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Comparison between patient-specific instruments and conventional instruments and computer navigation in total knee
Chun Hoi Yan1, Kwong Yuen Chiu2, Fu Yuen Ng2
1Department of Orthopaedics and Traumatology, 5/F, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China. yanchunhoi@gmail.com.
Summary
Patient-specific instruments (PSI) did not improve total knee arthroplasty (TKA) outcomes compared to conventional (CON) or computer navigation (NAV) techniques. PSI use was not associated with better alignment or function, and had more complications.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Medical Device Technology
Background:
- Total knee arthroplasty (TKA) aims to restore knee function and alignment.
- Instrumentation techniques, including conventional (CON), computer navigation (NAV), and patient-specific instruments (PSI), are used to guide TKA surgery.
- Optimizing lower limb alignment and component positioning is crucial for TKA success.
Purpose of the Study:
- To compare the accuracy of lower limb alignment and component positioning in TKA using CON, NAV, and PSI techniques.
- To evaluate if PSI offers superior accuracy over CON and NAV in TKA.
- To assess surgical efficiency and early clinical outcomes associated with each technique.
Main Methods:
- A randomized controlled trial involving 90 knees (81 patients) undergoing TKA.
- Patients were allocated to CON, NAV, or PSI groups in a 1:1:1 ratio.
- Radiographic assessment of lower limb mechanical axis and component positions; documentation of tourniquet/operation times and functional scores.
Main Results:
- Computer navigation (NAV) demonstrated a lower rate of excessively flexed femoral components compared to CON and PSI.
- No significant differences in postoperative alignment outliers or component positioning were observed among the three groups.
- CON and PSI groups had significantly shorter operation and tourniquet times than the NAV group; PSI group experienced more early complications.
Conclusions:
- Patient-specific instruments (PSI) do not offer significant radiological or clinical advantages over conventional (CON) or computer navigation (NAV) in TKA.
- Routine use of PSI in TKA is not recommended due to increased costs and waiting times.
- Further research may be needed to identify specific patient subgroups that could benefit from PSI.
