Skip to main content
SpringerLink
Log in

Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty: a meta-analysis

  • Review Article
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Because published studies on the accuracy achieved with patient-specific guides during total knee arthroplasty (TKA) contradict each other, this systematic review and meta-analysis sought to compare radiological TKA outcomes when patient-specific cutting blocks (PSCB) were used to the outcomes when standard manual instrumentation was used.

Methods

The meta-analysis was implemented according to PRISMA Statement Criteria. The primary endpoint was the hip-knee-ankle (HKA) angle, which represents the leg’s mechanical axis. The accuracy of component placement in the coronal and sagittal planes, and the accuracy of femoral component rotation were also compiled. After testing for publication bias and heterogeneity across studies, data were aggregated random-effects modeling when necessary.

Results

Fifteen articles were included: 916 total knee arthroplasty cases in the PSCB group and 998 in the MI group. The mechanical axis did not differ between the two groups (weighted mean difference 0.07°; 95 % CI, -0.5° to 0.65°; p = 0.8). Risk ratio analysis revealed no protective effect of using PSCB relative to the appearance of HKA angle outliers (RR = 0.88; 95 % CI, 0.68–1.13; p = 0.3). There was a trend towards a protective effect with PSCB for the risk of femoral component outliers, but the opposite was observed for the tibial component. The implantation procedure was stopped in 30 cases because the surgeon-authors found excessive discrepancies between the intra-operative observations and the pre-operative plan.

Conclusions

This meta-analysis found no evidence that using patient-specific cutting blocks provides superior accuracy to using manual instrumentation during TKA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Insall JN, Binazzi R, Soudry M, Mestriner LA (1985) Total knee arthroplasty. Clin Orthop Relat Res 192:13–22

    PubMed  Google Scholar 

  2. Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156

    PubMed  Google Scholar 

  3. Lotke PA, Ecker ML (1977) Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 59:77–79

    CAS  PubMed  Google Scholar 

  4. Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM (2002) Insall Award paper. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 404:7–13

    Article  PubMed  Google Scholar 

  5. Bargren JH, Blaha JD, Freeman MA (1983) Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 173:178–183

    PubMed  Google Scholar 

  6. Harrysson OL, Hosni YA, Nayfeh JF (2007) Custom-designed orthopedic implants evaluated using finite element analysis of patient-specific computed tomography data: femoral-component case study. BMC Musculoskelet Disord 8:91

    Article  PubMed Central  PubMed  Google Scholar 

  7. Nunley RM, Ellison BS, Zhu J, Ruh EL, Howell SM, Barrack RL (2012) Do patient-specific guides improve coronal alignment in total knee arthroplasty? Clin Orthop Relat Res 470:1242

    Article  PubMed Central  Google Scholar 

  8. Lombardi AV Jr, Berend KR, Adams JB (2008) Patient-specific approach in total knee arthroplasty. Orthopedics 31:927–930

    Article  PubMed  Google Scholar 

  9. Klatt BA, Goyal N, Austin MS, Hozack WJ (2008) Custom-fit total knee arthroplasty (OtisKnee) results in malalignment. J Arthroplasty 23:26–29

    Article  PubMed  Google Scholar 

  10. Spencer BA, Mont MA, McGrath MS, Boyd B, Mitrick MF (2009) Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment. Int Orthop 33:1571–1575

    Article  PubMed Central  PubMed  Google Scholar 

  11. White D, Chelule KL, Seedhom BB (2008) Accuracy of MRI vs CT imaging with particular reference to patient specific templates for total knee replacement surgery. Int J Med Robot 4:224–231

    Article  CAS  PubMed  Google Scholar 

  12. Victor J, Dujardin J, Vandenneucker H, Arnout N, Bellemans J (2014) Patient-specific guides do not improve accuracy in total knee arthroplasty: a prospective randomized controlled trial. Clin Orthop Relat Res 472:263–271

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ng VY, DeClaire JH, Berend KR, Gulick BC, Lombardi AV Jr (2012) Improved accuracy of alignment with patient-specific positioning guides compared with manual instrumentation in TKA. Clin Orthop Relat Res 470:99–107

    Article  PubMed Central  PubMed  Google Scholar 

  14. Noble JW Jr, Moore CA, Liu N (2012) The value of patient-matched instrumentation in total knee arthroplasty. J Arthroplasty 27:153–155

    Article  PubMed  Google Scholar 

  15. Watters TS, Mather RC 3rd, Browne JA, Berend KR, Lombardi AV Jr, Bolognesi MP (2011) Analysis of procedure-related costs and proposed benefits of using patient-specific approach in total knee arthroplasty. J Surg Orthop Adv 20:112–116

    PubMed  Google Scholar 

  16. Howell SM, Kuznik K, Hull ML, Siston RA (2008) Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients. Orthopedics 31:857–863

    Article  PubMed  Google Scholar 

  17. Slover JD, Rubash HE, Malchau H, Bosco JA (2012) Cost-effectiveness analysis of custom total knee cutting blocks. J Arthroplasty 27:180–185

    Article  PubMed  Google Scholar 

  18. Daniilidis K, Tibesku CO (2014) A comparison of conventional and patient-specific instruments in total knee arthroplasty. Int Orthop 38:503–508

    Article  PubMed Central  PubMed  Google Scholar 

  19. Macdessi SJ, Jang B, Harris IA, Wheatley E, Bryant C, Chen DB (2014) A comparison of alignment using patient specific guides, computer navigation and conventional instrumentation in total knee arthroplasty. Knee 21:406–409

    Article  PubMed  Google Scholar 

  20. Moubarak H, Brilhault J (2014) Contribution of patient-specific cutting guides to lower limb alignment for total knee arthroplasty. Orthop Traumatol Surg Res 100(Suppl):S239–S242

    Article  CAS  PubMed  Google Scholar 

  21. Roh YW, Kim TW, Lee S, Seong SC, Lee MC (2013) Is TKA using patient-specific instruments comparable to conventional TKA? A randomized controlled study of one system. Clin Orthop Relat Res 471:3988–3995

    Article  PubMed Central  PubMed  Google Scholar 

  22. Parratte S, Blanc G, Boussemart T, Ollivier M, Le Corroller T, Argenson JN (2013) Rotation in total knee arthroplasty: no difference between patient-specific and conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 21:2213–2219

    Article  PubMed  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. doi:10.1371/journal.pmed.1000097

    Google Scholar 

  24. Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A et al (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89:261–269

    Article  PubMed  Google Scholar 

  25. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD et al (2007) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  Google Scholar 

  26. Shearman CM, Brandser EA, Kathol MH, Clark WA, Callaghan JJ (1998) An easy linear estimation of the mechanical axis on long-leg radiographs. AJR Am J Roentgenol 170:1220–1222

    Article  CAS  PubMed  Google Scholar 

  27. Victor J (2009) Rotational alignment of the distal femur: a literature review. Orthop Traumatol Surg Res 95:365–372

    Article  CAS  PubMed  Google Scholar 

  28. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed Central  PubMed  Google Scholar 

  29. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61:991–996

    Article  PubMed  Google Scholar 

  30. Woolson ST, Harris AH, Wagner DW, Giori NJ (2014) Component alignment during total knee arthroplasty with use of standard or custom instrumentation: a randomized clinical trial using computed tomography for postoperative alignment measurement. J Bone Joint Surg Am 96:366–372

    Article  PubMed  Google Scholar 

  31. Chareancholvanich K, Narkbunnam R, Pornrattanamaneewong C (2013) A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement. Bone Joint J 95-B:354–359

    Article  CAS  PubMed  Google Scholar 

  32. Hamilton WG, Parks NL, Saxena A (2013) Patient-specific instrumentation does not shorten surgical time: a prospective, randomized trial. J Arthroplasty 28(Suppl):96–100

    Article  PubMed  Google Scholar 

  33. Barrack RL, Ruh EL, Williams BM, Ford AD, Foreman K, Nunley RM (2012) J Bone Joint Surg (Br) 94(Suppl A):95–99

    Article  CAS  Google Scholar 

  34. Chen JY, Yeo SJ, Yew AK, Tay DK, Chia SL, Lo NN et al (2014) The radiological outcomes of patient-specific instrumentation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:630–635

    Article  PubMed  Google Scholar 

  35. Barrett W, Hoeffel D, Dalury D, Mason JB, Murphy J, Himden S (2014) In-vivo alignment comparing patient specific instrumentation with both conventional and computer assisted surgery (CAS) instrumentation in total knee arthroplasty. J Arthroplasty 29:343–347

    Article  PubMed  Google Scholar 

  36. Yaffe M, Luo M, Goyal N, Chan P, Patel A, Cayo M et al (2013) Clinical, functional, and radiographic outcomes following total knee arthroplasty with patient-specific instrumentation, computer-assisted surgery, and manual instrumentation: a short-term follow-up study. Int J Comput Assist Radiol Surg. [Epub ahead of print]

  37. Marimuthu K, Chen DB, Harris IA, Wheatley E, Bryant CJ, MacDessi SJ (2014) A multi-planar CT-based comparative analysis of patient-specific cutting guides with conventional instrumentation in total knee arthroplasty. J Arthroplasty 29:1138–1142

    Article  PubMed  Google Scholar 

  38. Boonen B, Schotanus MG, Kort NP (2012) Preliminary experience with the patient-specific templating total knee arthroplasty. Acta Orthop 83:387–393

    Article  PubMed Central  PubMed  Google Scholar 

  39. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  PubMed  Google Scholar 

  40. Voleti PB, Hamula MJ, Baldwin KD, Lee GC (2014) Current data do not support routine use of patient-specific instrumentation in total knee arthroplasty. J Arthroplasty. doi:10.1016/j.arth.2014.01.039

    PubMed  Google Scholar 

  41. Conteduca F, Iorio R, Mazza D, Ferretti A (2014) Patient-specific instruments in total knee arthroplasty. Int Orthop 38:259–265

    Article  PubMed Central  PubMed  Google Scholar 

  42. Stronach BM, Pelt CE, Erickson J, Peters CL (2013) Patient-specific total knee arthroplasty required frequent surgeon-directed changes. Clin Orthop Relat Res 471:169–174

    Article  PubMed Central  PubMed  Google Scholar 

  43. Lustig S, Scholes CJ, Oussedik SI, Kinzel V, Coolican MR, Parker DA (2013) Unsatisfactory accuracy as determined by computer navigation of VISIONAIRE patient-specific instrumentation for total knee arthroplasty. J Arthroplasty 28:469–473

    Article  PubMed  Google Scholar 

  44. Thienpont E, Paternostre F, Pietsch M, Hafez M, Howell S (2013) Total knee arthroplasty with patient-specific instruments improves function and restores limb alignment in patients with extra-articular deformity. Knee 20:407–411

    Article  PubMed  Google Scholar 

  45. Johnson DR (2011) The benefits of customized patient instrumentation to lower-volume joint replacement surgeons: results from practice. Am J Orthop 40(Suppl):13–16

    PubMed  Google Scholar 

  46. Pietsch M, Djahani O, Hochegger M, Plattner F, Hofmann S (2013) Patient-specific total knee arthroplasty: the importance of planning by the surgeon. Knee Surg Sports Traumatol Arthrosc 21:2220–2226

    Article  CAS  PubMed  Google Scholar 

  47. Koch PP, Muller D, Pisan M, Fucentese SF (2013) Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique. Knee Surg Sports Traumatol Arthrosc 21:2200–2205

    Article  CAS  PubMed  Google Scholar 

  48. Plaskos C, Hodgson AJ, Inkpen K, McGraw RW (2002) Bone cutting errors in total knee arthroplasty. J Arthroplasty 17:698–705

    Article  PubMed  Google Scholar 

  49. Kotela A, Kotela I (2014) Patient-specific computed tomography based instrumentation in total knee arthroplasty: a prospective randomized controlled trail. Int Orthop. doi:10.1007/s00264-014-2399-6

    PubMed  Google Scholar 

  50. Soares HP, Daniels S, Kumar A, Clarke M, Scott C, Swann S et al (2004) Bad reporting does not mean bad methods for randomised trials: observational study of randomised controlled trials performed by the Radiation Therapy Oncology Group. BMJ 328:22–24

    Article  PubMed Central  PubMed  Google Scholar 

  51. Honl M, Dierk O, Gauck C, Carrero V, Lampe F, Dries S et al (2003) Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study. J Bone Joint Surg Am 85-A:1470–1478

    PubMed  Google Scholar 

  52. Vundelinckx BJ, Bruckers L, De Mulder K, De Schepper J, Van Esbroeck G (2013) Functional and radiographic short-term outcome evaluation of the Visionaire system, a patient-matched instrumentation system for total knee arthroplasty. J Arthroplasty 28:964–970

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Joanne Archambault, Ph.D. for her editorial support during preparation of this manuscript.

Conflict of interest

P. Chiron is a consultant for Zimmer, Smith & Nephew and Sanofi, and has received royalties from Zimmer and Integra. Jean Michel Laffosse is a consultant for Tornier and Stryker. The other authors have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Pôle Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, TSA 40031, 31059, Toulouse, France

    Etienne Cavaignac, Regis Pailhé, Gregoire Laumond, Jérôme Murgier, Nicolas Reina, Jean Michel Laffosse & Philippe Chiron

  2. Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-University of Toulouse III, Toulouse University Hospital (CHU), Toulouse, France

    Emilie Bérard

Authors
  1. Etienne Cavaignac
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Regis Pailhé
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregoire Laumond
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jérôme Murgier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicolas Reina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean Michel Laffosse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emilie Bérard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philippe Chiron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Etienne Cavaignac.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cavaignac, E., Pailhé, R., Laumond, G. et al. Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty: a meta-analysis. International Orthopaedics (SICOT) 39, 1541–1552 (2015). https://doi.org/10.1007/s00264-014-2549-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2549-x

Keywords

Search

Navigation