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

International Orthopaedics volume 39, pages 1541–1552 (2015)Cite this article

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.

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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.

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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

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  1. Etienne Cavaignac
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Correspondence to Etienne Cavaignac.

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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

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