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Favourable alignment outcomes with MRI-based patient-specific instruments in total knee arthroplasty
Martijn G M Schotanus1, Elke Thijs2, Marion Heijmans3
1Zuyderland Medical Centre, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, The Netherlands. martijnschotanus@hotmail.com.
Summary
For total knee arthroplasty (TKA) using patient-specific instruments (PSIs), MRI-based imaging offers superior alignment outcomes compared to CT-based imaging. This systematic review suggests MRI is the preferred modality to prevent malalignment in TKA surgery.
Area of Science:
- Orthopedic Surgery
- Biomedical Imaging
- Medical Device Technology
Background:
- Patient-specific instruments (PSIs) are utilized in total knee arthroplasty (TKA) and yield radiographic results comparable to conventional instrumentation.
- PSI use necessitates preoperative imaging, typically MRI or CT scans, or a combination thereof.
- A definitive consensus on the preferred imaging modality (MRI vs. CT) for TKA with PSIs is lacking.
Purpose of the Study:
- To systematically review and meta-analyze the differences in alignment outliers between CT- and MRI-based PSIs for TKA.
- To determine the preferred preoperative imaging modality for TKA utilizing PSIs to minimize malalignment.
Main Methods:
- A systematic literature review and meta-analysis of level I evidence randomized controlled trials comparing MRI- and CT-based PSIs for TKA.
- Searched Cochrane Database, MEDLINE/PubMed, and Embase for studies without date restrictions.
- Analyzed alignment outliers in the biomechanical axis and individual femoral and tibial components; qualitative synthesis was used where meta-analysis was not feasible.
Main Results:
- Twelve randomized controlled trials involving 841 knees were included.
- MRI-based PSIs demonstrated a significantly lower proportion of coronal plane outliers for the lateral femoral component (OR 0.52, P=0.02).
- No significant differences were observed in biomechanical axis, frontal femoral, or individual tibial component alignment between MRI- and CT-based PSIs.
Conclusions:
- Alignment outcomes with MRI-based PSIs are equivalent or superior to those with CT-based PSIs in TKA.
- MRI is identified as the preferred imaging modality for TKA surgery employing PSIs to mitigate the risk of malalignment.
