Patient-specific cutting guides for total knee arthroplasty

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Clinical trials

Background:

• Accurate lower limb alignment is crucial for total knee arthroplasty (TKA) outcomes.
• Patient-specific guides (PSGs) aim to enhance surgical precision and efficiency in TKA.
• The clinical benefits and functional impact of PSGs in TKA remain unclear.

Purpose of the Study:

• To evaluate the benefits and harms of PSGs versus conventional instrumentation or computer-assisted navigation in primary TKA.
• To compare implant survival, function, alignment, pain, and adverse events between different TKA guidance methods.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing PSGs to conventional instrumentation (CON) or computer-assisted navigation (NAV).
• Searched major databases including CENTRAL, MEDLINE, and Embase up to January 2025.
• Included 44 studies with 3664 participants, assessing outcomes like implant survival, function, alignment, pain, and adverse events.

Main Results:

• PSGs showed little to no difference in implant survival, function, lower limb alignment precision, pain, adverse events, or re-operation rates compared to conventional instrumentation (low-certainty evidence).
• Compared to computer-assisted navigation, PSGs demonstrated little to no difference in function but potentially worse precision in lower limb alignment (low-certainty evidence).
• Most included trials had a high risk of bias, particularly in performance and detection.

Conclusions:

• Low-certainty evidence suggests no significant differences in key outcomes (implant survival, function, pain, adverse events) between PSGs and conventional instrumentation or computer-assisted navigation in TKA.
• The current evidence base, characterized by high risk of bias, limits definitive conclusions on the superiority of PSGs.
• Further high-quality research is necessary to ascertain the true benefits of patient-specific guides in total knee arthroplasty.