Clinical Orthopaedics and Related Research®

, Volume 471, Issue 1, pp 169–174

Patient-specific Total Knee Arthroplasty Required Frequent Surgeon-directed Changes

  • Benjamin M. Stronach
  • Christopher E. Pelt
  • Jill Erickson
  • Christopher L. Peters
Symposium: Papers Presented at the Annual Meetings of the Knee Society

DOI: 10.1007/s11999-012-2573-3

Cite this article as:
Stronach, B.M., Pelt, C.E., Erickson, J. et al. Clin Orthop Relat Res (2013) 471: 169. doi:10.1007/s11999-012-2573-3

Abstract

Background

Patient-specific instrumentation potentially improves surgical precision and decreases operative time in total knee arthroplasty (TKA) but there is little supporting data to confirm this presumption.

Questions/purposes

We asked whether patient-specific instrumentation would require infrequent intraoperative changes to replicate a single surgeon’s preferences during TKA and whether patient-specific instrumentation guides would fit securely.

Methods

We prospectively evaluated the plan and surgery in 60 patients treated with 66 TKAs performed with patient-specific instrumentation and recorded any changes. A subset of six postoperative radiographic changes to the femoral and tibial components (implant size, coronal and sagittal alignment) was analyzed to determine if surgeon intervention was beneficial. Each guide was evaluated to determine fit. We compared patient demographics and implant sizing in the patient-specific instrumentation group with a control group in which traditional instrumentation was used.

Results

We recorded 161 intraoperative changes in 66 knee arthroplasties (2.4 changes/knee) performed with patient-specific instrumentation. The predetermined implant size was changed intraoperatively in 77% of femurs and 53% of tibias. We identified a subset of 95 intraoperative changes that could be radiographically evaluated to determine if our changes were an improvement or detriment to reaching goal alignment. Eighty-two of the 95 changes (86%) made by the surgeon were an improvement to the recommended alignment or size of patient-specific instrumentation. The guide did not fit securely on eight femurs (12%) and three tibias (5%). Tourniquet time and blood loss were not improved with patient-specific instrumentation.

Conclusions

We caution surgeons against blind acceptance of patient-specific instrumentation technology without supportive data.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Benjamin M. Stronach
    • 1
  • Christopher E. Pelt
    • 2
  • Jill Erickson
    • 2
  • Christopher L. Peters
    • 2
  1. 1.Department of Orthopaedic SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.University of Utah, University Orthopaedic CenterSalt Lake CityUSA

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