or to the use of PSPGs. Postoperatively a full-length standing anteroposterior radiograph and a postoperative CT scan were taken. On the CT scan the alignments were measured for both the femoral and tibial components in the frontal, sagit- tal, and axial plane. The Knee injury and Osteoarthritis Outcome Score (KOOS), the Eurocol-5D-3L (Eq5D) descriptive system and visual analogue scale (VAS), a pain score (NRS), and range of motion (ROM) were recorded preoperatively, and at 3 months, 1, and 2 years. The operation time and length of hospital stay were recorded. Results - 90 patients were available for postoperative CT mea- surements. A statistically significant difference was found between the conventional TKR instrumentation and the use of PSPGs for the frontal femoral (mean (SD) 0.6° (1.7) vs. -0.3° (2.2), CI 0.08 to 1.69) and tibial (-0.3° (1.5) vs. 0.9° (2.1), CI -1.98 to -0.44) compo- nent angles and for the tibial alignment in the sagittal plane (-3.8° (3.0) vs. -2.2° (2.5), CI -2.72; -0.42). The proportions of outliers were similar between the groups as well as the hip-knee-ankle angle, the KOOS sub scores, the Eq5D, pain (NRS), ROM, opera- tion time, and length of hospital stay. Interpretation - The use of PSPGs requires a preoperative CT scan or MRI and the guides have an additional cost. As this study was not able to prove any extra benefit of the use of PSPGs we recommend the conventional operation method for TKR.
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Affiliation(s)
- Justin A M J Van Leeuwen
- Department of Orthopaedic Surgery, Betanien Hospital, Skien, Norway,Faculty of Medicine, University of Oslo, Oslo, Norway,Correspondence:
| | - Finnur Snorrason
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stephan M Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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27
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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28
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Schoenmakers DAL, Schotanus MGM, Boonen B, Kort NP. Consistency in patient-reported outcome measures after total knee arthroplasty using patient-specific instrumentation: a 5-year follow-up of 200 consecutive cases. Knee Surg Sports Traumatol Arthrosc 2018; 26:1800-1804. [PMID: 29147744 PMCID: PMC5966470 DOI: 10.1007/s00167-017-4800-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the 5-year follow-up results of the first 200 total knee arthroplasties (TKA) performed by one high-volume surgeon, using patient-specific information (PSI). To date, there has been no other research into the mid-term follow-up of TKA performed using PSI. MATERIALS AND METHODS A total of 184 consecutive patients (200 TKA) were evaluated. Outcome measures included implant survival rate, adverse events, and the following patient-reported outcome measures (PROMs); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Pain Visual Analogue Score (VAS) and EuroQol-5D Score (EQ-5D). RESULTS Revision surgery was performed for late secondary prosthetic joint infection (n = 1, total revision), aseptic loosening (n = 1, tibial component revision), instability (n = 1, isolated polyethylene insert exchange), and polyethylene insert breakage (n = 1, isolated polyethylene insert exchange). Other adverse events were as follows: debridement, antibiotics and implant retention for early prosthetic joint infection (n = 1), surgical debridement for haemarthrosis (n = 1), superficial wound infection (n = 2), thromboembolic events (n = 2), compartment syndrome (n = 1), and nerve injury (n = 2). All median outcome scores for patient reported outcome measures at 5 years improved significantly compared with the preoperative values (p ≤ 0.05). Median outcome scores were not significantly different between 1- and 5-year moments of follow-up, except for a significant decrease of EQ-VAS (p ≤ 0.05) between these two follow-up moments. CONCLUSION PROMs are consistent for 5-year follow-up of TKA using PSI. After 5 years of follow-up, revision surgery for any reason occurred in four patients (2%). LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daphne A. L. Schoenmakers
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
| | - Martijn G. M. Schotanus
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
| | - Bert Boonen
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
| | - Nanne P. Kort
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
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Affiliation(s)
- M Ghert
- McMaster University, 711 Concession Street Level B3 Surgical Offices Hamilton, ON, Canada
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30
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Haddad FS. Evolving techniques: the need for better technology. Bone Joint J 2017; 99-B:145-146. [PMID: 28148653 DOI: 10.1302/0301-620x.99b2.38085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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Haddad FS. Debate is healthy: more data are needed. Bone Joint J 2016; 98-B:865-6. [PMID: 27365462 DOI: 10.1302/0301-620x.98b7.38073] [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: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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