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Insufficient evidence to confirm benefits of custom partial knee arthroplasty: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this systematic review was to synthesise the available literature and critically appraise current evidence on the functional and radiographic outcomes as well as reoperation and revision rates of custom partial knee arthroplasty, i.e., unicompartmental knee arthroplasty (UKA), bicompartmental knee arthroplasty (BKA), and patellofemoral arthroplasty (PFA).

Material and methods

This systematic review was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and a protocol was registered with Prospero. On 25 May 2021, two authors independently searched and screened Level I–IV studies that reported on outcomes of custom partial knee arthroplasty using the databases of MEDLINE®, EMBASE®, and the Cochrane Library without restriction on date of publication. Findings from eligible articles were synthesised and tabulated, and quality assessments were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists.

Results

Fifteen articles were eligible for data extraction, of which two comparative and four case series were on custom UKA (follow-up, 0–9 months), one comparative and five case series on custom BKA (follow-up, 0.25–72 months), and three case series on custom PFA (follow-up, 2–119 months). Three studies on custom UKA reported mean Knee Society Score (KSS) Knee of 86–94 and mean KSS Function of 94–95, and two studies on custom BKA reported mean KSS Knee of 90–94 and KSS function of 81, whereas one study on custom PFA reported KSS Knee of 91 and KSS Function of 89. Custom implants tended to have less bone–implant mismatch compared to off the shelf (OTS) implants. Revision rates were 3–25% for custom UKA (at 0–109 months), 3–5% for custom BKA (at 12–72 months), and 0–14% for custom PFA (at 2–119 months).

Conclusion

Due to the small number of comparative studies and lack of consistency in reported outcomes, it remains difficult to ascertain the benefits of custom partial knee arthroplasty. Anecdotal evidence suggests that, compared to OTS implants, custom implants result in less bone–implant mismatch and that 78–91% of patients are either satisfied or very satisfied after custom partial knee arthroplasty.

Level of evidence

IV.

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Acknowledgements

The members of the European Knee Associates (EKA) are: Mo Saffarini: ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland; Markus P. Arnold: Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland; Johannes Beckmann: Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Germany.

Funding

The authors are grateful to “GCS Ramsay Santé pour l’Enseignement et la Recherche” for funding the statistical analysis and manuscript preparation for this study.

Author information

Authors and Affiliations

  1. Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ramsay Santé, 29 Avenue des Sources, 69009, Lyon, France

    Guillaume Demey

  2. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Jacobus H. Müller & Luca Nover

  3. Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrase 35, 6020, Innsbruck, Austria

    Michael Liebensteiner

  4. IMUKA, Roosteren, The Netherlands

    Peter Pilot

  5. CortoClinics, Nederweert, The Netherlands

    Nanne Kort

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  1. Guillaume Demey
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  2. Jacobus H. Müller
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  3. Michael Liebensteiner
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  4. Peter Pilot
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  5. Luca Nover
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Consortia

European Knee Associates (EKA)

  • Mo Saffarini
  • , Markus P. Arnold
  •  & Johannes Beckmann

Contributions

GD study design, data interpretation, manuscript fine-tuning, and funding. JHM study design, literature search, data extraction, and manuscript preparation, ML study design, data interpretation, and manuscript enhancement. PP study design, data interpretation, and manuscript improvement. LN literature search, data extraction, and manuscript preparation. NK study design, data interpretation, and manuscript fine-tuning. MS study design, manuscript enhancement, and project coordination. MPA study design, data interpretation, and manuscript fine-tuning. JB study design, data interpretation, and manuscript fine-tuning.

Corresponding author

Correspondence to Jacobus H. Müller.

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Conflict of interest

JHM, LN, MS, PP, and GD have nothing to disclose. ML reports receiving honoraria from DePuy, and Stryker outside the submitted work. NK reports personal fees from BodyCad, Stryker, Zimmer-Biomet, and Bioventus outside the submitted work. MPA reports being a consultant for ConforMIS and Symbios outside the submitted work. JB reports receiving honoraria from DePuy, Smith + Nephew, and ConforMIS outside the submitted work.

Ethical approval

This was a systematic review and meta-analysis of published results, and therefore, IRB approval was not necessary.

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The members of the European Knee Associates (EKA) are listed in acknowledgements.

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Demey, G., Müller, J.H., Liebensteiner, M. et al. Insufficient evidence to confirm benefits of custom partial knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 30, 3968–3982 (2022). https://doi.org/10.1007/s00167-021-06766-7

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