Comparing conventional and patient specific instrumentation in total knee arthroplasty: an early analysis of function and satisfaction
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20233254Keywords:
PSI, Total knee arthroplasty, Satisfaction, FunctionAbstract
Background: Patient specific instrumentation (PSI) in TKA is a surgical technique created to improve the accuracy of implantation, surgical time, blood loss and workflow that has been a growing trend over the past decade. Our work aims to determine if there are improvements in patient satisfaction and functional results using PSI in comparison with conventional instrumentation (CI) in TKA.
Methods: The authors evaluated 716 patients from the past 10 years that underwent TKA, either by PSI (n=456) or by CI (n=260). The authors recorded the WOMAC index, articular range of motion, and the six-minute walking test at pre-op and day 90 post-op. T-student and Mann-Whitney tests were used considering p<0.05.
Results: The functional scores achieved 90 days after surgery were better for PSI compared to CI. The respective differences are found in the extension (p=0.022), gait distance (p=0.010) and in the pain and function WOMAC index (respectively p=0.018 and p=0.020). No statistical differences were found in satisfaction.
Conclusions: 90 days after TKA, the functional scores achieved with PSI were better compared to CI. However, better results in this area did not translate to significantly higher satisfaction in the patients. There seems to be a tendency in favor of better functional results in patients that underwent TKA by PSI in comparison to those submitted to CI. These results seem to follow the tendencies demonstrated in available literature.
References
Kizaki K, Shanmugaraj A, Yamashita F, Nicole S, Andrew D, Vickas K et al. Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis. BMC Musculoskelet Disord. 2019;20(1):561.
Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States–an alternative projection model. Osteoarthr Cartil. 2017;25(11):1797-803.
Szczech B, McDermott JD, Issa K, Rifai A, Festa A, Matarese WA et al. Patient-Specific Instrumentation in Total Knee Arthroplasty: What Is the Evidence? J Knee Surg. 2016;29(4):341-5.
Gong S, Xu W, Wang R, Wang Z, Wang B, Han L et al. Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1083-95.
Arbab D, Reimann P, Brucker M, Bouillon B, Lüring C. Alignment in total knee arthroplasty - A comparison of patient-specific implants with the conventional technique. Knee. 2018;25(5):8827.
Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br 1991;73:709-14.
Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res. 1994;299:153-6.
Fontes AP, Cintra RM, Gomes L, Sousa JP. What’s new in the Visionaire system® in second-generation for TKA? a comparative study of accuracy, efficiency and functional results. Int J Res Orthop. 2022;8:298-302.
Boonen B, Schotanus MG, Kerens B, van der Weegen W, Hoekstra HJ, Kort NP. No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively: a multicentre, double-blind, randomised controlled trial. Bone Joint J. 2016;98-B(7):939-44.
Chareancholvanich K, Narkbunnam R, Pornrattanamaneewong C. A prospective randomised controlled study of patient-specific cutting guides compared with conventional instrumentation in total knee replacement. Bone Joint J. 2013;95-B(3):354-9.
Reimann P, Brucker M, Arbab D, Lüring C. Patient satisfaction - A comparison between patient-specific implants and conventional total knee arthroplasty. J Orthop. 2019;16(3):273-7.
Camarda L, D’Arienzo A, Morello S, Peri G, Valentino B, D’Arienzo M. Patient-specific instrumentation for total knee arthroplasty: a literature review. Musculoskelet Surg. 2015;99:11-8.
Vide J, Freitas TP, Ramos A, Cruz H, Sousa JP. Patient-specific instrumentation in total knee arthroplasty: simpler, faster and more accurate than standard instrumentation-a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2616-21.