Surgeon Dominated Design Can Improve the Accuracy of Patient-Specific Instruments in Kinematically Aligned TKA

Precise bone resection is mandatory for kinematically aligned total knee arthroplasty (KA-TKA). This study is to investigate whether surgeon-dominated design can alter the accuracy of patient-specific instrumentation (PSI) in KA-TKA compared with the engineer design. A total of 24 patients (24 knees) who underwent KA-TKA in our institution were assigned to an engineer design group (10 knees) and surgeon design group (14 knees) chronologically. A novel portable medical-engineer interactive application can greatly enhance the surgeon's participation in PSI design. The bone resection discrepancies were used to evaluate the accuracy of PSI in bone resection. The overall discrepancy of bone resection was reduced by surgeon-designed PSI compared to engineer-designed PSI by 0.33 mm. Surgeon-designed PSI seems to reduce the outliers in terms of relative discrepancies in bone resection as well, but it does not reach statistical significance. Moreover, surgeon-designed PSI could significantly improve the accuracy of PSI in the restoration of the joint line in terms of medial proximal tibial angle and mechanical lateral distal femoral angle. This study indicates that the dominance of surgeons in both PSI design and subsequent surgical operation should be emphasized in efforts to improve the accuracy of PSI.