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Patient-specific total knee arthroplasty required frequent surgeon-directed changes
Benjamin M Stronach1, Christopher E Pelt, Jill Erickson
1Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
Clinical Orthopaedics and Related Research
|September 8, 2012
Summary
Patient-specific instrumentation in total knee arthroplasty (TKA) often requires frequent intraoperative adjustments and does not guarantee improved surgical outcomes or fit. Surgeons should critically evaluate this technology before adoption.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Surgical Technology
Background:
- Patient-specific instrumentation (PSI) is hypothesized to enhance precision and reduce operative time in total knee arthroplasty (TKA).
- However, robust clinical data supporting these presumed benefits of PSI in TKA remains limited.
Purpose of the Study:
- To assess the frequency of intraoperative modifications needed with PSI during TKA to align with surgeon preferences.
- To evaluate the security of fit for patient-specific instrumentation guides.
- To compare PSI with traditional instrumentation regarding surgical outcomes.
Main Methods:
- Prospective evaluation of 66 TKAs using PSI in 60 patients, meticulously recording all intraoperative changes.
- Radiographic analysis of femoral and tibial component placement (size, alignment) to assess surgeon interventions.
- Assessment of guide fit and comparison of patient demographics and implant sizing against a control group using conventional instrumentation.
Main Results:
- An average of 2.4 intraoperative changes per knee were recorded with PSI, with significant intraoperative adjustments in implant size (77% femurs, 53% tibias).
- Surgeon-modified alignments were deemed improvements in 86% of evaluated cases; however, guide fit was compromised in 12% of femurs and 5% of tibias.
- PSI did not demonstrate improvements in tourniquet time or blood loss compared to traditional methods.
Conclusions:
- The study advises caution regarding the uncritical adoption of patient-specific instrumentation in TKA.
- Further evidence is required to validate the purported advantages of PSI technology in routine surgical practice.