Skip to main content
Erschienen in: International Orthopaedics 2/2014

01.02.2014 | Original Paper

Patient-specific instruments in total knee arthroplasty

verfasst von: Fabio Conteduca, Raffaele Iorio, Daniele Mazza, Andrea Ferretti

Erschienen in: International Orthopaedics | Ausgabe 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In recent years, patient-specific instruments (PSI) has been introduced with the aim of reducing the overall costs of the implants, minimising the size and number of instruments required, and also reducing surgery time. The purpose of this study was to perform a review of the current literature, as well as to report about our personal experience, to assess reliability of patient specific instrument system in total knee arthroplasty (TKA).

Methods

A literature review was conducted of PSI system reviewing articles related to coronal alignment, clinical knee and function scores, cost, patient satisfaction and complications.

Results

Studies have reported incidences of coronal alignment ≥3° from neutral in TKAs performed with patient-specific cutting guides ranging from 6 % to 31 %.

Conclusions

PSI seem not to be able to result in the same degree of accuracy as the CAS system, while comparing well with standard manual technique with respect to component positioning and overall lower axis, in particular in the sagittal plane. In cases in which custom-made cutting jigs were used, we recommend performing an accurate control of the alignment before and after any cuts and in any further step of the procedure, in order to avoid possible outliers.
Literatur
1.
Zurück zum Zitat Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed
2.
Zurück zum Zitat Perillo-Marcone A, Barrett DS, Taylor M (2000) The importance of tibial alignment: finite element analysis of tibial malalignment. J Arthroplasty 15(8):1020–1027PubMedCrossRef Perillo-Marcone A, Barrett DS, Taylor M (2000) The importance of tibial alignment: finite element analysis of tibial malalignment. J Arthroplasty 15(8):1020–1027PubMedCrossRef
3.
Zurück zum Zitat Lützner J, Dexel J, Kirschner S (2013) No difference between computer-assisted and conventional total knee arthroplasty: five-year results of a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 21(10):2241–2247PubMedCrossRef Lützner J, Dexel J, Kirschner S (2013) No difference between computer-assisted and conventional total knee arthroplasty: five-year results of a prospective randomised study. Knee Surg Sports Traumatol Arthrosc 21(10):2241–2247PubMedCrossRef
4.
Zurück zum Zitat Hoffart HE, Langenstein E, Vasak N (2012) A prospective study comparing the functional outcome of computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 94(2):194–199PubMedCrossRef Hoffart HE, Langenstein E, Vasak N (2012) A prospective study comparing the functional outcome of computer-assisted and conventional total knee replacement. J Bone Joint Surg Br 94(2):194–199PubMedCrossRef
5.
Zurück zum Zitat Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20(5):618–626PubMedCrossRef Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20(5):618–626PubMedCrossRef
6.
Zurück zum Zitat Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop 36(8):1589–1593PubMedCentralPubMedCrossRef Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop 36(8):1589–1593PubMedCentralPubMedCrossRef
7.
Zurück zum Zitat Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2013) Evaluation of the accuracy of a patient-specific instrumentation by navigation. Knee Surg Sports Traumatol Arthrosc 21(10):2194–2199PubMedCrossRef Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2013) Evaluation of the accuracy of a patient-specific instrumentation by navigation. Knee Surg Sports Traumatol Arthrosc 21(10):2194–2199PubMedCrossRef
8.
Zurück zum Zitat Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J (2013) Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res. 2013 Apr 25. [Epub ahead of print] Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J (2013) Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res. 2013 Apr 25. [Epub ahead of print]
9.
Zurück zum Zitat Thienpont E, Bellemans J, Delport H, Van Overschelde P, Stuyts B, Brabants K, Victor J (2013) Patient-specific instruments: industry's innovation with a surgeon's interest. Knee Surg Sports Traumatol Arthrosc 21(10):2227–2233PubMedCrossRef Thienpont E, Bellemans J, Delport H, Van Overschelde P, Stuyts B, Brabants K, Victor J (2013) Patient-specific instruments: industry's innovation with a surgeon's interest. Knee Surg Sports Traumatol Arthrosc 21(10):2227–2233PubMedCrossRef
10.
Zurück zum Zitat Conteduca F, Massai F, Iorio R, Zanzotto E, Luzon D, Ferretti A (2009) Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop 33(6):1609–1613PubMedCentralPubMedCrossRef Conteduca F, Massai F, Iorio R, Zanzotto E, Luzon D, Ferretti A (2009) Blood loss in computer-assisted mobile bearing total knee arthroplasty. A comparison of computer-assisted surgery with a conventional technique. Int Orthop 33(6):1609–1613PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Iorio R, Bolle G, Conteduca F, Valeo L, Conteduca J, Mazza D, Ferretti A (2013) Accuracy of manual instrumentation of tibial cutting guide in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(10):2296–2300PubMedCrossRef Iorio R, Bolle G, Conteduca F, Valeo L, Conteduca J, Mazza D, Ferretti A (2013) Accuracy of manual instrumentation of tibial cutting guide in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21(10):2296–2300PubMedCrossRef
12.
Zurück zum Zitat Iorio R, Mazza D, Bolle G, Conteduca J, Redler A, Conteduca F, Ferretti A (2013) Computer-assisted surgery: a teacher of TKAs. Knee 20(4):232–235PubMedCrossRef Iorio R, Mazza D, Bolle G, Conteduca J, Redler A, Conteduca F, Ferretti A (2013) Computer-assisted surgery: a teacher of TKAs. Knee 20(4):232–235PubMedCrossRef
13.
Zurück zum Zitat Bali K, Walker P, Bruce W (2012) Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplasty 27(6):1149–1154PubMedCrossRef Bali K, Walker P, Bruce W (2012) Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplasty 27(6):1149–1154PubMedCrossRef
14.
Zurück zum Zitat Pietsch M, Djahani O, Hochegger M, Plattner F, Hofmann S (2013) Patient-specific total knee arthroplasty: the importance of planning by the surgeon. Knee Surg Sports Traumatol Arthrosc 21(10):2220–2226PubMedCrossRef Pietsch M, Djahani O, Hochegger M, Plattner F, Hofmann S (2013) Patient-specific total knee arthroplasty: the importance of planning by the surgeon. Knee Surg Sports Traumatol Arthrosc 21(10):2220–2226PubMedCrossRef
15.
Zurück zum Zitat Chen JY, Yeo SJ, Yew AK, Tay DK, Chia SL, Lo NN, Chin PL (2013) The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013 Aug 31. [Epub ahead of print]. Chen JY, Yeo SJ, Yew AK, Tay DK, Chia SL, Lo NN, Chin PL (2013) The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013 Aug 31. [Epub ahead of print].
16.
Zurück zum Zitat Nam D, Maher PA, Rebolledo BJ, Nawabi DH, McLawhorn AS, Pearle AD (2013) Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty. Knee 20(4):263–267PubMedCrossRef Nam D, Maher PA, Rebolledo BJ, Nawabi DH, McLawhorn AS, Pearle AD (2013) Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty. Knee 20(4):263–267PubMedCrossRef
17.
Zurück zum Zitat Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP (2013) Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 21(10):2206–2212PubMedCrossRef Boonen B, Schotanus MG, Kerens B, van der Weegen W, van Drumpt RA, Kort NP (2013) Intra-operative results and radiological outcome of conventional and patient-specific surgery in total knee arthroplasty: a multicentre, randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 21(10):2206–2212PubMedCrossRef
18.
Zurück zum Zitat Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson JN (2013) Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 21(10):2213–2219PubMedCrossRef Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson JN (2013) Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 21(10):2213–2219PubMedCrossRef
19.
Zurück zum Zitat Daniilidis K, Tibesku CO (2013) A comparison of conventional and patient-specific instruments in total knee arthroplasty. Int Orthop. 2013 Jul 31. [Epub ahead of print] Daniilidis K, Tibesku CO (2013) A comparison of conventional and patient-specific instruments in total knee arthroplasty. Int Orthop. 2013 Jul 31. [Epub ahead of print]
20.
Zurück zum Zitat Vundelinckx BJ, Bruckers L, De Mulder K, De Schepper J, Van Esbroeck G (2013) Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplasty 28(6):964–970PubMedCrossRef Vundelinckx BJ, Bruckers L, De Mulder K, De Schepper J, Van Esbroeck G (2013) Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplasty 28(6):964–970PubMedCrossRef
21.
Zurück zum Zitat Koch PP, Müller D, Pisan M, Fucentese SF (2013) Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique. Knee Surg Sports Traumatol Arthrosc 21(10):2200–2205PubMedCrossRef Koch PP, Müller D, Pisan M, Fucentese SF (2013) Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique. Knee Surg Sports Traumatol Arthrosc 21(10):2200–2205PubMedCrossRef
22.
Zurück zum Zitat Scholes C, Sahni V, Lustig S, Parker DA, Coolican MR (2013) 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. 2013 Sep 17. [Epub ahead of print] Scholes C, Sahni V, Lustig S, Parker DA, Coolican MR (2013) 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. 2013 Sep 17. [Epub ahead of print]
23.
Zurück zum Zitat Lustig S, Scholes CJ, Oussedik S, Kinzel V, Coolican MR, Parker DA (2013) Unsatisfactory accuracy with VISIONAIRE patient-specific cutting jigs for total knee arthroplasty. J Arthroplasty. 2013 Jul 25. [Epub ahead of print] Lustig S, Scholes CJ, Oussedik S, Kinzel V, Coolican MR, Parker DA (2013) Unsatisfactory accuracy with VISIONAIRE patient-specific cutting jigs for total knee arthroplasty. J Arthroplasty. 2013 Jul 25. [Epub ahead of print]
24.
Zurück zum Zitat Daniilidis K, Tibesku CO (2013) Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop 37(1):45–50PubMedCentralPubMedCrossRef Daniilidis K, Tibesku CO (2013) Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop 37(1):45–50PubMedCentralPubMedCrossRef
25.
Zurück zum Zitat Boonen B, Schotanus MG, Kort NP (2012) Preliminary experience with the patient-specific templating total knee arthroplasty. Acta Orthop 83(4):387–393PubMedCrossRef Boonen B, Schotanus MG, Kort NP (2012) Preliminary experience with the patient-specific templating total knee arthroplasty. Acta Orthop 83(4):387–393PubMedCrossRef
26.
Zurück zum Zitat Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470(1):99–107PubMedCrossRef Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470(1):99–107PubMedCrossRef
27.
Zurück zum Zitat Noble JW Jr, Moore CA, Liu N (2012) The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 27(1):153–155PubMedCrossRef Noble JW Jr, Moore CA, Liu N (2012) The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 27(1):153–155PubMedCrossRef
28.
Zurück zum Zitat Nunley RM, Ellison BS, Ruh EL, Williams BM, Foreman K, Ford AD, Barrack RL (2012) Are patient-specific cutting blocks cost-effective for total knee arthroplasty? Clin Orthop Relat Res 470(3):889–894PubMedCrossRef Nunley RM, Ellison BS, Ruh EL, Williams BM, Foreman K, Ford AD, Barrack RL (2012) Are patient-specific cutting blocks cost-effective for total knee arthroplasty? Clin Orthop Relat Res 470(3):889–894PubMedCrossRef
29.
Zurück zum Zitat Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22(8):1097–1106PubMedCrossRef Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22(8):1097–1106PubMedCrossRef
30.
Zurück zum Zitat Klatt BA, Goyal N, Austin MS, Hozack WJ (2008) Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty 23(1):26–29PubMedCrossRef Klatt BA, Goyal N, Austin MS, Hozack WJ (2008) Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty 23(1):26–29PubMedCrossRef
Metadaten
Titel
Patient-specific instruments in total knee arthroplasty
verfasst von
Fabio Conteduca
Raffaele Iorio
Daniele Mazza
Andrea Ferretti
Publikationsdatum
01.02.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 2/2014
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2230-9

Weitere Artikel der Ausgabe 2/2014

International Orthopaedics 2/2014 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.