Skip to main content
SpringerLink
Log in

A comparison of conventional and patient-specific instruments in total knee arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Several authors have observed that standard instrumentation (SI) may be insufficient for addressing component malalignment. Patient-matched cutting blocks (PMCB) technology was introduced to improve surgeons’ ability to achieve a neutral postoperative mechanical axis following total knee arthroplasty (TKA). The current retrospective study was designed to compare the ability of SI and PMCB to achieve a hip-knee-ankle angle (HKA) within ±3° of the ideal alignment of 180°.

Methods

Between October 2009 and December 2012, 170 TKAs in 166 patients (four bilateral) using VISIONAIRE (Smith & Nephew) PMCB technology were performed. Additionally, 160 TKAs in 160 consecutive patients that had received a total knee arthroplasty using SI during the same time period were used as a control group, All surgeries were performed by the same surgeon. Standardized pre- and postoperative long-leg standing x-rays were retrospectively evaluated to compare the two patient cohorts.

Results

X-rays were available for analysis for 156 knees in the SI group and 150 in the PMCB group. The average post-surgical HKA was 178.7 ± 2.5 in the SI group and 178.4 ± 1.5 in the PMCB group. However, the rate of ± 3° outliers was 21.2 % in the SI group and 9.3 % in the PMCB group. There were no intraoperative complications with the use of PMCB technology or SI.

Conclusions

PMCB technology proved superior to conventional instrumentation in achieving a neutral mechanical axis following TKA. Further follow-up will be needed to ascertain the long-term impact of these findings.

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

Similar content being viewed by others

References

  1. Bali K, Walker P, Bruce W (2012) Custom-fit total knee arthroplasty: our initial experience in 32 knees. J Arthroplasty 27:1149–1154

    Article  PubMed  Google Scholar 

  2. Barrack RL, Ruh EL, Williams BM, Ford AD, Foreman K, Nunley RM (2012) Patient specific cutting blocks are currently of no proven value. J Bone Joint Surg Br 94(11 Suppl A):95–99

    Article  CAS  PubMed  Google Scholar 

  3. Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86:682–687

    Article  CAS  PubMed  Google Scholar 

  4. Bjorgul K, Novicoff WM, Saleh KJ (2010) Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol 11:203–209

    Article  PubMed Central  PubMed  Google Scholar 

  5. 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 

  6. 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 

  7. Chauhan SK, Scott RG, Breidahl W, Beaver RJ (2004) Computer-assisted knee arthroplasty versus a conventional jig-based technique. A randomised, prospective trial. J Bone Joint Surg Br 86:372–377

    Article  CAS  PubMed  Google Scholar 

  8. Cheng T, Pan XY, Mao X, Zhang GY, Zhang XL (2012) Little clinical advantage of computer-assisted navigation over conventional instrumentation in primary total knee arthroplasty at early follow-up. Knee 19:237–245

    Article  CAS  PubMed  Google Scholar 

  9. Chin PL, Yang KY, Yeo SJ, Lo NN (2005) Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. J Arthroplasty 20:618–626

    Article  PubMed  Google Scholar 

  10. Collier MB, Engh CA Jr, McAuley JP, Engh GA (2007) Factors associated with the loss of thickness of polyethylene tibial bearings after knee arthroplasty. J Bone Joint Surg Am 89:1306–1314

    Article  PubMed  Google Scholar 

  11. Conteduca F, Iorio R, Mazza D, Caperna L, Bolle G, Argento G, Ferretti A (2012) Are MRI-based, patient matched cutting jigs as accurate as the tibial guides? Int Orthop 36:1589–1593

    Article  PubMed Central  PubMed  Google Scholar 

  12. Daniilidis K, Tibesku CO (2013) Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop 37:45–50

    Article  PubMed Central  PubMed  Google Scholar 

  13. Decking R, Markmann Y, Fuchs J, Puhl W, Scharf HP (2005) Leg axis after computer-navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 20:282–288

    Article  PubMed  Google Scholar 

  14. Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed SD, Rutten F, Sculpher M, Severens J (2009) Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report. Value Health 12:409–418

    Article  PubMed  Google Scholar 

  15. Haaker RG, Stockheim M, Kamp M, Proff G, Breitenfelder J, Ottersbach A (2005) Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res 433:152–159

    Article  PubMed  Google Scholar 

  16. Hafez MA, Chelule KL, Seedhom BB, Sherman KP (2006) Computer-assisted total knee arthroplasty using patient-specific templating. Clin Orthop Relat Res 444:184–192

    Article  CAS  PubMed  Google Scholar 

  17. Hart R, Janecek M, Chaker A, Bucek P (2003) Total knee arthroplasty implanted with and without kinematic navigation. Int Orthop 27:366–369

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Heyse TJ, Tibesku CO (2012) Improved femoral component rotation in TKA using patient-specific instrumentation. Knee. doi:10.1016/j.knee.2012.10.009

    Google Scholar 

  19. 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 

  20. Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714

    CAS  PubMed  Google Scholar 

  21. Jenny JY, Miehlke RK, Giurea A (2008) Learning curve in navigated total knee replacement. A multi-centre study comparing experienced and beginner centres. Knee 15:80–84

    Article  PubMed  Google Scholar 

  22. Johnson DR (2011) The benefits of customized patient instrumentation to lower-volume joint replacement surgeons: results from practice. Am J Orthop (Belle Mead NJ) 40(11 Suppl):13–16

    Google Scholar 

  23. Kim YH, Kim JS, Yoon SH (2007) Alignment and orientation of the components in total knee replacement with and without navigation support: a prospective, randomised study. J Bone Joint Surg Br 89:471–476

    Article  PubMed  Google Scholar 

  24. 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 

  25. Koeck FX, Beckmann J, Luring C, Rath B, Grifka J, Basad E (2011) Evaluation of implant position and knee alignment after patient-specific unicompartmental knee arthroplasty. Knee 18:294–299

    Article  PubMed  Google Scholar 

  26. 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 

  27. Matsumoto T, Tsumura N, Kurosaka M, Muratsu H, Kuroda R, Ishimoto K, Tsujimoto K, Shiba R, Yoshiya S (2004) Prosthetic alignment and sizing in computer-assisted total knee arthroplasty. Int Orthop 28:282–285

    Article  PubMed Central  PubMed  Google Scholar 

  28. Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89:236–243

    Article  PubMed  Google Scholar 

  29. Nam D, Maher PA, Rebolledo BJ, Nawabi DH, McLawhorn AS, Pearle AD (2013) Patient specific cutting guides versus an imageless, computer-assisted surgery system in total knee arthroplasty. Knee. doi:10.1016/j.knee.2012.12.009

    Google Scholar 

  30. 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 

  31. 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 

  32. 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 470:895–902

    Article  PubMed Central  PubMed  Google Scholar 

  33. 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 

  34. Sampath SA, Voon SH, Sangster M, Davies H (2009) The statistical relationship between varus deformity, surgeon's experience, BMI and tourniquet time for computer assisted total knee replacements. Knee 16:121–124

    Article  PubMed  Google Scholar 

  35. 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 

  36. Sikorski JM (2008) Alignment in total knee replacement. J Bone Joint Surg Br 90:1121–1127

    Article  CAS  PubMed  Google Scholar 

  37. Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85:830–835

    CAS  PubMed  Google Scholar 

  38. 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 

  39. Srivastava A, Lee GY, Steklov N, Colwell CW Jr, Ezzet KA, D'Lima DD (2012) Effect of tibial component varus on wear in total knee arthroplasty. Knee 19:560–563

    Article  PubMed  Google Scholar 

  40. Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186

    Article  PubMed  Google Scholar 

  41. Stulberg SD, Loan P, Sarin V (2002) Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 84-A(Suppl 2):90–98

    PubMed  Google Scholar 

  42. Tillett ED, Engh GA, Petersen T (1988) A comparative study of extramedullary and intramedullary alignment systems in total knee arthroplasty. Clin Orthop Relat Res 230:176–181

    PubMed  Google Scholar 

  43. Werner FW, Ayers DC, Maletsky LP, Rullkoetter PJ (2005) The effect of valgus/varus malalignment on load distribution in total knee replacements. J Biomech 38:349–355

    Article  PubMed  Google Scholar 

  44. Yaffe MA, Patel A, Mc Coy BW, Luo M, Cayo M, Ghate R, Stulberg SD (2012) Component sizing in total knee arthroplasty: patient-specific guides vs. computer-assisted navigation. Biomed Tech (Berl) 57:277–282

    Article  Google Scholar 

  45. Yau WP, Chiu KY, Zuo JL, Tang WM, Ng TP (2008) Computer navigation did not improve alignment in a lower-volume total knee practice. Clin Orthop Relat Res 466:935–945

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the medical assistants Ms. Christina Andrusiak, Ms. Sandra Schaefer, and Ms. Evi Schwarz for the collection of radiographic and patient data and Mr Robert Gartner for his assistance in the measurements. Smith & Nephew provided a medical writer (John Watson) who proofread and edited the manuscript for grammar and issues related to English language.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. C.O.T is a paid teaching consultant to Smith & Nephew. The authors declare that there are no other potential conflicts of interest in connection with this paper.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover; MHH), Hannover, Germany

    Kiriakos Daniilidis

  2. Sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Germany

    Carsten O. Tibesku

Authors
  1. Kiriakos Daniilidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carsten O. Tibesku
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carsten O. Tibesku.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daniilidis, K., Tibesku, C.O. A comparison of conventional and patient-specific instruments in total knee arthroplasty. International Orthopaedics (SICOT) 38, 503–508 (2014). https://doi.org/10.1007/s00264-013-2028-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-013-2028-9

Keywords

Search

Navigation