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J Knee Surg 2014; 27(03): 177-184
DOI: 10.1055/s-0034-1374813
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient-Specific Instrumentation in Total Knee Arthroplasty

Julio J. Jauregui
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Jeffrey J. Cherian
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Bhaveen H. Kapadia
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Samik Banerjee
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Kimona Issa
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
,
Steven F. Harwin
2   Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

19 February 2014

16 March 2014

Publication Date:
24 April 2014 (online)

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Abstract

Patient-specific instrumentation (PSI) is a technology that allows the surgeon to perform a total knee arthroplasty (TKA) potentially more easily with preformed cutting blocks and jigs, which are developed from preoperative computed tomographic or magnetic resonance image scans of the knee. It was introduced with the goal of reducing surgical time, minimizing costs, improving alignment, and reducing radiographic outliers when performing a TKA. Although multiple reports have demonstrated that PSI can reduce the amount of trays and instrumentation required, operative time, and turnover rates, this has not been extrapolated to an overall cost reduction. This is potentially related to the costs of preoperative imaging and the intrinsic costs of production of the patient-specific guides. With the present technology, it is also controversial whether improvements in alignment can be achieved. In addition, it remains to be seen whether this will lead to a reduction in costs and improvements in clinical, radiographic, and functional outcomes. As PSI is relatively new, there is a paucity of long-term studies, which makes it difficult to predict whether long-term improvements in implant survivorship will lead to substantial improvements in patient function, overall outcomes, or cost benefits.

Keywords

patient-specific instrumentation - total knee arthroplasty - preoperative templating
 

  • References

  • 1 Thienpont E, Bellemans J, Delport H , et al. Patient-specific instruments: industry's innovation with a surgeon's interest. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2227-2233
    CrossrefPubMedGoogle Scholar
  • 2 Lachiewicz PF, Henderson RA. Patient-specific instruments for total knee arthroplasty. J Am Acad Orthop Surg 2013; 21 (9) 513-518
    CrossrefPubMedGoogle Scholar
  • 3 Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977; 59 (1) 77-79
    PubMedGoogle Scholar
  • 4 Elloy MA, Manning MP, Johnson R. Accuracy of intramedullary alignment in total knee replacement. J Biomed Eng 1992; 14 (5) 363-370
    CrossrefPubMedGoogle Scholar
  • 5 Kalairajah Y, Cossey AJ, Verrall GM, Ludbrook G, Spriggins AJ. Are systemic emboli reduced in computer-assisted knee surgery?: A prospective, randomised, clinical trial. J Bone Joint Surg Br 2006; 88 (2) 198-202
    CrossrefPubMedGoogle Scholar
  • 6 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
    CrossrefPubMedGoogle Scholar
  • 7 Caillouette JT, Anzel SH. Fat embolism syndrome following the intramedullary alignment guide in total knee arthroplasty. Clin Orthop Relat Res 1990; (251) 198-199
    PubMedGoogle Scholar
  • 8 Radermacher K, Portheine F, Anton M , et al. Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 1998; (354) 28-38
    PubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Lombardi Jr AV, Berend KR, Adams JB. Patient-specific approach in total knee arthroplasty. Orthopedics 2008; 31 (9) 927-930
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J. Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res 2014; 472 (1) 263-271
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Chotanaphuti T, Wangwittayakul V, Khuangsirikul S, Foojareonyos T. The accuracy of component alignment in custom cutting blocks compared with conventional total knee arthroplasty instrumentation: prospective control trial. Knee 2014; 21 (1) 185-188
    CrossrefPubMedGoogle Scholar
  • 15 Yaffe M, Luo M, Goyal N , et al. Clinical, functional, and radiographic outcomes following total knee arthroplasty with patient-specific instrumentation, computer-assisted surgery, and manual instrumentation: a short-term follow-up study. Int J Comput Assist Radiol Surg 2013; ; December 13 (Epub ahead of print); doi: 10.1007/s11548-013-0968-6
    PubMedGoogle Scholar
  • 16 Russell R, Brown T, Huo M, Jones R. Patient-specific instrumentation does not improve alignment in total knee arthroplasty. J Knee Surg 2014; ; February 6 (Epub ahead of print); doi: 10.1055/s-0034-1368143
    PubMedGoogle Scholar
  • 17 Nam D, Maher PA, Rebolledo BJ, Nawabi DH, McLawhorn AS, Pearle AD. Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty. Knee 2013; 20 (4) 263-267
    CrossrefPubMedGoogle Scholar
  • 18 Barrack RL, Ruh EL, Williams BM, Ford AD, Foreman K, Nunley RM. Patient specific cutting blocks are currently of no proven value. J Bone Joint Surg Br 2012; 94 (11, Suppl A ): 95-99
    CrossrefPubMedGoogle Scholar
  • 19 Noble Jr JW, Moore CA, Liu N. The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 2012; 27 (1) 153-155
    CrossrefPubMedGoogle Scholar
  • 20 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
    PubMedGoogle Scholar
  • 21 Hamilton WG, Parks NL, Saxena A. Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty 2013; 28 (8, Suppl): 96-100
    CrossrefPubMedGoogle Scholar
  • 22 Slover JD, Rubash HE, Malchau H, Bosco JA. Cost-effectiveness analysis of custom total knee cutting blocks. J Arthroplasty 2012; 27 (2) 180-185
    CrossrefPubMedGoogle Scholar
  • 23 Issa K, Rifai A, McGrath MS , et al. Reliability of templating with patient-specific instrumentation in total knee arthroplasty. J Knee Surg 2013; 26 (6) 429-433
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Stronach BM, Pelt CE, Erickson J, Peters CL. Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res 2013; 471 (1) 169-174
    CrossrefPubMedGoogle Scholar
  • 25 Ensini A, Timoncini A, Cenni F , et al. Intra- and post-operative accuracy assessments of two different patient-specific instrumentation systems for total knee replacement. Knee Surg Sports Traumatol Arthrosc 2014; 22 (3) 621-629
    CrossrefPubMedGoogle Scholar
  • 26 Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP. Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2206-2212
    CrossrefPubMedGoogle Scholar
  • 27 Conteduca F, Iorio R, Mazza D, Ferretti A. Patient-specific instruments in total knee arthroplasty. Int Orthop 2014; 38 (2) 259-265
    CrossrefPubMedGoogle Scholar
  • 28 Chen JY, Yeo SJ, Yew AK , et al. The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22 (3) 630-635
    CrossrefPubMedGoogle Scholar
  • 29 Scholes C, Sahni V, Lustig S, Parker DA, Coolican MR. Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation. Knee Surg Sports Traumatol Arthrosc 2014; 22 (3) 660-665
    CrossrefPubMedGoogle Scholar
  • 30 Conteduca F, Iorio R, Mazza D , et al. Evaluation of the accuracy of a patient-specific instrumentation by navigation. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2194-2199
    CrossrefPubMedGoogle Scholar
  • 31 Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson JN. Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2213-2219
    CrossrefPubMedGoogle Scholar
  • 32 Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty?. Clin Orthop Relat Res 2012; 470 (3) 895-902
    CrossrefPubMedGoogle Scholar
  • 33 Pietsch M, Djahani O, Hochegger M, Plattner F, Hofmann S. Patient-specific total knee arthroplasty: the importance of planning by the surgeon. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2220-2226
    CrossrefPubMedGoogle Scholar
  • 34 Vundelinckx BJ, Bruckers L, De Mulder K, De Schepper J, Van Esbroeck G. Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplasty 2013; 28 (6) 964-970
    CrossrefPubMedGoogle Scholar
  • 35 Bali K, Walker P, Bruce W. Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplasty 2012; 27 (6) 1149-1154
    CrossrefPubMedGoogle Scholar
  • 36 Daniilidis K, Tibesku CO. Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop 2013; 37 (1) 45-50
    CrossrefPubMedGoogle Scholar
  • 37 Koch PP, Müller D, Pisan M, Fucentese SF. Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2200-2205
    CrossrefPubMedGoogle Scholar