AAOS2017: No RSA or clinical benefit of PSI over conventional instruments in TKA

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
50 patients scheduled for total knee arthroplasty were randomized to the procedure completed with either patient-specific instrumentation (PSI) or conventional instruments. Patients were assessed for clinical scores, component migration on radiostereometric analysis, operative time, surgical resource consumption and waste production, and overall cost per patient. PSI was associated Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Patient-specific instrumentation in total knee arthroplasty was developed for improvement in accuracy and ease of component positioning. Nevertheless, inconsistent results have been obtained in previous randomized controlled trials. There has been an absence of evaluating component migration in previous studies, which this study sought to address.
What was the principal research question?
In total knee arthroplasty, does the use of patient-specific instrumentation significantly affect RSA-assessed component migration, operative time, the number of instrument trays, surgical waste, cost, or patient-reported clinical scores when compared to standard instrumentation when assessed at 6-month follow-up?
Population: 50 patients scheduled for total knee arthroplasty with a posterior-stabilized implant. All patients received intraoperative placement of tantalum markers to facilitate postoperative radiosterometric analysis (RSA).
Intervention: PSI group: Preoperative, patients underwent MRI, from which patient-specific cutting guides were manufactured. (n=25)
Comparison: Conventional group: Patients underwent total knee arthroplasty with the use of standard instrumentation. (n=25)
Outcomes: Radiostereometric analysis was used to assess maximum total point motion of the femoral and tibial components. Intraoperative outcomes included the operative time, the number of instrument trays used, and operative waste volume. Costs were documented, including any associated with complications or additional intervention. Clinical outcome scores included the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form 12-Item General Health Survey, the EuroQoL 5-dimensions (EQ5D) questionnaire, and the University of California-Los Angeles functional score.
Methods: RCT
Time: Patients were assessed perioperatively of surgical-related outcomes. RSA and clinical outcomes were assessed at 6 months postoperatively.
What were the important findings?
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What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.