Design improvement in patient-specific instrumentation for total knee arthroplasty improved the accuracy of the tibial prosthetic alignment in the coronal and axial planes

  • Kazumasa Yamamura
  • Yukihide MinodaEmail author
  • Ryo Sugama
  • Yoichi Ohta
  • Suguru Nakamura
  • Hideki Ueyama
  • Hiroaki Nakamura



The accuracy of patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) is still controversial, especially in the tibial prosthesis. It was hypothesized that the design modification of PSI improved the tibial prosthetic alignment and reduced the associated complications. The aim of this study was to compare the accuracy of a conventional PSI with that of a newly designed PSI for total knee arthroplasty (TKA) using a new three-dimensional (3D) measurement method.


Thirty TKAs each using the conventional and newly designed PSIs were studied. The postoperative 3D-computed tomography (3D CT) image was superimposed on the preoperative 3D CT plan. The absolute differences in the tibial prosthetic alignment between the preoperative and postoperative 3D CT images were directly measured in the coronal, sagittal, and axial planes. Knees in which the difference in the prosthetic alignment was > 3° were considered deviations.


The new PSI showed less mean absolute differences and lower rate of deviations than the conventional PSI in the coronal and axial planes (p = 0.045 and p = 0.004, respectively). The deviations (> 3°) of the tibial prosthesis using the conventional PSI were 27, 30, and 63% and of those using the new PSI were 0, 20, and 20% in the coronal, sagittal, and axial planes, respectively.


This is the first report to evaluate the effect of improvement in PSI design on the postoperative alignment using 3D method, and it clearly showed that the modification significantly improved the accuracy of alignment and reduced the deviations.

Level of evidence

Therapeutic study, case–control study, Level III.


Total knee arthroplasty Patient-specific instrumentation Three-dimensional evaluation Prosthetic alignment 


Compliance with ethical standards

Conflict of interest

Author YM has received research Grants and speaker honorarium from MicroPort.

Ethical approval

This study was approved by the institutional review board of Osaka City University Graduate School of Medicine and Faculty of Medicine (ID number 1992).

Informed consent

All patients provided informed consent.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Kazumasa Yamamura
    • 1
  • Yukihide Minoda
    • 1
    Email author
  • Ryo Sugama
    • 1
  • Yoichi Ohta
    • 1
  • Suguru Nakamura
    • 1
  • Hideki Ueyama
    • 1
  • Hiroaki Nakamura
    • 1
  1. 1.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsakaJapan

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