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Related Experiment Video

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Patient-specific instruments in total knee arthroplasty.

Fabio Conteduca1, Raffaele Iorio, Daniele Mazza

  • 1Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "Sapienza", Via Grottarossa 1035, Rome, Italy.

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Summary

Patient-specific instruments (PSI) in total knee arthroplasty (TKA) show variable accuracy in coronal alignment compared to computer-assisted surgery (CAS). While comparable to manual techniques, careful intraoperative control is recommended for custom jigs.

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Medical Device Technology

Background:

  • Patient-specific instruments (PSI) offer potential benefits in total knee arthroplasty (TKA), including cost reduction and decreased instrument usage.
  • The reliability and accuracy of PSI systems in achieving optimal surgical outcomes remain an area of active investigation.

Purpose of the Study:

  • To conduct a literature review and present personal experience assessing the reliability of patient-specific instrument systems in total knee arthroplasty.
  • To evaluate the effectiveness of PSI in TKA concerning cost, surgical time, and patient outcomes.

Main Methods:

  • A comprehensive literature review was performed, focusing on studies evaluating PSI systems in TKA.
  • Key outcome measures included coronal alignment, clinical knee and function scores, cost-effectiveness, patient satisfaction, and complication rates.

Main Results:

  • Literature reports varying incidences of coronal malalignment (≥3° from neutral) in TKAs using PSI cutting guides, ranging from 6% to 31%.
  • PSI systems demonstrated comparable component positioning and overall lower axis accuracy to standard manual techniques, particularly in the sagittal plane.

Conclusions:

  • Patient-specific instruments may not achieve the accuracy of computer-assisted surgery (CAS) systems for TKA.
  • However, PSI systems perform comparably to traditional manual techniques. Careful intraoperative alignment checks are crucial when using custom cutting jigs to prevent outliers.