Patient-specific instrumentation makes sense in total knee arthroplasty

ABSTRACT

Introduction

Patient-specific instrumentation (PSI) for total knee arthroplasty (TKA) surgery was initially developed to increase accuracy. The potential PSI benefits have expanded in the last decade, and other advantages have been published. However, different authors are critical of PSI and argue that the advantages are not such and do not compensate for the extra cost. This article aims to describe the recently published advantages and disadvantages of PSI.

Areas covered

Narrative description of the latest publications related to PSI in accuracy, clinical and functional outcomes, operative time, efficiency, and other benefits.

Expert opinion

We have published high accuracy of the system, with a not clinically relevant loss of accuracy, significantly higher precision with PSI than with conventional instruments, and a high percentage of cases in the optimal range and similar to that obtained with computer-assisted navigation, greater imprecision for tibial slope, a significant blood loss reduction, and time consumption, an acceptable and non-significant increase in the cost per procedure, and no difference in complications during hospital admission and at 90 days. We think that PSI will not follow the Scott Parabola and that it will continue to be a valuable type of device in some instances of TKA surgery.

KEYWORDS:

• Patient-specific instrumentation (PSI)
• total knee arthroplasty (TKA)
• total knee replacement (TKR)
• patient-matched technology
• knee

Article highlights

• PSI has some advantages over conventional instruments, and, fundamentally, it does not present results with a significant statistical difference, which does not necessarily indicate a worse result.

• PSI accuracy analyses have been extended to large series and 3D evaluation.

• The type of instrumentation used to perform TKA surgery probably does not influence the clinical outcome in short- or medium-term follow-ups.

• Recent studies have proposed alternatives to CT or MRI imaging-based PSI.

• Assistive technologies for TKA surgery (including PSI) are not following ‘Scott’s parabola.’

Declaration of interest

VL has received honoraria for speaking at symposia and financial support from Medacta International SA to attend symposia and educational programs. All other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewers Disclosure

One reviewer declares being a paid consultant for: SERF, ORTHOFIX, NORAKER and having received royalties from: ADLER ORTHO. The other peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded