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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 30.10.2018 | KNEE

Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

verfasst von: Song Gong, Weihua Xu, Ruoyu Wang, Zijian Wang, Bo Wang, Lizhi Han, Guo Chen

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2019

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.

Introduction

According to reports, the rate of component malpositioning can be 20% to 40% using standard instrumentation (SI) [7, 18], and component positioning is an essential factor that affects postoperative functional recovery, patient satisfaction, and especially long-term component survival [14, 46]. In recent years, the introduction of patient-specific instrumentation (PSI) has gradually become popular among orthopaedic surgeons and is expected to improve component alignment and positioning, postoperative functional recovery, and patient satisfaction [8, 35]. The fundamental processes are preoperative computed tomography (CT) and/or magnetic resonance imaging, computer-aided three-dimensional (3D) reconstruction, 3D printing from a disposable template, accurate intraoperative placement and osteotomy. Several meta-analyses have compared the application of PSI to that of SI for total knee arthroplasty (TKA) in recent years, but no comprehensive systematic review and meta-analysis has been published [2, 9, 17, 19, 30, 42, 45, 51‐54, 60]. PSI is hypothesized to have advantages with respect to improving component alignment, shortening the surgical time and length of hospital stay, and decreasing perioperative blood loss.

Materials and methods

A literature search was performed in the PubMed, Embase, and Cochrane Library databases following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The Cochrane Central Register of Controlled Trials was searched using the following terms: total knee arthroplasty, TKA, total knee replacement, TKR, standard instrumentation, conventional instrumentation, patient-specific instrumentation, PSI, patient-matched, customised instrumentation, and custom cutting block. The searches were restricted to the English language. Two independent reviewers (SG and RYW) selected the articles obtained from the PubMed, Embase, and Cochrane Library databases. Disagreements between the reviewers were resolved by consulting a superior (WHX) to reach a consensus.

Inclusion and exclusion criteria

Studies of TKA comparing PSI with SI in terms of at least one of the following: coronal, sagittal and axial component alignment; number of outliers; operative time; perioperative blood loss; and length of hospital stay, were included

Randomized controlled trials (RCTs)

Minimum of 40 patients in both the PSI and the SI TKA groups

Patients older than 18 years

Studies with an Improved Jadad Rating Scale score of less than 3 were excluded

Fracture, deformity, tumour, animal and cadaver studies were excluded

Studies exclusively reporting unicondylar knee component outcomes were excluded

To ensure a high-quality analysis, studies involving RCTs and a strict Improved Jadad Rating Scale score of at least 3 were included. The patients were required to be of legal age (at least 18 years old) to ensure that they had the right to sign the consent form for the surgery. Studies lacking any of the above-mentioned inclusion criteria or involving any of the above-mentioned exclusion criteria were excluded.

Data collection and methodological quality assessment

Two reviewers (SG and ZJW) independently extracted the following data from each study: first author, country of origin, Improved Jadad Rating Scale score, number of patients, mean age, pre-imaging results, gender ratio, body mass index (BMI), PSI system, accuracy of component alignment, number of outliers, surgical time, perioperative blood loss, and length of hospital stay. Several of the initial articles contained some indicators of the means and 95% confidence intervals (CIs), which were converted to the means and standard deviations [63]. The deviation angle from the target alignment is expressed as an absolute value. The methodological quality evaluation included all studies, which were graded using the seven-point Improved Jadad Rating Scale. This widely used scale evaluates the reporting of studies based on four fundamental methodological criteria: the method of randomization, reasonable allocation concealment, adequacy of blinding, and description of withdrawals and dropouts. The quality was classified to as high (score of 4–7) or low (score of 0–3) [36, 37, 63]. The minimum score for inclusion in our study was 3, and all but one of the included studies were evaluated as high-quality. The numbers of patients in the test and control groups were extracted from each article, resulting in a total of 2058 patients. Any disagreements regarding study quality evaluation were resolved by reviewing the study in question and discussing discrepancies.

Statistical analysis

The statistical analysis was performed using Review Manager version 5.3 (The Cochrane Collaboration, Oxford, UK). For each study, we calculated risk ratios (RRs) with 95% CIs for dichotomous data and mean differences with 95% CIs for continuous data. Where appropriate, we pooled the results of comparable groups of trials using a fixed-effect model (via the Mantel–Haenszel test) or a random-effect model (via the DerSimonian–Laird method). A random-effect model was used when significant heterogeneity was detected among studies (p < 0.10; I² > 25%). Otherwise, a fixed-effect model was used.

Results

The initial searches produced 1388 studies, of which 370 were duplicates and 833 were excluded because the title and abstract were irrelevant. The remaining 185 studies were retrieved for evaluation of the materials and methods, and 159 of these articles were excluded because they did not include a comparison with SI or were not RCTs; furthermore, three full-text articles were excluded because they did not report an outcome of interest. The remaining 23 RCTs [1, 4‐6, 10, 13, 15, 16, 20‐23, 25, 38, 39, 43, 48, 55‐58, 61, 64] were included in our meta-analysis. A flow diagram detailing the study selection is shown in Fig. 1. A total of 2058 patients who underwent TKA were included in this study. Details of the study characteristics and participant demographics are shown in Tables 1 and 2. Heterogeneity, 95% CIs, and p values of the research parameters are shown in Table 3.

Table 1

Characteristics of the included studies

References	Country	Improved Jadad Rating Scale	No. of patients		Mean age (years)
References	Country	Improved Jadad Rating Scale	PSI	SI	PSI	SI
Abane et al. [1]	France	5	70	70	67.8 (47–84)	70.4 (54–83)
Boonen et al. [4]	Netherlands	7	90	90	69.0 ± 8.0	65.0 ± 8.8
Boonen et al. [5]	Netherlands	7	90	90	69.0 ± 8.0	65.0 ± 8.8
Chareancholvanich et al. [6]	Thailand	5	40	40	69.5 (55–84)	70.3 (53–85)
De et al. [10]	Belgium	5	20	24	NR	NR
Gan et al. [13]	China	4	35	35	68.5 ± 4.8	67.8 ± 3.4
Hamilton et al. [15]	USA	4	26	26	68.1 (52–86)	68.1 (52–86)
Huijbregts et al. [16]	Australia	5	69	64	66.7 ± 9.1	69.0 ± 9.6
Khuangsirikul et al. [20]	Thailand	3	40	40	NR	NR
Kotela and Kotela [21]	Poland	5	49	46	66.1 ± 8.4	68.6 ± 9.9
Kotela et al. [22]	Poland	5	49	46	66.1 ± 8.4	68.6 ± 9.9
Kosse et al. [23]	Netherlands	5	21	21	62.7 ± 4.5	63.4 ± 4.2
Maus et al. [25]	Germany	5	59	66	68.1 ± 8.5	71.5 ± 8.1
Parratte et al. [38]	France	4	20	20	NR	NR
Pietsch et al. [39]	Australia	7	40	40	71.4 ± 6.6	69.2 ± 9.4
Roh et al. [43]	Korea	7	42	48	70 ± 7.2	70 ± 5.1
Silva et al. [48]	Portugal	4	23	22	73 (67–78)	74 (70.5–80)
Vundelinckx et al. [55]	Belgium	5	31	31	64.65 ± 8.23	68.19 ± 8.48
Victor et al. [56]	Belgium	5	64	64	67 (52–87)	66 (36–92)
Vide et al. [57]	Portugal	5	47	48	67.8 ± 8.4	69.3 ± 6.5
Van et al. [58]	Norway	5	44	50	67 ± 8.8	64 ± 6.9
Woolson et al. [61]	USA	5	22	26	NR	NR
Yan et al. [64]	China	5	30	30	67.5 ± 8.0	69.5 ± 8.4

PSI patient-specific instrumentation, SI standard instrumentation, NR not reported

Table 2

Characteristics of the included studies

Study	Pre-imaging	Gender (F/M)		BMI		PSI system
Study	Pre-imaging	PSI	SI	PSI	SI	PSI system
Abane et al. [1]	MRI	27/43	40/30	28.8 (20–40)	28.6 (20–40)	Smith & Nephew, Memphis, TN, USA
Boonen et al. [4]	MRI	56/34	50/40	30.3	29.5	Biomet, Inc., Warsaw, IN, USA
Boonen et al. [5]	MRI	56/34	50/40	30.3 (22.9–40.7)	29.5 (21.3–42.7)	Vanguard Complete Knee System
Chareancholvanich et al. [6]	MRI	34/6	36/4	27.7 (20.2–44.15)	28.0 (22–39.6)	Zimmer, Warsaw, IN, USA
De et al. [10]	MRI	NR	NR	NR	NR	Biomet, Inc., Warsaw, IN, USA
Gan et al. [13]	CT	25/10	26/9	NR	NR	Stryker, Mahwah, NJ, USA
Hamilton et al. [15]	CT	12/14	19/7	30.9 (21.5–39.6)	31.1 (22–38.4)	TruMatch, DePuy Orthopaedics, Warsaw, IN, USA
Huijbregts et al. [16]	MRI	40/29	32/32	NR	NR	Smith & Nephew
Khuangsirikul et al. [20]	CT	NR	NR	NR	NR	DePuy, Warsaw, IN, USA
Kotela and Kotela [21]	CT	33/16	33/13	30.0 ± 4.6	29.6 ± 5.6	Biomet, Inc., Warsaw, IN, USA
Kotela et al. [22]	CT	33/16	33/13	30.0 ± 4.6	29.6 ± 5.6	Biomet, Inc., Warsaw, IN, USA
Kosse et al. [23]	MRI	13/8	9/12	28.1 ± 3.3	27.8 ± 3.1	Smith & Nephew, Memphis, TN, USA
Maus et al. [25]	MRI	33/26	43/23	31.8 ± 6.1	30.6 ± 5.3	Aesculap AG, Tuttlingen
Parratte et al. [38]	MRI	NR	NR	NR	NR	Zimmer, Warsaw, IN, USA
Pietsch et al. [39]	MRI	27/13	21/19	29.0 ± 3.5	30.8 ± 4.9	Genera, Zimmer, Warsaw, IN, USA
Roh et al. [43]	CT	39/3	43/5	27 ± 4.2	27 ± 2.7	Biomet, Inc., Warsaw, IN, USA
Silva et al. [48]	MRI	NR	NR	NR	NR	Vanguard, Biomet, Inc
Vundelinckx et al. [55]	MRI	16/15	20/11	27.61 ± 3.82	31.11 ± 5.25	Smith & Nephew
Victor et al. [56]	MRI	43/21	43/21	NR	NR	Biomet, Inc., Warsaw, IN, USA; DePuy, Inc., Warsaw, IN, USA; Smith & Nephew, Inc., Memphis, TN, USA; Zimmer, Inc., Warsaw, IN, USA
Vide et al. [57]	MRI	32/15	33/15	31.0	30.3	Smith & Nephew, Inc., Memphis, TN, USA
Van et al. [58]	MRI	30/14	32/18	31 ± 4.9	29 ± 4.6	Biomet, Inc., Warsaw, IN, USA
Woolson et al. [61]	CT	NR	NR	NR	NR	NR
Yan et al. [64]	MRI	17/13	24/6	NR	NR	Zimmer, Warsaw, IN, USA

PSI patient-specific instrumentation, SI standard instrumentation, NR not reported

Table 3

Heterogeneities, 95% CIs, and p values of research parameters

Research parameters	Heterogeneity (I²) (%)	95% CI	p value
Mechanical axis of the limb	68	− 0.41 to 0.23	n.s.
Outliers of the mechanical axis of the limb	41	0.72 to 1.24	n.s.
Femoral coronal alignment	79	− 0.41 to 0.17	n.s.
Outliers of the femoral coronal alignment	37	0.57 to 1.30	n.s.
Tibial coronal alignment	62	− 0.12 to 0.30	n.s.
Outliers of the tibial coronal alignment	46	0.75 to 2.49	n.s.
Femoral sagittal alignment	83	− 1.40 to 0.41	n.s.
Outliers of the femoral sagittal alignment	46	0.84 to 1.35	n.s.
Tibial sagittal alignment	50	− 0.81 to 0.04	n.s.
Outliers of the tibial sagittal alignment	57	0.92 to 1.86	n.s.
Femoral axial alignment	48	− 0.71 to − 0.21	0.0004
Outliers of the femoral axial alignment	32	0.45 to 1.29	n.s.
Operative time	78	− 10.95 to − 3.75	< 0.0001
Perioperative blood loss	74	− 146.65 to − 20.18	0.01
Length of hospital stay	19	− 0.40 to 0.07	n.s.

n.s. non-significant

Fifteen studies [1, 4, 6, 13, 16, 21, 23, 25, 38, 43, 56‐58, 61, 64] reported the postoperative mechanical axis of the limb (expressed as the hip–knee–ankle angle, HKA) as the mean and standard deviation (Fig. 2). Fourteen studies [1, 4, 6, 13, 15, 16, 21, 38, 43, 56‐58, 61, 64] involving 1391 patients and reporting postoperative outliers of the mechanical axis of the limb were included. The PSI group contained 147 outliers among 628 patients, whereas 160 outliers were recorded among the 645 patients in the SI group (23.4% vs. 24.8%).

Thirteen studies [1, 4, 6, 9, 16, 21, 25, 38, 43, 56, 58, 61, 64] reported the postoperative femoral coronal alignment as the mean and standard deviation (Fig. 3). The target alignment was 90°. Twelve studies [1, 4, 6, 13, 14, 16, 21, 43, 56, 58, 61, 64] involving 1137 patients and reporting postoperative outliers of the femoral coronal alignment were included. The PSI group contained 69 outliers among 562 patients, whereas 86 outliers were recorded among the 575 patients in the SI group (12.3% vs. 15.0%).

Fourteen studies [1, 4, 6, 9, 16, 21, 23, 25, 38, 43, 56, 58, 61, 64] reported the postoperative tibial coronal alignment as the mean and standard deviation (Fig. 4). Twelve studies [1, 4, 6, 13, 15, 16, 21, 43, 56, 58, 61, 64] involving 1137 patients and reporting postoperative outliers of the tibial coronal alignment were included. The PSI group contained 64 outliers among 562 patients, whereas 47 outliers were recorded among the 575 patients in the SI group (11.4% vs. 8.2%).

Eight studies [4, 16, 21, 23, 43, 56, 58, 64] reported the postoperative femoral sagittal alignment as the mean and standard deviation (Fig. 5). The target alignment was defined differently in the literature. The absolute deviation between the actual measured value and the target alignment was recorded. Nine studies [1, 4, 15, 16, 21, 43, 56, 58, 64] involving 941 patients that reported postoperative outliers of the femoral sagittal alignment were included. The PSI group contained 179 outliers among 466 patients, whereas 175 outliers were recorded among the 475 patients in the SI group (38.4% vs. 36.8%).

Eight studies [4, 16, 21, 23, 43, 56, 58, 64] reported the postoperative tibial sagittal alignment as the mean and standard deviation (Fig. 6). The target alignment was defined differently in the literature. The absolute deviation between the actual measured value and the target alignment was recorded. Ten studies [1, 4, 15, 16, 21, 43, 56, 58, 61, 64] involving 989 patients and reporting the postoperative outliers of the tibial sagittal alignment were included. The PSI group included 143 outliers among 488 patients, whereas 112 outliers were recorded among the 501 patients in the SI group (29.3% vs. 22.4%).

Nine studies [4, 9, 16, 20, 43, 48, 56, 58, 61] reported the postoperative femoral axial alignment as the mean and standard deviation (Fig. 7). The target alignment was parallel to the transcondylar line. Six studies [16, 20, 44, 56, 58, 61] involving 566 patients and reporting postoperative outliers of the femoral axial alignment were included. The PSI group contained 34 outliers among 277patients, whereas 53 outliers were recorded among the 289 patients in the SI group (12.3% vs. 18.3%).

Nine studies [4, 6, 13, 16, 25, 39, 57, 61, 64] reported the operative time as the mean and standard deviation (Fig. 8). Five studies [6, 13, 22, 25, 39] reported the perioperative blood loss as the mean and standard deviation (Fig. 9). Seven studies [4, 6, 22, 25, 55, 57, 61] reported the length of hospital stay as the mean and standard deviation (Fig. 10).

Discussion

The most important findings of the present study were that PSI resulted in approximately 0.4° less deviation from the transcondylar line, reduced perioperative blood loss by 90 ml and reduced the operative time by an average of 7 min compared to SI. No significant differences between PSI and SI were found with respect to alignment of the remaining components, number of outliers, and length of hospital stay.

The effectiveness of PSI compared to that of SI is not completely clear, and the existing data are conflicting. The present study produced results that are consistent with some published studies showing that PSI and SI exhibited no significant difference in mechanical alignment [12, 17, 26, 27, 31, 40, 41, 49, 65]. However, other published studies reached a conclusion opposite to that of the present investigation [3, 44, 59]. Postoperative mechanical alignment is critical to the long-term survival of the prosthesis. Therefore, more well-designed, high-quality, long-term RCTs are needed monitor the survival of the prosthesis. A few studies showed a significant reduction in outliers of the mechanical alignment for PSI compared to SI [3, 11, 28, 33, 44]. However, in the present study, no evident difference in outliers of mechanical alignment was found between PSI and SI. The existing studies showed no significant difference in the coronal and sagittal alignment of the femoral component [12, 17, 26, 40, 65]. Several studies showed no significant difference in the coronal and sagittal alignment of the tibial component [17, 26, 40]. In fact, the mechanical alignment was ultimately determined by the coronal alignment of the femoral and tibial components. Therefore, it was reasonable that we concluded that PSI and SI produced no evident difference in the mechanical alignment. PSI and SI had no evident difference in outliers of the coronal and sagittal alignment of the femoral and tibial component. Two published papers showed the same outcome [26, 65].

PSI showed approximately 0.4° less deviation from the transcondylar line than SI. Theoretically, the femoral axial alignment should be parallel to the transcondylar line. The clinical relevance of a 0.4° deviation is questionable despite the statistically significant difference. In the future, additional clinically relevant studies of femoral axial alignment should be conducted.

PSI reduced the operative time by an average of 7 min compared to SI. Several published studies supported our opinions [29, 32, 44, 50] due to simplification of the operative procedures. However, the clinical relevance of a 7-min reduction is questionable, despite the statistically significant difference. Additional studies should be conducted regarding the clinical relevance of a reduction in operative time in the future. PSI could reduce the perioperative blood loss by approximately 90 ml compared to SI because PSI avoids invasion of the femoral medullary cavity and shortens the operative time. Published studies have reported analogous outcomes [24, 34, 47].

There are some limitations to this study. First, the data showed large heterogeneity among the included studies, which may have affected the analysis of the results. Second, some of the data conversions in the articles may have affected the analysis of the results.

Conclusion

PSI has advantages for axial alignment of the femoral component, operative time, and perioperative blood loss compared to SI. However, no significant differences were observed between PSI and SI with respect to the alignment of the remaining components, number of outliers, and length of hospital stay. High-quality, long-term RCTs are needed to determine whether PSI is superior to SI in other respects.

Compliance with ethical standards

Conflict of interest

No benefits or funds were received in support of this study.

Ethical approval

There were no ethical approval, because this study was a meta-analysis based on the data of previously published studies.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Abane L, Anract P, Boisgard S, Descamps S, Courpied JP, Hamadouche M (2015) A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: a multicentre randomized controlled trial. Bone Jt J 97-B:56–63CrossRef

Alcelik I, Blomfield M, Öztürk C, Soni A, Charity R, Acornley A (2017) A comparison of short term radiological alignment outcomes of the patient specific and standard instrumentation for primary total knee arthroplasty: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 51(3):215–222CrossRefPubMedPubMedCentral

Anderl W, Pauzenberger L, Kölblinger R, Kiesselbach G, Brandl G, Laky B, Kriegleder B, Heuberer P, Schwameis E (2016) Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 24:102–111. 183CrossRefPubMed

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, randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 21:2206–2212CrossRefPubMed

Boonen B, Schotanus MG, Kerens B, Van der Weegen W, Hoekstra HJ, Kort NP (2016) No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively: a multicentre, double-blind, randomised controlled trial. Bone Jt J 98-B:939–944. 191CrossRef

Chareancholvanich K, Narkbunnam R, Pornrattanamaneewong C (2013) A prospective randomized controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement. Bone Jt J 95-B:354–359CrossRef

Cheng T, Zhao S, Peng X, Zhang X (2012) Does computer-assisted surgery improve postoperative leg alignment and implant positioning following total knee arthroplasty? A meta-analysis of randomized controlled trials? Knee Surg Sports Traumatol Arthrosc 20:1307–1322CrossRefPubMed

Camarda L, D’Arienzo A, Morello S, Peri G, Valentino B, D’Arienzo M (2015) Patient-specific instrumentation for total knee arthroplasty: a literature review. Musculoskelet Surg 99:11–18CrossRefPubMed

Cavaignac E, Pailhé R, Laumond G, Murgier J, Reina N, Laffosse JM (2015) Evaluation of the accuracy of patient—specific cutting blocks for total knee arthroplasty: a meta-analysis. Int Orthop 39(8):1541–1552CrossRefPubMed

10.

De RV, Pellikaan P, Dhollander A, Vander JS (2017) Three-dimensional analysis of accuracy of component positioning in total knee arthroplasty with patient specific and conventional instruments: a randomized controlled trial. Knee 24:1469–1477CrossRef

11.

Daniilidis K, Tibesku CO (2014) A comparison of conventional and patient-specific instruments in total knee arthroplasty. Int Orthop 38:503–508CrossRefPubMed

12.

Fu H, Wang J, Zhou S, Cheng T, Zhang W, Wang Q (2015) No difference in mechanical alignment and femoral component placement between patient-specific instrumentation and conventional instrumentation in TKA. Knee Surg Sports Traumatol Arthrosc 23:3288–3295CrossRefPubMed

13.

Gan Y, Ding J, Xu Y, Hou C (2015) Accuracy and efficacy of osteotomy in total knee arthroplasty with patient-specific navigational template. Int J Clin Exp Med 8:12192–12201PubMedPubMedCentral

14.

Gill GS, Joshi AB (2001) Long-term results of cemented, posterior cruciate ligament-retaining total knee arthroplasty in osteoarthritis. Am J Knee Surg 14:209–214PubMed

15.

Hamilton WG, Parks NL, Saxena A (2013) Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty 28(8 Suppl):96–100CrossRefPubMed

16.

Huijbregts HJ, Khan RJ, Fick DP, Hall MJ, Punwar SA, Sorensen E (2016) Component alignment and clinical outcome following total knee arthroplasty: a randomised controlled trial comparing an intramedullary alignment system with patient-specific instrumentation. Bone Jt J 98-B:1043–1049CrossRef

17.

Huijbregts HJTAM, Khan RJK, Sorensen E, Fick DP, Haebich S (2016) Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty. Acta Orthop 87(4):386–394CrossRefPubMedPubMedCentral

18.

Iorio R, Bolle G, Conteduca F, Valeo L, Conteduca J, Mazza D (2013) Accuracy of manual instrumentation of tibial cutting guide in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 21:2296–2300CrossRefPubMed

19.

Jiang J, Kang X, Lin Q, Teng Y, An L, Ma J (2015) Accuracy of patient-specific instrumentation compared with conventional instrumentation in total knee arthroplasty. Orthopedics 38(4):e305CrossRefPubMed

20.

Khuangsirikul S, Lertcharoenchoke T, Chotanaphuti T (2014) Rotational alignment of femoral component between custom cutting block and conventional technique in total knee arthroplasty. J Med Assoc Thai 97(Suppl 2):S47–S51PubMed

21.

Kotela A, Kotela I (2014) Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled study. Int Orthop 38:2099–2107CrossRefPubMed

22.

Kotela A, Lorkowski J, Kucharzewski M, Wilkfrańczuk M, Śliwiński Z, Frańczuk B (2015) Patient-specific ct-based instrumentation versus conventional instrumentation in total knee arthroplasty: a prospective randomized controlled study on clinical outcomes and in-hospital data. Biomed Res Int 2015:165908CrossRefPubMedPubMedCentral

23.

Kosse NM, Heesterbeek PJC, Schimmel JJP, Hellemondt GGV, Wymenga AB, Defoort KC (2018) Stability and alignment do not improve by using patient-specific instrumentation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 26(6):1–8CrossRef

24.

León VJ, Lengua MA, Calvo V, Lisón AJ (2017) Use of patient-specific cutting blocks reduces blood loss after total knee arthroplasty. Eur J Orthop Surg Traumatol 27:273–277CrossRefPubMed

25.

Maus U, Marques CJ, Scheunemann D, Lampe F, Lazovic D, Hommel H (2017) No improvement in reducing outliers in coronal axis alignment with patient-specific instrumentation. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-017-4741-1 CrossRefPubMed

26.

Marimuthu K, Chen DB, Harris IA, Wheatley E, Bryant CJ, Macdessi SJ (2014) A multi-planar ct-based comparative analysis of patient-specific cutting guides with conventional instrumentation in total knee arthroplasty. J Arthroplasty 29:1138–1142CrossRefPubMed

27.

Moubarak H, Brilhault J (2014) Contribution of patient-specific cutting guides to lower limb alignment for total knee arthroplasty. Orthop Traumatol Surg Res 100(4 Suppl):S239–S242CrossRefPubMed

28.

Molicnik A, Naranda J, Dolinar D (2015) Patient-matched instruments versus standard instrumentation in total knee arthroplasty: a prospective randomized study. Wien Klin Wochenschr 127(Suppl 5):S235–S240CrossRefPubMed

29.

MacDessi SJ, Jang B, Harris IA, Wheatley E, Bryant C, Chen DB (2014) A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty. Knee 21:406–409CrossRefPubMed

30.

Mannan A, Smith TO, Sagar C, London NJ, Molitor PJ (2015) No demonstrable benefit for coronal alignment outcomes in psi knee arthroplasty: a systematic review and meta-analysis. Orthop Traumatol Surg Res 101(4):461–468CrossRefPubMed

31.

Nam D, Park A, Stambough JB, Johnson SR, Nunley RM, Barrack RL (2016) The mark coventry award: custom cutting guides do not improve total knee arthroplasty clinical outcomes at 2 years followup. Clin Orthop Relat Res 474:40–46CrossRefPubMed

32.

Nunley RM, Ellison BS, Ruh EL, Williams BM, Foreman K, Ford AD (2012) Are patient-specific cutting blocks cost-effective for total knee arthroplasty? Clin Orthop Relat Res 470:889–894CrossRefPubMed

33.

Ng VY, Declaire JH, Berend KR, Gulick BC Jr, Lombardi A (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470:99–107CrossRefPubMed

34.

Nabavi A. Olwill CM (2015) Early outcome after total knee replacement using computed tomography-based patient specific cutting blocks versus standard instrumentation. J Orthop Surg 23:182–184CrossRef

35.

Nam D, Mcarthur BA, Cross MB, Pearle AD, Mayman DJ, Haas SB (2012) Patient-specific instrumentation in total knee arthroplasty: a review. J Knee Surg 25:213–219CrossRefPubMed

36.

Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y (2001) Interrater reliability of the modified jadad quality scale for systematic reviews of alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 12(3):232–236CrossRefPubMed

37.

Olivo SA, Macedo LG, Gadotti IC, Fuentes J, Stanton T, Magee DJ (2008) Scales to assess the quality of randomized controlled trials: a systematic review. Phys Ther 88(2):156–175CrossRefPubMed

38.

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 21:2213–2219CrossRefPubMed

39.

Pietsch M, Djahani O, Zweiger C, Plattner F, Radl R, Tschauner C, Hofmann S (2013) Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes. Knee Surg Sports Traumatol Arthrosc 21:2234–2240CrossRefPubMed

40.

Pourgiezis N, Reddy SP, Nankivell M, Morrison G, VanEssen J (2016) Alignment and component position after patient-matched instrumentation versus conventional total knee arthroplasty. J Orthop Surg 24:170–174CrossRef

41.

Predescu V, Prescura C, Olaru R, Savin L, Botez P, Deleanu B (2017) Patient specific instrumentation versus conventional knee arthroplasty: comparative study. Int Orthop 41:1361–1367CrossRefPubMed

42.

Qing-Meng Z, Ji-Ying C, Heng L, Wei C, Ming N, Zhen-Dong Z (2015) No evidence of superiority in reducing outliers of component alignment for patient-specific instrumentation for total knee arthroplasty: a systematic review. Orthop Surg 7(1):19–25CrossRef

43.

Roh YW, Kim TW, Lee S, Seong SC, Lee MC (2013) Is TKA using patient-specific instruments comparable to conventional TKA? A randomized controlled study of one system. Clin Orthop Relat Res 471:3988–3995CrossRefPubMedPubMedCentral

44.

Renson L, Poilvache P, Wyngaert HVD (2014) Improved alignment and operating room efficiency with patient-specific instrumentation for TKA. Knee 21:1216–1220CrossRefPubMed

45.

Russell R, Brown T, Huo M, Jones R (2014) Patient-specific instrumentation does not improve alignment in total knee arthroplasty. J Knee Surg 27(06):501–504CrossRefPubMed

46.

Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB (1994) Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res 309:136–145

47.

Schwarzkopf R, Brodsky M, Garcia GA, Gomoll AH (2015) Surgical and functional outcomes in patients undergoing total knee replacement with patient-specific implants compared with “off-the-shelf” implants. Orthop J Sports Med. https://doi.org/10.1177/2325967115590379 CrossRefPubMedPubMedCentral

48.

Silva A, Sampaio R, Pinto E (2014) Patient-specific instrumentation improves tibial component rotation in TKA. Knee Surg Sports Traumatol Arthrosc 22:636–642CrossRefPubMed

49.

Stronach BM, Pelt CE, Erickson JA, Peters CL (2014) Patient-specific instrumentation in total knee arthroplasty provides no improvement in component alignment. J Arthroplasty 29:1705–1708CrossRefPubMed

50.

Steinhaus ME, McLawhorn AS, Richardson SS, Maher P, Mayman DJ (2016) Handheld navigation device and patient-specific cutting guides result in similar coronal alignment for primary total knee arthroplasty: a retrospective matched cohort study. HSS J 12:224–234CrossRefPubMedPubMedCentral

51.

Sharareh B, Schwarzkopf R (2015) Review article: patient-specific versus standard instrumentation for total knee arthroplasty. J Orthop Surg 23(1):100CrossRef

52.

Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX (2015) Patient-specific instrumentation does not improve accuracy in total knee arthroplasty. Orthopedics 38(3):178–188CrossRef

53.

Thienpont E, Schwab PE, Fennema P (2017) Efficacy of patient-specific instruments in total knee arthroplasty: a systematic review and meta-analysis. J Bone Jt Surg Am 99(6):521CrossRef

54.

Thienpont E, Schwab PE, Fennema P (2014) A systematic review and meta-analysis of patient-specific instrumentation for improving alignment of the components in total knee replacement. Bone Jt J 410(6825):1052–1061CrossRef

55.

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 28:964–970CrossRefPubMed

56.

Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J (2014) Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res 472:263–271CrossRefPubMed

57.

Vide J, Freitas TP, Ramos A, Cruz H, Sousa JP (2017) Patient-specific instrumentation in total knee arthroplasty: simpler, faster and more accurate than standard instrumentation—a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 25:2616–2621CrossRefPubMed

58.

Van JL, Snorrason F, Röhrl SM (2018) No radiological and clinical advantages with patient-specific positioning guides in total knee replacement. Acta Orthop 89:89–94CrossRef

59.

Vaishya R, Vijay V, Birla VP, Agarwal AK (2016) Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty. World J Orthop 7:426–433CrossRefPubMedPubMedCentral

60.

Voleti PB, Hamula MJ, Baldwin KD, Lee GC (2014) Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty. J Arthroplasty 29(9):1709–1712CrossRefPubMed

61.

Woolson ST, Harris AH, Wagner DW, Giori NJ (2014) Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Jt Surg Am 96:366–372CrossRef

62.

Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14(1):135CrossRefPubMedPubMedCentral

63.

Wu PL, Lee M, Huang TT (2017) Effectiveness of physical activity on patients with depression and parkinson’s disease: a systematic review. PLoS One 12(7):e0181515CrossRefPubMedPubMedCentral

64.

Yan CH, Chiu KY, Ng FY, Chan PK, Fang CX (2015) Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 23:3637–3645CrossRefPubMed

65.

Zhang QM1, Chen JY, Li H, Chai W, Ni M, Zhang ZD, Yang F (2015) No evidence of superiority in reducing outliers of component alignment for patient-specific instrumentation for total knee arthroplasty: a systematic review. Orthop Surg 7:19–25CrossRefPubMed

Titel: Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty
verfasst von: Song Gong
Weihua Xu
Ruoyu Wang
Zijian Wang
Bo Wang
Lizhi Han
Guo Chen
Publikationsdatum: 30.10.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5256-0

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