Patient-specific instrumentation does not improve radiographic alignment or clinical outcomes after total knee arthroplasty

Figures & data

Figure 1. Flow diagram of the study.

Table 1. Baseline characteristics of the studies included

	Author	Country	Patient-specific system	M/F	Conventional Age	BMI	M/F	PSI Age	BMI
1	Abane	France	Visionaire	26/44	70 (54–83)	27 (20–40)	19/51	68 (47–84)	29 (20–40)
2	Abdel	France	PSI	8/12	71 (55–83)	30 (24–41)	8/12	71 (61–81)	28 (20–36)
3	Boonen	Netherlands	Signature	40/50	65 ± 8.8	30	34/56	69 ± 8.0	30
4	Chareancholvanich	Thailand	PSI	6/34	70 (53–85)	28 (22–40)	4/36	70 (55–84)	28 (20–44)
5	Chen	Singapore	PSI	5/25	65 ± 8	29 ± 5.8	9/20	65 ± 8	29 ± 6.5
6	Chotanaphuti	Thailand	Trumatch	40	69 ± 5.5	25 ± 2.1	40	70 ± 5.5	25 ± 2.4
7	Ferrara	Italy	PSI	7/8	74 ± 7.2	28 ± 3.8	6/9	75 ± 6.7	28 ± 3.6
8	Hamilton	USA	Trumatch	7/19	67 (51–88)	31 (22–38)	14/12	68 (52–86)	31 (22–40)
9	Huijbregts	Australia	Visionaire	32/32	69 ± 1.2	*	29/40	67 ± 1.1	*
10	Kotela	Poland	Signature	13/33	68 ± 9.9	30 ± 5.6	16/33	66 ± 8.4	30 ± 4.6
11	Molicnik	Slovenia	Signature	5/14	66 ± 6.7	33 ± 5.5	2/17	67 ± 7.1	32 ± 5.3
12	Ng	USA	PSI	13/14	79 ± 8.1	31 ± 6.8	17/34	66 ± 7.5	34 ± 6.3
13	Noble	USA	Visionaire	6/8	68 (56–80)	31 (21–40)	8/7	65 (57–76)	30 (22–35)
14	Parratte	France	PSI	20	*	*	20	*	*
15	Pietsch	Austria	PSI	19/21	69 ± 9.4	31 ± 4.9	13/27	71 ± 6.6	29 ± 3.5
16	Roh	Korea	Signature	5/43	70 ± 5.1	27 ± 2.7	3/39	70 ± 7.2	27 ± 4.2
17	Silva	Portugal	Signature	22	74 (71; 80)	*	23	73 (67; 78)	*
18	Victor	Belgium	Sign/TruM/Vis/PSI	21/43	66 (36–92)	*	21/43	67 (52–87)	*
19	Vundelinckx	Belgium	Visionaire	11/20	68 ± 8.5	31 ± 5.3	15/16	65 ± 8.2	28 ± 3.8
20	Woolson	USA	Trumatch	26/0	65	*	22/0	67.2	*
21	Yan	China	PSI	6/24	69 ± 8.4	*	13/17	68 ± 8.0	*
	Total			782			805

Means are shown with standard deviation or with range (in parentheses). Where an asterisk is shown, no data were provided. Abdel et al. and Parratte et al. analyzed the same patients. Data by Huijbregts are mean with standard error. Data by Silva are median and interquartile range.

Visionaire: Smith and Nephew, Memphis, TN. PSI: Zimmer, Warsaw, IN. Signature: Biomet, Warsaw, IN. TruMatch: DePuy, Warsaw, IN.

Figure 2. Forest plot for hip-knee-ankle axis outliers per patient-specific system.

Figure 3. Forest plot for coronal tibial outliers

Figure 4. Forest plot for deviation from intended femoral rotation.

Figure 7. Risk-of-bias summary; “–” indicates high risk of bias, “?” indicates unclear risk, and “+” indicates low risk of bias.

Figure 8. Funnel plots. A. Funnel plot of publication bias for deviation of intended hip-knee-ankle axis. B. Funnel plot of publication bias for hip-knee-ankle axis outliers.