Clinical Orthopaedics and Related Research®

, Volume 471, Issue 12, pp 3988–3995 | Cite as

Is TKA Using Patient-specific Instruments Comparable to Conventional TKA? A Randomized Controlled Study of One System

  • Yoon Whan Roh
  • Tae Woo Kim
  • Sahnghoon Lee
  • Sang Cheol Seong
  • Myung Chul Lee
Clinical Research

Abstract

Background

Patient-specific CT-based instrumentation may reduce implant malpositioning and improve alignment in TKA. However, it is not known whether this innovation is an advance that benefits patients.

Questions/purposes

We evaluated (1) the precision of patient-specific TKA by comparing the incidence of outliers in postoperative alignment between TKAs using patient-specific instruments and TKAs using conventional instruments, and (2) the reliability of patient-specific instruments by intraoperatively investigating whether the surgery could be completed with patient-specific instruments alone.

Methods

In this randomized controlled trial, we compared patient-specific TKA instruments from one manufacturer (n = 50) with conventional TKA instruments (n = 50). Postoperative hip-knee-ankle angles, femoral component rotation, and coronal and sagittal alignments of each component were measured. The validity of the patient-specific instrument was examined using cross-checking procedures with conventional instruments during the surgeries. When the procedure could not be completed accurately with patient-specific instruments, the procedure was converted to TKA using conventional instruments, and the frequency of this occurrence was tallied.

Results

Outliers in the hip-knee-ankle angle were comparable between groups (12% in the patient-specific instrument group and 10% in the conventional instrument group). Other parameters such as sagittal alignment and femoral component rotation did not differ in terms of outliers. Patient-specific guides were abandoned in eight knees (16%) during the surgery because of malrotation of the femoral components and decreased slope of the tibia.

Conclusions

Accuracy was comparable between TKAs done with patient-specific instruments and those done with conventional instruments. However, the patient-specific instrument procedures had to be aborted frequently, incurring expenses that did not benefit patients.

Level of Evidence

Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

References

  1. 1.
    Bathis H, Perlick L, Tingart M, Luring C, Grifka J. CT-free computer-assisted total knee arthroplasty versus the conventional technique: radiographic results of 100 cases. Orthopedics. 2004;27:476–480.PubMedGoogle Scholar
  2. 2.
    Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty: a comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br. 2004;86:682–687.PubMedCrossRefGoogle Scholar
  3. 3.
    Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D. Navigated total knee replacement: a meta-analysis. J Bone Joint Surg Am. 2007;89:261–269.PubMedCrossRefGoogle Scholar
  4. 4.
    Blakeney WG, Khan RJ, Wall SJ. Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011;93:1377–1384.PubMedCrossRefGoogle Scholar
  5. 5.
    Bonutti P, Dethmers D, Stiehl JB. Case report: femoral shaft fracture resulting from femoral tracker placement in navigated TKA. Clin Orthop Relat Res. 2008;466:1499–1502.PubMedCrossRefGoogle Scholar
  6. 6.
    Chareancholvanich K, Narkbunnam R, Pornrattanamaneewong C. A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement. Bone Joint J. 2013;95:354–359.PubMedCrossRefGoogle Scholar
  7. 7.
    Delp SL, Stulberg SD, Davies B, Picard F, Leitner F. Computer assisted knee replacement. Clin Orthop Relat Res. 1998;354:49–56.PubMedCrossRefGoogle Scholar
  8. 8.
    Dennis DA, Komistek RD, Kim RH, Sharma A. Gap balancing versus measured resection technique for total knee arthroplasty. Clin Orthop Relat Res. 2010;468:102–107.PubMedCrossRefGoogle Scholar
  9. 9.
    Dossett HG, Swartz GJ, Estrada NA, LeFevre GW, Kwasman BG. Kinematically versus mechanically aligned total knee arthroplasty. Orthopedics. 2012;35:e160–169.PubMedGoogle Scholar
  10. 10.
    Fehring TK. Rotational malalignment of the femoral component in total knee arthroplasty. Clin Orthop Relat Res. 2000;380:72–79.PubMedCrossRefGoogle Scholar
  11. 11.
    Hafez MA, Chelule KL, Seedhom BB, Sherman KP. Computer-assisted total knee arthroplasty using patient-specific templating. Clin Orthop Relat Res. 2006;444:184–192.PubMedCrossRefGoogle Scholar
  12. 12.
    Howell SM, Howell SJ, Kuznik KT, Cohen J, Hull ML. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res. 2013;471:1000–1007.PubMedCrossRefGoogle Scholar
  13. 13.
    Howell SM, Kuznik K, Hull ML, Siston RA. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics. 2008;31:857–863.PubMedCrossRefGoogle Scholar
  14. 14.
    Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73:709–714.PubMedGoogle Scholar
  15. 15.
    Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ. Blood loss after total knee replacement: effects of computer-assisted surgery. J Bone Joint Surg Br. 2005;87:1480–1482.PubMedGoogle Scholar
  16. 16.
    Klatt BA, Goyal N, Austin MS, Hozack WJ. Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty. 2008;23:26–29.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee DH, Park JH, Song DI, Padhy D, Jeong WK, Han SB. Accuracy of soft tissue balancing in TKA: comparison between navigation-assisted gap balancing and conventional measured resection. Knee Surg Sports Traumatol Arthrosc. 2010;18:381–387.PubMedCrossRefGoogle Scholar
  18. 18.
    Lombardi AV Jr, Berend KR, Adams JB. Patient-specific approach in total knee arthroplasty. Orthopedics. 2008;31:927–930.PubMedCrossRefGoogle Scholar
  19. 19.
    Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. 2007;22:1097–1106.PubMedCrossRefGoogle Scholar
  20. 20.
    Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res. 1988;226:49–64.PubMedGoogle Scholar
  21. 21.
    Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr. Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res. 2012;470:99–107.PubMedCrossRefGoogle Scholar
  22. 22.
    Novicoff WM, Saleh KJ, Mihalko WM, Wang XQ, Knaebel HP. Primary total knee arthroplasty: a comparison of computer-assisted and manual techniques. Instr Course Lect. 2010;59:109–117.PubMedGoogle Scholar
  23. 23.
    Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL. Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res. 2012;470:895–902.PubMedCrossRefGoogle Scholar
  24. 24.
    Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN. Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc. 2011;19:1496–1503.PubMedCrossRefGoogle Scholar
  25. 25.
    Rand JA, Coventry MB. Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res. 1988;232:168–173.PubMedGoogle Scholar
  26. 26.
    Ritter MA, Herbst SA, Keating EM, Faris PM, Meding JB. Long-term survival analysis of a posterior cruciate-retaining total condylar total knee arthroplasty. Clin Orthop Relat Res. 1994;309:136–145.PubMedGoogle Scholar
  27. 27.
    Spencer BA, Mont MA, McGrath MS, Boyd B, Mitrick MF. Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop. 2009;33:1571–1575.PubMedCrossRefGoogle Scholar
  28. 28.
    Stronach BM, Pelt CE, Erickson J, Peters CL. Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res. 2013;471:169–174.PubMedCrossRefGoogle Scholar
  29. 29.
    Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J. Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res. 2013 Apr 24. [Epub ahead of print].Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Yoon Whan Roh
    • 1
  • Tae Woo Kim
    • 2
  • Sahnghoon Lee
    • 2
  • Sang Cheol Seong
    • 2
  • Myung Chul Lee
    • 2
  1. 1.Joint Reconstruction CenterSeoul NOW HospitalKyungki-DoKorea
  2. 2.Department of Orthopedic SurgerySeoul National University HospitalSeoulKorea

Personalised recommendations