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Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with ‘personalised alignment’ would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on off-the-shelf (OTS) TKA.

Methods

Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and five refused participation, leaving 140 patients for analysis. Patients completed pre- and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical findings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical findings as means, standard deviations (SD) and ranges, or numbers and percentages.

Results

At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisfied or very satisfied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses.

Conclusions

At a minimum follow-up of two years following custom TKA combined with ‘personalised alignment’, 94% of patients were either satisfied or very satisfied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with sufficient statistical power are needed to corroborate these findings and generalise them to unselected TKA patients.

Level of evidence

IV, retrospective cohort study.

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Data availability

The authors can upon reasonable request provide access to the anonymised raw data.

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Acknowledgements

ReSurg collaborators: Jacobus H. Müller, MScEng, PhD, cobus@resurg.com. Sonia Dubreuil, MSc, sdubreuil01@gmail.com. Mo Saffarini MEng MBA, journals@resurg.com.

Funding

This work was supported by ‘GCS Ramsay Santé pour l’Enseignement et la Recherche’, which provided funding for data collection and manuscript preparation. This work was also supported by Symbios for statistical analysis.

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Authors and Affiliations

  1. Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France

    Lampros Gousopoulos, Andreas Dobbelaere, Salvatore Ratano, Louka Bondoux, Sonia Dubreuil, Tarik Aït-Si-Selmi & Michel P. Bonnin

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

    Jacobus H. Müller, Sonia Dubreuil & Mo Saffarini

  3. KniePraxis, Straubing, Germany

    Sonia Dubreuil & Carsten O. Tibesku

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  1. Lampros Gousopoulos
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  2. Andreas Dobbelaere
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  3. Salvatore Ratano
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ReSurg

  • Jacobus H. Müller
  • , Sonia Dubreuil
  •  & Mo Saffarini

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Conflict of interest

LG, AD, SR, LB, JHM, SD, MS has nothing to disclose. COT reports personal fees from Symbios during the conduct of the study; personal fees from Smith & Nephew outside the submitted work. TASS reports personal fees from Symbios during the conduct of the study; reports personal fees from DePuy-Synthes outside the submitted work. MPB reports personal fees from Symbios during the conduct of the study; reports personal fees from Wright Medical, Integra, DePuy Synthesis outside the submitted work.

Ethical approval

All patients had provided written informed consent for the use of their data and images for research and publishing purposes and the institutional review board of Ramsay Santé pour l’Enseignement et la Recherche approved the study in advance (IRB reference number: COS-RGDS-2021-03-004-BONNIN-M).

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Gousopoulos, L., Dobbelaere, A., Ratano, S. et al. Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years. Knee Surg Sports Traumatol Arthrosc 31, 1276–1283 (2023). https://doi.org/10.1007/s00167-023-07318-x

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