The use of customized TKA implants for increased efficiency in the OR
Efficiency in surgical procedures saves time and money and can decrease medical complications. Several sources of inefficiency exist in the operating room, including preoperative and intraoperative. The instruments used during TKA are frequently redundant. Customized instruments and implants can improve efficiency by reducing steps. Additional benefits may include improved alignment and kinematics. This chapter addresses the various sources of inefficiency, provides suggestions to overcome them, and introduces the concept of customized guides and implants as a method to improve efficiency.
KeywordsKnee replacement Efficiency Customized instruments Patient specific implants
RK Sinha: board membership with ConforMIS, Inc, consultant to Zimmer and Robodoc, has grants from ConforMIS, Inc, Zimmer, and Superstat, receives royalties from ConforMIS and Zimmer, develops educational presentations for Angiotech, and has stock options with ConforMIS, Inc.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.•• Watters TS, Mather III RC, Browne JA, Berend KR, Lombardi Jr AV, Bolognesi MP. Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv. 2011;20(6):112–6. This study compares custom guide based, navigation based, and standard TKA. Costs were similar between standard and custom guide TKA, but surgical time of the latter was, on average, 28 minutes shorter. PubMedGoogle Scholar
- 6.JFK Memorial Hospital Working Group internal data.Google Scholar
- 8.• 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. This study compared conventional instruments, patient specific guides targeting the mechanical axis, and patient specific guides targeting the kinematic axis. Overall percentages of outliers vis-à-vis the mechanical axis were similar between the first 2, although conventional guides tended to produce more overall varus. Kinematic axis guides produced more valgus outliers. PubMedCrossRefGoogle Scholar