scholarly journals Should we abandon the patient-specific instrumentation ship in total knee arthroplasty? Not quite yet!

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
László Török ◽  
Péter Jávor ◽  
Petra Hartmann ◽  
László Bánki ◽  
Endre Varga
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Patient Specific ◽  
Transfusion Rate ◽  
Component Alignment ◽  
Patient Specific Instrumentation ◽  
Patient Reported ◽  
Total Knee

AbstractPatient-specific Instrumentation (PSI) is an innovative technique aiding the precise implementation of the preoperative plan during total knee arthroplasty (TKA) by using patient-specific guides and cutting blocks. Despite of the theoretical advantages, studies have reported contradictory results, thus there is no consensus regarding the overall effectiveness of PSI. Through the critical assessment of a meta-analysis published lately, this correspondence aims to highlight the complexity of comparing the efficacy of PSI to standard instrumentation (SI). The accuracy of component alignment, patient-reported outcome measures (PROMs), surgery time, blood loss, transfusion rate, and postoperative complications are commonly used outcomes for investigating the efficacy of PSI-aided TKA. By assessing component alignment, the expertise of the surgeon(s) should be taken into consideration, since PSI may not provide benefits for expert surgeons but might improve accuracy and patient safety during the learning curve of novice surgeons. With respect to PROMs and postoperative complications, PSI may not improve short-term results; however, long-term follow up data is missing. Regarding transfusion rates, favorable trends can be observed, but further studies utilizing recent data are needed for a clear conclusion. When assessing surgery time, we suggest focusing on operating room turnover instead of procedure time.

CT- versus MRI-based patient-specific instrumentation for total knee arthroplasty: A systematic review and meta-analysis

The Surgeon ◽  
2017 ◽  
Vol 15 (6) ◽  
pp. 336-348 ◽  
Author(s):  
Xiang-Dong Wu ◽  
Bing-Yan Xiang ◽  
Martijn G.M. Schotanus ◽  
Zun-Han Liu ◽  
Yu Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Total Knee

Accuracy of MRI-based vs. CT-based patient-specific instrumentation in total knee arthroplasty: A meta-analysis

2017 ◽  
Vol 22 (1) ◽  
pp. 116-120 ◽  
Author(s):  
Vincent V.G. An ◽  
Brahman S. Sivakumar ◽  
Kevin Phan ◽  
Yadin David Levy ◽  
Warwick J.M. Bruce
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Patient Specific ◽  
Patient Specific Instrumentation ◽  
Total Knee

The Accuracy and Clinical Success of Robotic-Assisted Total Knee Arthroplasty

2021 ◽  
pp. 155633162110263
Author(s):  
Brian T. Nickel ◽  
Kaitlin M. Carroll ◽  
Andrew D. Pearle ◽  
Laura J. Kleeblad ◽  
Joost Burger ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Rating Scale ◽  
High Reliability ◽  
Patient Specific ◽  
Component Alignment ◽  
Robotic Assisted ◽  
Patient Reported ◽  
Total Knee

Background: Robotic-assisted total knee arthroplasty (rTKA) has emerged as a patient-specific customizable tool that enables 3-dimensional preoperative planning, intraoperative adjustment, robotic-assisted bone preparation, and soft-tissue protection. Haptic rTKA may enhance component positioning, but only a few small studies have examined patient satisfaction and clinical outcomes after haptic rTKA. Purpose: In patients who underwent haptic rTKA, we sought to evaluate (1) the discrepancy in alignment between the executed surgical plan and implanted alignment in the coronal and sagittal planes 1 year postoperatively and (2) patient-reported outcomes 2 years postoperatively. Methods: From a prospectively collected database, we reviewed 105 patients who underwent haptic rTKA from August 2016 to May 2017. Two fellowship-trained arthroplasty surgeons independently reviewed hip-to-ankle standing biplanar radiographs to measure overall limb alignment and individual tibial and femoral component alignment relative to the mechanical axis and compared this to the executed surgical plan. Patient-reported outcomes were collected preoperatively and at 2 years postoperatively using the Lower Activity Extremity Score (LEAS), Knee Injury and Osteoarthritis Outcome Score Junior (KOOS Jr.), and Numeric Pain Rating Scale (NPRS). Results: Mean patient age was 62.4 years, and mean body mass index was 30.6 kg/m2. Interobserver reliability was significant with a κ of 0.89. Absolute mean deviations in postoperative coronal alignment compared to intraoperative alignment were 0.625° ± 0.70° and 0.45° ± 0.50° for the tibia and femur, respectively. Absolute mean deviations in postoperative tibial sagittal alignment were 0.47° ± 0.76°. Overall mechanical alignment was 0.97° ± 1.79°. Outcomes in LEAS, KOOS Jr., and NPRS changed from 8 to 10, 78 to 88.3, and 8 to 1, respectively. Conclusions: Haptic rTKA demonstrated high reliability and accuracy (less than 1°) of tibial coronal, femoral coronal, and tibial sagittal component alignment postoperatively compared to the surgical plan. Patient-reported outcomes improved, as well. A more rigorous study on long-term outcomes is warranted.

scholarly journals A study on radiological outcomes of accelerometer based hand held navigation system in total knee arthroplasty

2020 ◽  
Vol 6 (3) ◽  
pp. 556
Author(s):  
Hiranyakumar S. ◽  
Shivaraj Nadagouda ◽  
Vishnu Harikrishnan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Navigation System ◽  
Mechanical Axis ◽  
Patient Specific ◽  
Computer Assisted ◽  
Component Alignment ◽  
Patient Specific Instrumentation ◽  
Wear And Tear ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> The goal of obtaining more accurate component alignment in total knee arthroplasty (TKA) has led to the development of techniques like portable accelerometer-based handheld navigation system, computer assisted system, patient specific instrumentation. Among which hand held navigation has showed promising results for achieving accurate resection and alignment and only few studies were done to assess radiological outcome or the effective component alignment using portable accelerometer-based hand held navigation system in TKA.</p><p class="abstract"><strong>Methods:</strong> TKA using portable accelerometer-based hand held navigation system (Smith and Nephew- knee align) was done on 25 knees with primary osteoarthritis. Preoperative and post-operative mechanical axis and component alignments were measured using hip-to-ankle radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the femoral components, 92.0% were placed within 90°±2° to the femoral mechanical axis in the coronal and   96.0% of the tibial components were placed within 90°±2° to the mechanical axis in the coronal plane, 94.3% of the TKAs had an overall lower extremity alignment within 3° of neutral to the mechanical axis, based on postoperative hip-to-ankle radiographs.</p><p class="abstract"><strong>Conclusions:</strong> The degree of accuracy in positioning the femoral and tibial component in TKA using portable accelerometer-based hand held navigation system (knee align) is very much promising and is an effective intraoperative tool for reducing the proportion of outliers for component placement and thus decreasing the chances of instability and early wear and tear of the components in TKA.</p>

Patient-Specific Instrumentation in Total Knee Arthroplasty Provides No Improvement in Component Alignment

2014 ◽  
Vol 29 (9) ◽  
pp. 1705-1708 ◽  
Author(s):  
Benjamin M. Stronach ◽  
Christopher E. Pelt ◽  
Jill A. Erickson ◽  
Christopher L. Peters
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Specific ◽  
Component Alignment ◽  
Patient Specific Instrumentation ◽  
Total Knee
Sign in / Sign up

Export Citation Format

Share Document