Patient-specific instrumentation improves alignment of lateral unicompartmental knee replacements by novice surgeons

Patient-specific instrumentation (PSI) has the potential to offer numerous benefits-not least of all, improved resection accuracy; but its potential has not been realised in clinical studies. An explanation may be the focus of such studies on the total knee replacement (TKR-a common procedure, with which surgeons are generally very familiar. Consequently, we sought to investigate the potential role of PSI in guiding novice surgeons to perform the more technically demanding and less familiar lateral unicondylar knee replacement (LUKR).

Twelve orthopaedic trainees naive to LUKR were instructed to perform the procedure according to a pre-operative plan. These were carried out on synthetic sawbones and were completed once with conventional instrumentation alone and once with the adjunct of PSI, allowing a comparison of the plan adherence achieved by the two sets of instrumentation.

There was a tendency for PSI to demonstrate improved plan adherence, though a statistically significant improvement was only seen in compound rotational error of the femoral implant (p = 0.004). PSI was, however, able to produce narrower standard deviations in the mean translational displacement of the femoral implant and also the mean rotational displacement of both implants, suggesting a higher degree of precision.

Our study provides some evidence that PSI can improve the ability of novice surgeons to replicate a pre-operative plan, but our results suggest the need for larger-scale clinical studies to establish the role of PSI in this procedure.