Download PDF
J Knee Surg 2012; 25(03): 213-220
DOI: 10.1055/s-0032-1319785
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient-Specific Instrumentation in Total Knee Arthroplasty: A Review

Denis Nam
1   Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
,
Benjamin A. McArthur
1   Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
,
Michael B. Cross
1   Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
,
Andrew D. Pearle
1   Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
,
David J. Mayman
1   Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
,
Steven B. Haas
1   Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York
› Author Affiliations
Further Information

Publication History

23 February 2012

06 May 2012

Publication Date:
28 June 2012 (online)

    Permissions and Reprints

Abstract

Recently, patient-specific approaches to total knee arthroplasty (TKA) have been introduced, in which preoperative imaging (plain radiographs, computed tomography, and magnetic resonance imaging) are used to manufacture cutting blocks specific to a patient's anatomy. Proposed benefits of patient-matched cutting blocks include a decrease in operative time, instrument trays required, and the ability to preoperatively plan a patient's component size, position, and alignment. In addition, an improvement in postoperative mechanical alignment is expected, without violation of the intramedullary canal. However, questions remain regarding patient outcomes and the cost-effectiveness associated with patient-specific cutting block technology. This article will review the evolution of surgical techniques in TKA, the development of patient-specific cutting blocks, surgical considerations, and the literature associated with this new technology.

Keywords

total knee arthroplasty - patient-specific instrumentation - alignment - cost-effectiveness
 

  • References

  • 1 Berend ME, Ritter MA, Meding JB , et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; 428 (428) 26-34
    CrossrefPubMedSearch in Google Scholar
  • 2 Ritter MA, Davis KE, Meding JB, Pierson JL, Berend ME, Malinzak RA. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am 2011; 93 (17) 1588-1596
    CrossrefPubMedSearch in Google Scholar
  • 3 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (7) 1487-1497
    CrossrefPubMedSearch in Google Scholar
  • 4 Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 2007; 22 (8) 1097-1106
    CrossrefPubMedSearch in Google Scholar
  • 5 Reed MR, Bliss W, Sher JL, Emmerson KP, Jones SM, Partington PF. Extramedullary or intramedullary tibial alignment guides: a randomised, prospective trial of radiological alignment. J Bone Joint Surg Br 2002; 84 (6) 858-860
    CrossrefPubMedSearch in Google Scholar
  • 6 Dennis DA, Channer M, Susman MH, Stringer EA. Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty. J Arthroplasty 1993; 8 (1) 43-47
    CrossrefPubMedSearch in Google Scholar
  • 7 Cates HE, Ritter MA, Keating EM, Faris PM. Intramedullary versus extramedullary femoral alignment systems in total knee replacement. Clin Orthop Relat Res 1993; 286 (286) 32-39
    PubMedSearch in Google Scholar
  • 8 Bardakos N, Cil A, Thompson B, Stocks G. Mechanical axis cannot be restored in total knee arthroplasty with a fixed valgus resection angle: a radiographic study. J Arthroplasty 2007; 22 (6, Suppl 2) 85-89
    Search in Google Scholar
  • 9 Dorr LD, Merkel C, Mellman MF, Klein I. Fat emboli in bilateral total knee arthroplasty. Predictive factors for neurologic manifestations. Clin Orthop Relat Res 1989; 248 (248) 112-118 , discussion 118–119
    PubMedSearch in Google Scholar
  • 10 Church JS, Scadden JE, Gupta RR, Cokis C, Williams KA, Janes GC. Embolic phenomena during computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 2007; 89 (4) 481-485
    CrossrefPubMedSearch in Google Scholar
  • 11 Hinarejos P, Corrales M, Matamalas A, Bisbe E, Cáceres E. Computer-assisted surgery can reduce blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2009; 17 (4) 356-360
    CrossrefPubMedSearch in Google Scholar
  • 12 Millar NL, Deakin AH, Millar LL, Kinnimonth AW, Picard F. Blood loss following total knee replacement in the morbidly obese: Effects of computer navigation. Knee 2011; 18 (2) 108-112
    CrossrefPubMedSearch in Google Scholar
  • 13 Schnurr C, Csécsei G, Eysel P, König DP. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics 2010; 33 (7) 474
    PubMedSearch in Google Scholar
  • 14 Confalonieri N, Manzotti A, Pullen C, Ragone V. Computer-assisted technique versus intramedullary and extramedullary alignment systems in total knee replacement: a radiological comparison. Acta Orthop Belg 2005; 71 (6) 703-709
    PubMedSearch in Google Scholar
  • 15 Canale ST, Beaty JH. Campbell's operative orthopaedics. Vol One. Eleventh ed. Philadelphia, PA: Elsevier Inc.; 2008
    Search in Google Scholar
  • 16 Pang CH, Chan WL, Yen CH , et al. Comparison of total knee arthroplasty using computer-assisted navigation versus conventional guiding systems: a prospective study. J Orthop Surg (Hong Kong) 2009; 17 (2) 170-173
    PubMedSearch in Google Scholar
  • 17 Nam D, Dy CJ, Cross MB, Kang MN, Mayman DJ. Cadaveric results of an accelerometer based, hand-held navigation system for the tibial resection in total knee arthroplasty. Knee 2011 Oct 25 [Epub ahead of print]
    PubMed
  • 18 Nam D, Cross M, Deshmane P, Jerabek S, Kang M, Mayman DJ. Radiographic results of an accelerometer-based, handheld surgical navigation system for the tibial resection in total knee arthroplasty. Orthopedics 2011; 34 (10) e615-e621
    PubMedSearch in Google Scholar
  • 19 Nam D, Jerabek SA, Haughom B, Cross MB, Reinhardt KR, Mayman DJ. Radiographic analysis of a hand-held surgical navigation system for tibial resection in total knee arthroplasty. J Arthroplasty 2011; 26 (8) 1527-1533
    CrossrefPubMedSearch in Google Scholar
  • 20 Lombardi Jr AV, Berend KR, Adams JB. Patient-specific approach in total knee arthroplasty. Orthopedics 2008; 31 (9) 927-930
    CrossrefPubMedSearch in Google Scholar
  • 21 Radermacher K, Portheine F, Anton M , et al. Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 1998; 354 (354) 28-38
    CrossrefPubMedSearch in Google Scholar
  • 22 Holt GE, Dennis DA. Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res 2004; 429 (429) 209-214
    CrossrefPubMedSearch in Google Scholar
  • 23 Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK. Bridging massive acetabular defects with the triflange cup: 2- to 9-year results. Clin Orthop Relat Res 2001; 393 (393) 216-227
    CrossrefPubMedSearch in Google Scholar
  • 24 Siston RA, Patel JJ, Goodman SB, Delp SL, Giori NJ. The variability of femoral rotational alignment in total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (10) 2276-2280
    CrossrefPubMedSearch in Google Scholar
  • 25 Millar NL, Deakin AH, Millar LL, Kinnimonth AW, Picard F. Blood loss following total knee replacement in the morbidly obese: Effects of computer navigation. Knee 2011; 18 (2) 108-112
    CrossrefPubMedSearch in Google Scholar
  • 26 Klatt BA, Goyal N, Austin MS, Hozack WJ. Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty 2008; 23 (1) 26-29
    CrossrefPubMedSearch in Google Scholar
  • 27 Howell SM, Kuznik K, Hull ML, Siston RA. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 2008; 31 (9) 857-863
    CrossrefPubMedSearch in Google Scholar
  • 28 Mont MA, Johnson AJ, Zywiel MG, Bonutti PM. Surgeon perceptions regarding custom-fit positioning technology for total knee arthroplasty. Surg Technol Int 2010; 20: 348-351
    PubMedSearch in Google Scholar
  • 29 Spencer BA, Mont MA, McGrath MS, Boyd B, Mitrick MF. Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop 2009; 33 (6) 1571-1575
    CrossrefPubMedSearch in Google Scholar
  • 30 Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi Jr AV. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 2012; 470 (1) 99-107
    CrossrefPubMedSearch in Google Scholar
  • 31 Watters TS, Mather III RC, Browne JA, Berend KR, Lombardi Jr AV, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv 2011; 20 (2) 112-116
    PubMedSearch in Google Scholar
  • 32 Slover J, Rubash H, Malchau H, Bosco J. Cost-effectiveness analysis of custom total knee cutting blocks. J Arthroplasty 2011;
    PubMedSearch in Google Scholar