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Patient specific instrumentation versus conventional knee arthroplasty: comparative study.
Vlad Predescu1, Catalin Prescura2, Razvan Olaru2
1University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
International Orthopaedics
|December 21, 2016
Summary
Patient-specific instrumentation (PSI) in total knee replacement (TKR) offers comparable alignment and reduced blood loss to conventional methods. However, further research is needed to confirm surgical or economic benefits of PSI-TKR.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Achieving neutral alignment (hip-knee-ankle angle of 180° ± 3°) is crucial for successful knee replacement.
- Conventional total knee replacement (TKR) relies on visual referencing, while customized cutting blocks offer precision and may reduce complications.
- Patient-specific instrumentation (PSI) aims to improve accuracy in bone cuts during TKR.
Purpose of the Study:
- To compare the outcomes of total knee arthroplasty (TKA) using patient-specific instrumentation (PSI) versus conventional instrumentation (CVI).
- To evaluate alignment, blood loss, and accuracy of bone cuts in PSI-TKA compared to CVI-TKA.
Main Methods:
- A comparative study of 80 total knee arthroplasties (TKAs), with 40 using PSI (Visionaire) and 40 using CVI (Genesis II Smith & Nephew).
- Patients had pre-existing varus deformity.
- Tranexamic acid and suction drains were used; blood loss and hemoglobin levels were monitored. Alignment was assessed via long leg standing radiographs.
Main Results:
- Both PSI and CVI groups achieved neutral alignment post-surgery (mean HKA 178.9° vs 178.6°).
- PSI group showed significantly less blood drainage (185 ml vs 260 ml) and lower mean blood loss (3.5 g/dl vs 4.2 g/dl) compared to CVI.
- Intraoperative bone cuts were accurate within 1 mm for both techniques.
Conclusions:
- PSI-TKA is a viable alternative to CVI-TKA, providing similar coronal alignment.
- PSI-TKA demonstrated reduced blood loss compared to CVI-TKA.
- Further studies are required to determine the definitive surgical and economic advantages of using customized instruments in TKR.
