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Are Patient-specific Cutting Blocks Cost-effective for Total Knee Arthroplasty?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Using patient-specific cutting blocks for TKA increases the cost to the hospital for these procedures, but it has been proposed they may reduce operative times and improve implant alignment, which could reduce the need for revision surgery.

Questions/purposes

We compared TKAs performed with patient-specific cutting blocks with those performed with traditional instrumentation to determine whether there was improved operating room time management and component coronal alignment to support use of this technology.

Methods

We retrospectively reviewed 57 patients undergoing primary TKAs using patient-specific custom cutting blocks for osteoarthritis and compared them with 57 matched patients undergoing TKAs with traditional instrumentation during the same period (January 2009 to September 2010). At baseline, the groups were comparable with respect to age, sex, and BMI. We collected data on operative time (total in-room time and tourniquet time) and measured component alignment on plain radiographs.

Results

On average, TKAs performed with patient-specific instrumentation had similar tourniquet times (61.0 versus 56.2 minutes) but patients were in the operating room 12.1 minutes less (137.2 versus 125.1 minutes) than those in the standard instrumentation group. We observed no difference in the femorotibial angle in the coronal plane between the two groups.

Conclusions

Patient-specific instrumentation for TKA shows slight improvement in operating room time management but none in component alignment postoperatively. Therefore, routine use of this new technology may not be cost-effective in its current form.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO, 63110, USA

    Ryan M. Nunley MD, Bradley S. Ellison MD, Erin L. Ruh MS, Brandon M. Williams DC & Robert L. Barrack MD

  2. John Cochran Division, VA Medical Center, St Louis, MO, USA

    Ryan M. Nunley MD

  3. Barnes-Jewish Hospital, St Louis, MO, USA

    Keith Foreman RN, BS, CNOR & Adrienne D. Ford MPH

Authors
  1. Ryan M. Nunley MD
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  2. Bradley S. Ellison MD
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  3. Erin L. Ruh MS
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  4. Brandon M. Williams DC
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  5. Keith Foreman RN, BS, CNOR
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  6. Adrienne D. Ford MPH
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  7. Robert L. Barrack MD
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Corresponding author

Correspondence to Ryan M. Nunley MD.

Additional information

One author (RMN) is a paid consultant for Smith & Nephew Orthopaedics (Memphis, TN, USA), Wright Medical Technology Inc (Arlington, TN, USA), Salient Surgical Technologies Inc (Portsmouth, NH, USA), and CardioMEMS Inc (Atlanta, GA, USA). One author (RLB) has received royalties from Smith & Nephew Orthopaedics. Each of the remaining authors certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Washington University.

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Nunley, R.M., Ellison, B.S., Ruh, E.L. et al. Are Patient-specific Cutting Blocks Cost-effective for Total Knee Arthroplasty?. Clin Orthop Relat Res 470, 889–894 (2012). https://doi.org/10.1007/s11999-011-2221-3

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  • DOI: https://doi.org/10.1007/s11999-011-2221-3

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